Precepting

Yet again, it has been far too long since the last time I posted here. The past few weeks have been a whirlwind of varying degrees of craziness and I have finally found a few minutes to put it into words. Three weeks ago I sat in my car outside the main station of the ambulance service which serves as our primary transporting agency for our county. My hands were sweaty, my heart was racing and I truly believed that if I had tried to get out and walk the 100 feet to the front door that my knees may give way. I don't recall the last time I had been so nervous about embarking on a new adventure.

The medical director for our county requires that all incoming paramedics train with a field training officer on a large number of high acuity calls before they can work independently as a paramedic. So, there I was, come to take the next step in my precepting. I actually received the go-ahead several months ago to precept and I have been doing so in my home agency. However, our call volume is not such that it supports the required level of skills performance that our medical director is looking for. So, as are most paramedics, I was shunted to the high-volume agency for the remainder of my precepting.
The last two weeks have truly opened my eyes in many ways. Good, bad or indifferent, each moment has shaped me more than I could have imagined. Let me start from that very first day 3 weeks ago...
After I peeled myself from the driver's seat of my car & slowed my breathing, I wandered into the ambulance station to meet the man who would make or break the next few months of my life. I had talked to him on the phone on more than a few occasions but never met him in person. From the moment, he entered the room and shook my hand for the first time, I was captivated. My preceptor immediately ordered that I follow him to the ambulance. Once there, he hastily shoved a check-off sheet in my hands and told me to familiarize myself with the rig. Obediently, I began rummaging through cabinets and first response bags.
A short while later, before I had made it through my check sheet, our first call toned out. It was to an unkempt tiny house in the old part of town, the address of which was familiar to both my preceptor and the EMT who was driving. As I bailed from the rig, completely unprepared for what lay ahead, my preceptor rattled off essentially what was my patient's entire medical history.
The fire department was already on-scene and a few of them retreated from the house and met us in the yard to share the report of their initial assessment. When they were done, I made my way onto the run-down low porch of the house and entered the back door. The smell which met me was overwhelming but not entirely unfamiliar to me...the smell of human body odor, alcohol, smoke, pets and years of a tiny dirty house being closed up to the fresh outside air. More often than not, medical calls involve at least one, if not all of those smells. It is an aspect of my job that no longer phases me. I learned long ago to acknowledge unpleasant odors while simultaneously tuning them out.
Our patient was a complacent older gentleman who had consumed far too much alcohol. It was not the first time his wife had called EMS because she was worried about him...and I was certain this would not be the last. We swiftly loaded him onto our cot and whisked him to our ambulance. En route to the hospital, I did a standard assessment and tried, unsuccessfully, to start an IV in my patient's arm. Fail #1. My preceptor immediately moved to my patient's side, asked me for the IV kit and set to work. In a few short seconds, he had a beautiful patent line established in my patient's left arm. I was defeated.
After dropping off our patient at the hospital and putting our truck back in service, we returned to the station for lunch. It was then that the massive migraine hit me. I am not a “drug seeker” when it comes to headaches. Most often I will let them simmer for several hours in hopes that they will resolve on their own before I give in and go looking for the headache meds. I did not have that option that day so I began hunting around for something to calm the incessant pain. Before my search could yield any results, our pagers once again toned...and they kept doing so for the next several hours.
Our next patient was an ill elderly female who had been fighting the flu for the past few days. I found her on the floor of her dining room, too weak to move. In spite of her current state, she was in good spirits and we were able to get her moved to our cot and into the ambulance without any issue. On the way into the hospital, however, she continually complained that she was cold. Although the day outside was well into the 80s, my preceptor obligingly turned on the heat...as I missed another IV attempt. Once again my preceptor moved to my patient's side, asked for the IV kit and quickly established a line. Frustration, the added heat and swaying of the ambulance, and my headache were quickly taking their toll on my stomach. As I pushed meds through my patient's IV to stave her nausea, I silently wished that I could give myself some too. Thankfully we arrived at the hospital a short while later. Solid ground and AC mitigated, if only slightly, my current condition. But I didn't get much time to enjoy either before the tones went off again.
