Baptism By FIRE.... the early days

Just last week, Hunny and I were discussing our early experiences in EMS. I had shared my experiences with my first "tote" job. Crazy Family Drama EMS. The company is known in the Metro-Atlanta EMS community for their surprising longevity, and the fact that they had had some of the worst contracts ever. Most local "old-heads" got their start there. I guess I fall into that category. The current opinion is if you survived 5+ years at Grady EMS these days you've earned your "old head" badge.

When I worked for CFD EMS, their primary money maker contract was with Grady Hospital, to take home all discharges off the floor that were true "bed-bound" stretcher patients: paraplegics, quadriplegics, contractured stroke survivors, amputees, etc. They also did ALL the ER discharges. Sure, there were the true bed-bound patients. But you also did a fair share of providing taxi service for lazy healthy and/or youthful adults... ambulatory folks who refused to cough up $1.75 in transit fare to get home, medicaid recipients who already had ran up an unnecessary $400 ambulance bill for their stomach flu symptoms and didn't wanna call babydaddy to give them a ride home, and the indigent un-bathed homeless folks needing a cab ride over to which ever shelter the social worker had conned into accepting them at 2am... you name it.

A bad spot to be caught in was ending up somewhere close to Grady around 10 am when the oncology floor began their daily ship out of a dozen or so cancer patients needing EMS transfer to the radiology clinic two blocks down the street for their treatments. It would be nonstop all morning and afternoon. Go to the floor and get patient A, take them to the clinic and leave them on the table for treatment, rush back over to the hospital and get patient B. Leave patient B and take patient A back to the floor and get patient C. See the pattern here? The non-stop "Radiation Shuffle" could occupy the better part of 4+ hours to shuffle these dozen or so patients back and fourth. No, there was no time to grab lunch in this disaster of air traffic control. That was the shitty part of it.

The one good that came from this mess was that I quickly learned the city, and really learned the Grady EMS response territory inside and out. I was well prepared to drive a Grady Ambulance, rarely needing a map book in the 7 years I worked there. I simply don't understand EMT's with 5+ years at Grady who never remember frequent flyer pickup locations and busy neighborhoods.

The other aspect of working for CFD EMS, was that 75% of their daytime business was medicare dialysis transports from all over the 5 county metro-Atlanta area. These were often some really sick folks. Many times they would get to the dialysis clinic only to be deemed too sick to do their treatment, and we were called right back out to transfer the hypertensive bradycardic pulmonary edema patient to the ER for stabilization.

Herein lies my "Baptism By Fire" as Hunny labeled it. I often worked the day half of my 24 hour shift with a lazy ass burnt out medic and RRT (respiratory tech) we will call Harry. Harry was all of 5 feet 3 inches, and weighed a buck twenty at best. For so long I thought Harry had the most severe case of Napoleon Syndrome I'd ever witnessed. He was always hyper-agitated, hyper-aggressive, and hyper-anxious. He often cursed out nurses and hospital staffers, and was a total jackass to family members and co-workers. AND he was lazy.

All those SICK dialysis patients got pawned off on me, a super-green EMT with wet ink still on her card. I learned quickly how to run EKGs, give breathing treatments, and give Lasix to dialysis patients. Yes I said give breathing treatments and Lasix to dialysis patients. Not only was that beyond my scope of practice, but I was being directed to treat patients with medications that were usually inappropriate and often futile for their history and current conditions. Lasix works on the kidneys. Dialysis patients often have little or no kidney function. So this was a waste of drugs. Secondly dumping breathing treatments on patients who were already oxygen starved and short of breathe didn't really help their heart's demand for oxygen to keep the heart tissues nourished.

Crazy Family Drama EMS was a sink or swim experience for me. It taught me a lot, good and bad. There for, as Hunny pointed out... it was my Baptism By Fire.

Only a few weeks after I left CFD EMS did I find an answer to all his behavioral issues. HE WAS COKED OUT!!! Apparently he went ape shit one morning before shift because he had lost his keys at the station. He refused to go inservice without those keys. The owner even offered to pay for a lock-doc to come during the day and unlock his truck encase they were in there. Finally he bowed out and went to work. Later in the day someone found his keys, complete with a vial of cocaine neatly linked to his keys by a chain. Um.... YEAH. That explained A LOT!

I QUICKLY DEVELOPED THE MINDSET OF WHAT KIND OF MEDIC I DIDN'T EVER WANT TO BE: lazy, irresponsible, slack-skilled, uneducated, jackass. Between Harry, and the first couple of shitty skilled medics I got partnered with at Grady, I quickly developed an appetite to learn my scope of practice, have good skills, and (sometimes to a fault) be very demanding of perfection. My underlying OCD reared its ugly head and peaked when I hit Paramedic school. My opinion is that OCD and demand for perfection can only make you the best medic possible when it comes to competent patient care and documentation. CQI/QA will back me up here. That can only be in your patient's favor. Unfortunately if your partner doesn't share your concept, it will quickly become sand in their panties!!! Especially when in your partner's first quarter of paramedic school, they already know more than your established attending physician **A-hem**

So with all that said, I think I became a better medic for it. I have an unequaled demand for my patients advocacy, care, and transfer of care to a competent and appropriate facility for whatever ails them. Heart attacks don't go to a non-cathlab hospital. High mechanism traumas go to Atlanta Medical Center, or Grady (on Emory days). Strokes go to Neuro-capable ERs. No one can ever say any patient of mine suffered for it. Partners... well, that is obviously a different story.

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