Advice for a new Paramedic

This is blatantly ripped off from The Happy Medic http://thehappymedic.com/

but it bears repeating. Just as relevant to a First Responder, EMT-B, or EMT-I/Parkmedic. My comments are in italics.

Advice for a new Paramedic

Over the years I’ve been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.

I can never stress enough the first and most important tip I have:

It’s not your emergency

No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.

This one is difficult to follow. Adrenaline is pumping, you want to help, but the people I am learning to admire on scene are the ones who are un-ruffled, calm, and quiet. I need to work on this.

You will never know enough

There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.

Don't need any help understanding this concept. The more I read, the less I feel I know...

Don’t tune your patients out

Many folks don’t know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don’t get stuck in the SAMPLE questions, but use them as a starting point.

This is another good one - I like talking with patients and am getting more comfortable asking the probing and leading questions. I try to listen to the more experienced folks, and am feeling more comfortable speaking up for myself. I need to stop interrupting people, though...one of my big faults.

The most important person in the room is you

Scene safety is paramount. It’s not as easy as simply saying, “We’ll wait for PD” like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.

Love the last line.

Don’t leave the hospital so fast

Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it’s pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You’d be amazed how many times I’ve seen a Doc spot something the machine misses.

This is a problem for me. I always feel like I'm in the way in the ED. Easier just to grab the cot and leave, but I need to spend more time in the room when we get there.

Buy Dubin’s

Dubin’s Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.

Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.

Ordered it, got it, and started to read. Then I found out that my anatomy & physiology knowledge is so lacking that I need to read that first. EKG reading is still an intriguing mystery to me.

Find your comfort zone and avoid it

If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don’t know the answer to.

Ha! I don't have a comfort zone in ANYTHING yet, so no worries. Good advice, though.

Practice humility

People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn’t suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a “war story” but as an addition to a lecture, lesson or discussion.

Again, great advice. I've been lucky so far with mostly grateful patients. The follow-up is awkward and mostly third-hand (through the medic)

Warm lunch, warm dinner, go home safe

Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn’t matter.

Sounds like a good plan to me.

Thanks Happy Medic!

(btw, if you don't read his blog, you should)

Also from the Happy Medic:

Glossary of terms:

Jedi Vitals – When you know the patient is fine, but still need to record something, you pass your hand in front of them just like Obi Wan Kenobi and poof! the vitals come into your mind.

Mr Fishbiscuit – Husband of the ill fated Mrs Fishbiscuit, a rarity, but can be seen in the wild.

Saint Closest – The nearest hospital.

Saint Farthest – The farthest possible hospital we can legally transport to. This haul always ruins dinner.

F&B – Private ambulance company.

Erma Fish Biscuit – The elderly woman who needed a Doctor a year ago, but never went, and who’s symptoms don’t seem to match anything treatable, yet not in the green zone for signing a refusal. She’s often slightly altered, but good humored and has a list of meds longer than my…clipboard.

Fella – A person of the non-heterosexual community.

Bob, Bubba, Billy – The type of gentleman who wears a 3XL T-shirt and wonders why he is in such bad health. Also seen living in Erma’s basement well into his 40s.

Engine 99, Medic 99, anything 99 – If I tell you what unit I work on, then you’ll look me up on the busiest Ambulance list from Firehouse magazine and all is lost. Seems one rig keeps making the top 25 and it has a unique number. I’ve said too much already.

Steph – My BS Medic name. A name used by responders to communicate to one another that the incident they are working is, in fact, a no merit call. The names are used to avoid actually saying, “This is BS” in front of the patient. Other BS names I work with include: Johnny Ampersand, Fred Garvin, Ricardo Montecarlo, Woo Kie (Asian fellow who makes a dead on Chewbacca noise)

the Brass – Command Staff. The folks in charge. Many have been off the streets a little too long.

Visitors

My Pops is here visiting for a couple of days. Ostensibly for fishing with the Tuck man, but he's up shopping tax-free in Bozeman today.

Also got a call the other day from Kendra - she's finally filling up the part of the map in MT and NW WY, and visiting Yellowstone! Can't wait to meet the 'new' baby boy, too (well, new to me since I've only seen him on blogs).

So another busy week in Yellowstone. Summer seems to be here. Finally. And the tourons visitors are in their summer best - petting bison, speeding, walking into closure areas, ahh...summer!

The webinar from hell...

How is it that some people can take a topic that should be interesting, and should be quick (less than 10 minutes) and stretch it into an hour-long boring diatribe of "um" "uh" and "so..."

??????????????????????????

WW2 People's War (BBC History Page)

http://www.bbc.co.uk/ww2peopleswar/

Histories written by those who lived them. Very interesting site, thought I'd share.

Announcement coming, re: Potter

If you click on the owls on pottermore.com, up pops a YouTube video with a countdown:

More Potter?

http://www.pottermore.com/

Confusing, but exciting as well!