We responded to a young man who had had a seizure while working on a construction site. By the time we arrived, he was awake, coherent and adamant that he did not want an ambulance ride to the hospital. After signing off on the needed paperwork, we were again on our way...this time to an elderly female who had fallen and had pain in her hip. En route to the call, my headache and stomach surprisingly found peace and I thought the worst was over. My patient met me at the front door of her home and I helped her onto our cot and into the ambulance. As I prepped her to start an IV and give her some pain medications, both my headache and stomach issues returned with a vengeance. In spite of willing myself to push on, I knew that the game was over. I looked at my preceptor and the second his eyes met mine, he knew something was wrong. He grabbed my arm and shoved me into the captain's chair behind my patient's head. As I watched him deftly start yet another IV that should have been mine, I grabbed an emesis basin from the nearby shelf and promptly threw up my lunch. Yay for making an impression on my first day.
Needless to say, I got sent home…defeated.
Thankfully my preceptor is one of the greatest human beings to grace the EMS profession and when I called him a few days later to schedule my next shift, he happily welcomed me back…although not without the promise of being forever picked on. I accepted. When I arrived for my next shift, there were no pleasantries exchanged. My preceptor walked up to me with a broad smile, smacked me on the shoulder & asked, very loudly, “Can I get you some Zofran?” He laughed and immediately walked away...beckoning for me to follow him. It was go time.
Our day was rather uneventful that day, except for yet another missed IV on a cardiac patient. My preceptor saved the day…again. Ugh. My frustration was mounting.
They say EMS (and any other emergency profession) is hours of boredom interspersed with moments of terror. My third shift certainly held true to that adage. We spent the majority of the day shuffling patients between hospice, long-term care facilities and the hospital. Although many EMS providers shirk at non-emergent transports, I don’t mind them. They are definitely less stressful than any emergent call. Seven and a half hours into my shift, however, the tones dropped…and all chaos broke loose. We were dispatched to motor vehicle accident on a main thoroughfare just outside of town. One car was rolled in the ditch, one car was blocking traffic…there were multiple victims and entrapment. Within minutes, we arrive at the scene. In spite of the overwhelming radio report, nothing could prepare us for what we arrived to find. As we approached the scene, my eyes immediately fixated on a red pick-up heavy front-end damage to the front passenger side that was turned sideways in the middle of the road.
“Where is the car that rolled?” And then I saw it, a crumpled, gray, nearly unrecognizable mass lying in the ditch. When the ambulance came to a complete stop, I flung open the back door…ignoring my equipment on the way. It would only weigh me down. This was a mass casualty response. First assess our patients and then figure out a plan to care for them.
I glanced toward the pick-up where several frenzied firefighters already were working frantically with the jaws of life to open the doors of the vehicle.
I initially avoid the truck and sprint toward the car in the ditch. Another paramedic is already there, reaching toward the victim in the overturned car. He reaches in to check for a pulse and simultaneously, his eyes meet mine. He doesn't have to tell me what I already know. We won't be working on this victim. We must move on and help those who can still be helped. I do a quick 360 around the car and crouch low to look through the shattered windows to check for additional victims. There are none. In that very moment, our complete attention turns to the victims trapped in the pick-up.
A mass of firefighters, is sawing and pulling at the car from every angle. There are 4 people inside and we have no idea what their status is. Within seconds, the front doors are off and the back of the truck is fileted opened. There are 2 small girls crying in the backseat, surprisingly with no apparent injuries. Backboards, trauma bags and C-spine kits began being flung from arriving emergency vehicles. I initially grab the older of the 2 children and quickly fasten her to a backboard. She is crying but easily consolable. She disappears into an awaiting ambulance that has just arrived. I grab the next child and move her quickly from the truck onto a backboard. She too is crying and pleading for her mother. I tell her that mommy will meet her at the hospital and she needs to ride with sissy right now. She obliges and is also whisked away to the ambulance.
Sheer relief floods over me and I say a silent prayer of thanks that those little girls were wearing their seatbelts. Once their ambulance rolls out of site, my attention turns to the 2 remaining occupants of the truck…both of whom have been pinned by the dashboard. Firefighters are still working away with the jaws and hydraulic cutters, working to carefully shift the dash forward to buy us the needed extra few inches to pull them from the vehicle. Both are awake and talking but badly injured. Arriving medical crews and other units have arrived onscene and, with their help, both patients are finally freed from the vehicle. Forty-five minutes after the chaos commenced, they are en route to the hospital.
Later, in the hospital ambulance bay, all of the crews who were involved share silence stares of knowing. We have all been pushed to the brink of human thought and now must go back to our “normal” lives...a process which is much easier talked about than carried out. The next call will come, whether we are mentally, emotionally or physically prepared for it.
And so has went the last few weeks of my life. I have had other calls which I will share in future posts. As for my precepting over all, I have not been on nearly as many calls as I had thought I would be at this point. We'll see what the next few weeks bring...