Monday, December 31, 2007

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.

Sunday, December 16, 2007

NEW JOB....

NEW JOB - Grady Jr. EMS

I spent Monday (12-10-07) through Friday (12-14-07) doing the typical classroom orientation stuff. How GJ-EMS got it's start, how it's grown, benefits, training and CEU programs *a lot of CEU's ONLINE - yippie*, Toughbook's and touchpoint PCR software, road safety / CEVO, HIPPA, etc.I was definitely impressed with their "employees are our most valuable asset" concept: meaning that if Mama ain't happy, ain't nobody happy. They eat it, breathe it, sleep it, poop it, and maybe even brand it on your ass when you get released from orientation. But it's true. Basically they believe that if they meet (actually, most often exceed) the expectations of how the employees want to be treated, perks, nice equipment, comprehensive training, new (and actually functioning) technology, etc... that we will be more productive, nicer to colleagues, patients, and the public, less likely to burnout, less likely to climb a tower in Smyrna and start taking pop-shots at cars on 285, you get the picture. I like that. Actually from what little I have had the chance to observe, I see it in full action. The employees ARE HAPPY, NICE, and so far even seem competent. It is a 180 from Grady EMS. THAT, I LIKE.

Example one: On day three of class, my hunny went to the orthopaedic who is treating the ever persistant back injury. Doc said it's time to try Cortisone epidurals. Before I even knew what day it was gonna be scheduled, I asked the Ops Manager (sooo unlike his Grady EMS counterpart "Dragon Lady, head of the Grady Gestapo") what our third ride schedule was going to look like so I might plan to be off for the procedure. He tells me to go ahead and schedule the procedure and they will work around it. Say what? That shit would never have happened at Grady. The Grady mentality was screw you, screw your family. You work around OUR needs, not yours or theirs! Off the bat - I'm impressed.

I did my first third ride yesterday. Obviously since I've been around the ambulance a few times, my FTO asked me what *I* needed to work on to feel more comfortable to transition to GJ-EMS. I answered honestly that I was very inexperienced (intimidated) with the laptop and the PCR software. He immediately designated THAT as my main task for the day... to write all the PCR's for all the trips.

The mind blower came with our final call of the day. We responded to a vehicle that may have hydroplaned sideways on a 4-lane and was struck at high speed t-boned in the passenger door. Lucky for that car it was a single occupant, because there was nearly two feet of intrusion damage to the passenger side. She did not walk away unscathed though. She had a positive loss of consciousness and kept asking repetitive questions all the way to the trauma center. Probably a nasty concussion, not to dismiss a more serious brain injury is also to be considered. But what amazed me was Cobb Fire. Their rescue unit was already on scene, the patient was in a collar, c-spine being held, a full assessment had been performed, an IV started, and they were just waiting on the transport unit to arrive before pulling her out and back-boarding her in the downpour. Once we arrived the tented a tarp over the work area keeping us all dry as we worked as a TEAM to get her immobilized and into the ambulance. TEAMWORK! Smooth as glass teamwork!

I think I am gonna like it here!