MOVIE TALK on Yahoo!Movies » Movie Talk

A Mysterious Harry Potter Site

http://blog.movies.yahoo.com/blog/1589-a-mysterious-harry-potter-site

It's a bittersweet time for fans of Harry Potter. The eighth and final movie hits theaters this summer. The series of books concluded several years ago. What's a hard-core Hogwarts fan to do?

Fear not! A newly launched URL,pottermore.com, indicates that author J.K. Rowling has a few more tricks up her sleeve. As of now, there really isn't much to go on. The site is bare-bones. Two owls sit atop branches and there's a "coming soon" message. That's it. Click on the owls and you're taken to a YouTube link with a countdown to the mysterious announcement. As of now, the big reveal is a little less than a week away on Wednesday, June 22.

Clues are frustratingly scarce, but interest in the new URL is anything but. Over the past 24 hours, web searches on "pottermore," "pottermore.com" and "new harry potter web site" have all soared like a Nimbus 2000. Related lookups on "jk rowling announcement" are also spiking. She sure knows how to drum up interest.

The Associated Press talked with Rowling spokesperson Rebecca Salt about the project. Salt did say the site is not (repeat: not) a reference to a new book nor is it "directly related" to the upcoming Potter movie, "Harry Potter and the Deathly Hallows: Part 2." Alas, the Rowling camp isn't saying anything else.

Fan sites and blogs are, of course, not letting the lack of details slow the speculation. Among the possibilities being floated around: a new amusement park, an improved website for all things Harry Potter, or, perhaps, a new Harry Potter encyclopedia. The Leaky Cauldron, one of the top Potter fansites, has a slew of theories from readers. One or the most popular: a massive multiplayer online game. If so, we got dibs on "Dumbledore."

Expect an announcement on or around June 22.

A Shady Deal

It's 9:30 pm and the phone rings. The woman on the other end tells me I'll be meeting my contact in the Albertson's parking lot in Livingston. He should be there in an hour or so.

Good thing I grabbed a nap. I wipe the sleep from my eyes and take a swig of water, grab keys, head for the car. I wake up on the drive down the hill. Driving in the twilight and just-dark night begs for animals to step out in the road. None do.

I arrive at the parking lot at 10:40. Pouring rain. I reach in my wallet and pull out the money, folding the crisp hundreds and shoving them in my right front pocket. And wait. Store will be closing in a couple minutes, so I run in to grab a few needed items. My phone rings as I'm at the checkout. He's in the parking lot. White truck, black horse trailer.

We exchange greetings and he digs in the back of his truck. Finds my package. I hand over the cash.

56.9 lbs of bison meat for my freezer. Yay!

What else would I be buying in the middle of the night?

rofl

So I ordered half of a front quarter of a tallgrass-prairie fed bison. The packages are stowed neatly in the freezer and I can't wait to try them. We ordered from http://www.tallgrassbison.com/

Will post reviews once we start up the bbq!

Settling in

The house is slowly coming together.

The number of full boxes in the garage is down, the dryer is installed, and the place is starting to feel a bit more home-like.

My room is still a disaster (big surprise) and I need to do much more to get the chaos under control. I plan on getting rid of a bunch of books and DVDs, which seem to be the bulk of the mess.

I mean, really, do I plan on reading "The Cartoon History of the United States" ever again?

Yep, I'm up!

So its 0351 in the morning on Friday. I have to be to work in a few hours.

I'm getting used to the tones of my pager going off these days. For the first couple calls it was a struggle to clear my head and recall what the sound was. Is that my alarm? Is it time to go to the office?

But now, the first tones go off and my feet hit the floor. I'm throwing on my uniform and boots, checking pockets for drivers license, gloves, pen, gum (no time to brush those teeth...) and the obligatory ziplock bag with some spare cash so I can grab some caffeine and a snack after the call.

I grab keys, jump in the car and head up for the ambulance bay. Now that we moved up the hill I'm only a couple of minutes away. Almost there...and the call comes over the radio -- stand down. (aka - "We thank you for your quick response, but we don't need you")

Tell that to my adrenals at 0200!

I'm keyed up and ready to go, but there's no where to get to. No rush. I pull up to the bay, turn around, and drive back home. Get back in the jammies and try to sleep. No dice.

So I do dishes. Take the dogs out for a quick walk. Surf the internet. Read. Study Anatomy and Physiology. And wait for the sun to rise.

Meyers-Briggs Analysis - my life in four letters

OK, so I've taken a few of these lovely "assessments" over the years. I always come up the same.

ISTP

Four little letters that sum up who you are. According to the M-B folks, I am:

Portrait of an ISTP - Introverted Sensing Thinking Perceiving
(Introverted Thinking with Extraverted Sensing)

---

The Mechanic

As an ISTP, your primary mode of living is focused internally, where you deal with things rationally and logically. Your secondary mode is external, where you take things in via your five senses in a literal, concrete fashion.

ISTPs have a compelling drive to understand the way things work. They're good at logical analysis, and like to use it on practical concerns. They typically have strong powers of reasoning, although they're not interested in theories or concepts unless they can see a practical application. They like to take things apart and see the way they work.

