Expanding Our Role

So a couple times this week, today being the last day, I've been the "standby EMT" for a television show filming in my area. I'd love to share all the details, but I've been sworn to secrecy by a contract that is many pages with many long words. All I'll say is that this show will be aired on a national cable channel in July, but I look forward to sharing more then!

It's actually not as glamorous as it sounds. I've been sitting in my car, jump bag with all equipment in the seat next to me, for three hours now. I've accomplished a lot of homework and reading, and now I'm going to use my computer until it runs out of battery. Maybe something will happen requiring some use of medical skill, but probably not. The network's insurance policy requires an EMT on set "just in case", so here I am.

Early in my class, we had the typical section on what is expected of a medic, what the role of the medic is in society, etc. We learned about the field growing to primary care, industrial medicine, sports medicine, flight medicine, and more. I guess that me sitting here waiting for something to happen is kind of industrial medicine - I'm on the scene of an industry as the chief (and only!) medical personnel. It's interesting to look back on EMS history and see all the opportunities we've gotten since then...

In my opinion, the earliest we can trace EMS back to is Napoleon's times, where the first triage system was used. 911 was "invented" as the national emergency number in 1968 (to be finalized by President Clinton in 1999), after EMS was established as part of the DOT in 1966. Since then, it's just a big history of laws and changes. We've lost and received funding from Congress several times. We're currently working under "The EMS Agenda for the Future" from 2006, trying to develop more in research, financing, education, prevention, care, and more.

I hope to focus my career on two of the newer aspects of paramedicine - aircare and education. And while I do want to teach BLS and ALS, as well as AHA, I also want to educate the public. I want to go to birthing classes and teach new parents how to properly install a carseat to protect their children. I want to go to local elderly church groups and teach signs of stroke and the importance of early recognition - did you know that every MINUTE during a stroke, 2 million neurons and 14 billion synapses die?! I'm sure I could come up with many more. I think that preventative education could save lives, and it's something that's not nearly offered enough.

My computer's down to 12% battery life. Darn...looks like I'll have to find something else to keep me occupied until filming wraps for the day! Back to the books again.

Tomorrow, I'm taking my good friend up to DC for an important interview she has. I'm looking forward to an interesting morning while she's at her interview and then Alpha/Beta Therapy in class tomorrow night.

"There is no Medicine Like Hope"

I spent most of today at a critical care and trauma conference hosted by one of my area's medical flight programs. I make it a point to go to every continuing education and conference that I can - I love to keep up with the new research and what the major hospitals and air crews are doing. Also, I've had the fortune of making many friends in this field through all the ways I've found myself involved, and it's great fun to spend a day learning together.

As I walked in to check in this morning, I was handed a name tag that said "EMT-P" under my name. Oops! I told the registering woman that I was only a student and certified only at the Basic level. She told me that she was confident I would pass and so she gave me the "upgraded" name tag! Ha! So I started the day feeling like a real fraud - what were they thinking?! I haven't even come close to this! I can't be expected to perform at this level!

The lectures started and were very interesting. We first got a lecture from a neurologist from a local Primary Stroke Center hospital facility. I was familiar (of course) with stroke recognition and tPA therapy, but I hadn't heard of the surgical interventions for stroke she discussed. MERCI (Mechanical Embolus Removal in Cerebral Ischemia) involves sticking a tiny corkscrew in the blood vessel througha catheter to remove the clot! Amazing what technology can do. We then had a regional coordinator come and talk with us about pre-hospital care of the mechanical circulatory support device patient. Again, I was amazed at how far we've come from seeing the first generation pump to the new third generation - this specialist told us that her facility, which is about 30 miles away from me, is about to implant the fifth third-generation in the world. Amazing! I had never learned much about these VAD devices, but I feel confident if I ever encountered one now, that I'd at least recognize it and know how to treat simple mechanical problems and transfer. Our final morning lecture was on the cutting-edge and still fairly new Induced Therapeutic Hypothermia with adult comatose survivors of cardiac arrest. I had heard of this before, but it was interesting to see it spelled out. We don't have protocols for it in the field yet, and I don't anticipate them coming soon. Our local hospital, though it is highly accredited and a trauma center, doesn't even perform this therapy.

After a nice lunch, it was time to move on to some small group/skills stations. This is where I was worried that my being advertised as a medic might cause some problems - although I made sure to say that I was only a student! Amazingly, I was worried for nothing. I successfully needle cric'd my pig with no trouble and got my tube in the simulator on the first try with no stylet. The flight nurse overseeing that station said I was an intubation natural, which is one of the nicest things I've ever heard. I then placed in the "Jeopardy!" competition, answering some of the questions on cardiac meds, flight ops, hypothermia therapy, and stroke treatment. Our final small group station was hearing from a 41-year-old cardiac arrest survivor (still unsure what caused the arrest to begin with) who was a successful recipient of the hypothermia treatment. It was incredible to see this patient, now a flight medic for the company that transported him to the therapy facility.

The day finished out with a lecture on battlefield medicine. We learned that the three most common causes of death in combat are: bleeding to death from extremity wounds, tension pneumothorax, and airway obstruction. All things we could fix so easily here at home in the field! It is sad to think of all those soldiers that are dying of conditions we have simple fixes for.

While I still feel a little guilty about that name tag, I left the conference feeling like I had learned a great deal and performed in skills much better than I expected of myself. I left with hope (and significant study!) that I could be a flight paramedic one day too - my ultimate goal. I left with hope and awe at what medicine has accomplished and what it hopes to accomplish in the future. And I left grateful that families and patients have gotten hope out of the truly incredible treatments and specialties I learned about today.

You Thought This Was Going to be Easy??

It's been awhile since the start of my class, but the instructor wasn't lying or exaggerating when he greeted us with a "You thought this was going to be easy?". All of us fresh-faced students sat there flipping through our crammed-full 3" binders and wearing our plastic nametags that will identify us as "Student" in every field rotation, clinical rotation, and class period. Even our program-issued polo shirts identify us as "Student."

Once our expectations were laid out for us that day, students started to leave. Some never even showed up to claim their binders and nametags and were accordingly dropped from the roster.

The ones that have stayed so far are already getting bogged down, and as we were all told last class, we're really only beginning. My head is swimming with lymphatic physiology, hemocrit, blood antigens, pharmacodynamics, and medication schedules. My program is accelerated - we will learn in 5 months what most programs take 10-12 months to complete. This draws people to the class that have a 2, and even 3, hour drive. The ones that have stayed with us are motivated, and we all have our own stories for being here.

For about a year now, I've been fortunate enough to spend about 20 hours a month with a paramedic partner. Rarely, prior to my "release" as a BLS Attendant-in-Charge, had I ever run on a BLS unit. The day that I was released was a typical Southern hot and humid day, and my unit was sent to a park for a referee who was severely dehydrated. He was still conscious, breathing, and was fully oriented. However, I could look at him and tell that he needed some fluid. It occurred to me that I couldn't fix him - I couldn't even start the job that would be finished at the hospital. I got him as comfortable as I could, gave some oxygen and cold packs, and initiated transport. Our transport time is almost always 7 minutes or less, but I still wanted to help this very friendly patient. My skills weren't enough, and I left the call feeling horribly inadequate.

I then decided to begin the road to ALS provider. It's a rough road. I have the fortune of many paramedics to look up to, and I want to make them proud. I want to make my patients confident in their decision to call for me. And most of all, I want to make myself proud in my abilities.

Thanks for reading and joining me on this trip. For now, my instructor has told me to be "as one" with my Paramedic Care book, and it's right on top of that binder...time to get back to work.