ISTPs have an adventuresome spirit. They are attracted to motorcycles, airplanes, sky diving, surfing, etc. They thrive on action, and are usually fearless. ISTPs are fiercely independent, needing to have the space to make their own decisions about their next step. They do not believe in or follow rules and regulations, as this would prohibit their ability to "do their own thing". Their sense of adventure and desire for constant action makes ISTPs prone to becoming bored rather quickly.

ISTPs are loyal to their causes and beliefs, and are firm believers that people should be treated with equity and fairness. Although they do not respect the rules of the "System", they follow their own rules and guidelines for behavior faithfully. They will not take part in something which violates their personal laws. ISTPs are extremely loyal and faithful to their "brothers".

ISTPs like and need to spend time alone, because this is when they can sort things out in their minds most clearly. They absorb large quantities of impersonal facts from the external world, and sort through those facts, making judgments, when they are alone.

ISTPs are action-oriented people. They like to be up and about, doing things. They are not people to sit behind a desk all day and do long-range planning. Adaptable and spontaneous, they respond to what is immediately before them. They usually have strong technical skills, and can be effective technical leaders. They focus on details and practical things. They have an excellent sense of expediency and grasp of the details which enables them to make quick, effective decisions.

ISTPs avoid making judgments based on personal values - they feel that judgments and decisions should be made impartially, based on the fact. They are not naturally tuned in to how they are affecting others. They do not pay attention to their own feelings, and even distrust them and try to ignore them, because they have difficulty distinguishing between emotional reactions and value judgments. This may be a problem area for many ISTPs.

An ISTP who is over-stressed may exhibit rash emotional outbursts of anger, or on the other extreme may be overwhelmed by emotions and feelings which they feel compelled to share with people (often inappropriately). An ISTP who is down on themself will foray into the world of value judgments - a place which is not natural for the ISTP - and judge themself by their inability to perform some task. They will then approach the task in a grim emotional state, expecting the worst.

ISTPs are excellent in a crisis situations. They're usually good athletes, and have very good hand-eye coordination. They are good at following through with a project, and tying up loose ends. They usually don't have much trouble with school, because they are introverts who can think logically. They are usually patient individuals, although they may be prone to occasional emotional outbursts due to their inattention to their own feelings.

ISTPs have a lot of natural ability which makes them good at many different kinds of things. However, they are happiest when they are centered in action-oriented tasks which require detailed logical analysis and technical skill. They take pride in their ability to take the next correct step.

ISTPs are optimistic, full of good cheer, loyal to their equals, uncomplicated in their desires, generous, trusting and receptive people who want no part in confining commitments.

Jungian functional preference ordering:

Dominant: Introverted Thinking
Auxiliary: Extraverted Sensing
Tertiary: Introverted Intuition
Inferior: Extraverted Feeling

#################################################################

And for an alternate interpretation, try this website

http://www.atomicnerds.com/?p=4724

ISTP- Introverted Sensing Thinking Percieving

Quiet, flexible problem-solvers generally unnoticeable until one of them is using forty slides of Power Point to explain something to you you never knew was a problem and don’t care about. Tireless combers of data and analyzers of cause-effect relationship with a powerful wish to make both processes more efficient if not more desirable. Rumor has it all of them work for corporations, agencies, and institutions usually abbreviated into some alphabetical combination.

And, my exact opposite. (You know who you are:)

ENFJ- Extroverted iNtuiting Feeling Judging

Empathetic, cooperative, responsive, and group-oriented. These people pick up every emotion and ripple in their social circle and will reflect it back at you twice as large. Good at group workshops. Less good at working in prisons.

A new view

The view from the back patio of #374, Mammoth Hot Springs, WY. The Guiles' new home.

I've been bidding on houses up here for some time. The bid process involves tallying up a score based on the number of people living with you, the amount of time you've worked for the government, and a bunch of other nonsense. You get an extra point for each kid, a point if they are of opposite sex. I tried to argue that dogs should count. People with kids argue that "it's your choice to have a pet" well, so is having a kid. Living with Tucker for a while, I've come to realize that the dogs are less destructive and much better trained. Anyway, after a long string of disappointments - bid sheets coming back where I ranked just out of the running on a house - I finally won. We are now the proud renters of a 3 bedroom, 1 bath, 1336 square foot house built in 1958.

The garage is the same size as the apartment I'm currently renting.

Seriously.

There's a garage! And flat parking! And a DISHWASHER!!!!

Granted, there are issues with the place - a lack of insulation is the number one complaint for most residents in Mammoth. The costs of propane for heating, mold issues, all that. But compared to living in a daylight basement where my landlords dogs crap outside the only window in the place, and bark constantly whenever he leaves, this is a big step up. I have enjoyed living there, don't get me wrong. I got lucky to have one of the best landlords ever. And great friends and neighbors. But it's past time to move on.

The view is lovely - I sat out on the picnic table in the back for a while and just enjoyed the sounds. It feels good to be moving back into the park. It's easy to get disconnected with the happenings in Yellowstone when you live in Gardiner. Too easy to forget why I work here for less money than I could make on the outside. I love this place.