My flipped vehicle

January has been a stressful month, yesterday has been even more so.  I was driving on the highway to work.  Everything went as the usual, I was just two exits away from my destination when a vehicle decided to merge into my lane, a little too tight for my comfort.  It was no big deal though, I decided to change lanes to the left.  As I changed lanes I must have hit a slippery patch because I could feel my rear tires lose traction.  My car started to fish-tail.  Like a dog wagging its tail frantically, too eager to see its owner.  My car bucked like a rodeo bull as I desperately turned my steering wheel to counter the swinging movements.  I was but a foot away from the vehicle beside me, I remember thinking Don’t hit the vehicle!  Please!  As I tried with all my might to steer the car in the opposite direction.  My hopes of getting traction back vanished as my vehicle just fishtailed even harder.  I can visualize my car spinning out.  This all happened in a matter of seconds, there wasn’t enough time to think as my car swerved towards the side of the highway.  I didn’t have time to look in my side mirrors to see if there were vehicles nearby in the heavy traffic of rush hour.  All I remember seeing were the bushes rushing up to meet my face as I slammed on my breaks in hopes to slow the vehicle down.  I remember thinking Shit!! And hoping not to hit any rocks or trees or rolling over too many times.  Next thing I knew, I was sitting inside the vehicle that has been tilted sideways onto its left side.  My heart was pounding, I’ve never felt so much adrenaline in my body before.  My hands were shaking.  I remember trying to turn the engine off, but it wouldn’t let me.  I tried a couple of times, not realizing that I was still in drive (thanks to the adrenaline), and gave up.  I also remember being frustrated that the radio was still on and creating noise that I don’t need to deal with at the moment.  

Instinctively I grabbed my cell phone, thankful that it hadn’t been flung away from me.  My first thought was to call 911, then decided there was probably someone outside calling 911 right now.  Besides, I’m okay, I don’t need an ambulance (also the thought of my colleagues coming to rescue me doesn’t necessarily strike a high note in my books).  So I called my boyfriend instead as I unbuckled my seatbelt.

Boyfriend:  ”Hey.”

Me:  ”Hey…(in a slightly shaky voice)…I got in a car accident.  I’m stuck and I can’t get out.”

Boyfriend:  ”Awww babe.  Where are you?”

I attempted the side passenger door but wasn’t able to open it.  I walked to the rear of the vehicle and managed to push up on the right rear passenger door and open it a crack.

Me:  ”I’m on the highway at xxxxx…”

Surprised, I saw a hand from the outside help hold the vehicle door open.  Several witnesses had stopped along the highway and decided to help.  One man held the door open as I pulled myself out of the vehicle.  He helped me down from the car.  Then they saw my uniform and I saw a surprised look on their faces.  I’m sure I’ll make a great dinner time story for their families.

Me:  ”Did I hit anyone?  Is anyone else hurt?”

Bystander:  ”No, it was just you.”

I breathed a sigh of relief, I was so worried I might have caused an accident behind me or hit another vehicle.

Bystander:  ”Are you okay?”

Me:  ”Yeah…thank you.”

I was shaking all over from the horrific event.  I could have died, yet I got away without a scratch.  One lady was on her cell phone talking to dispatch.  When she saw me, she handed me the phone and told me to talk to them.  I told them I’m a paramedic and that I’m okay as I stepped away from the vehicle towards the side of the highway.  Then to my surprise I was greeted by two familiar faces.  One of my colleagues who was also driving to the same workplace had stopped to help out.  It was a relief to see someone I know, especially so unexpectedly.  He sat me down in his vehicle so I could calm my nerves and spoke to dispatch instead.

Within minutes an ALS crew arrived, even though I told dispatch I’m fine and I don’t need an ambulance.  Another minute later a BLS unit arrived along with three fire trucks, and a police officer.  Gosh, what a mess!  I went into the ALS ambulance where I met two fellow colleagues and introduced ourselves.  He ran a set of vitals on me, as per usual standards.  I told him I’m fine and I won’t be needing to go to the hospital, that I’m just shaken up from the incident.  I remember seeing this medic the day before when I was working out of a nearby station.  What a strange place and situation to be making friends.

Instead of tying up an ALS crew, I was left with the BLS crew who decided to wait with me until my boyfriend came to pick me up.  We watched as the tow truck driver pulled my vehicle from its side onto its wheels then dragged up the ditch onto the road.  

Firefighter:  ”So who’s car is this?”

BLS Paramedic points at me.  The firefighter looks at me and chuckles, thinking it’s a joke (remember I’m in uniform so I blend right in with the crew).  

Firefighter:  ”Wait, are you serious?”

I nodded thinking, gosh, this story sure is going to go around:  Paramedic crashes vehicle.

It was not until later that I realized I just narrowly missed a concrete barrier and a pole when I plummeted into the ditch.  It took a miracle for me to have been going 100km/hr in rush hour traffic to spin out, not hit any other vehicles, nor cause any accidents behind me, and to be able to walk out with no injuries aside from a stiff neck.  If there was such a thing, I crashed into the perfect place.  A nice muddy ditch, moistened by rain, and then into a soft bush.  There were rocks and trees around, and somehow I missed all of those and landed in the perfect spot.

I’ve seen many motorvehicle accidents on the highways, I know what could happen.  In fact, I did a really bad call two weeks ago where my patient had died despite everything we did to save him.  That could have been me.  I could have died.  I could have suffered serious injuries.  I could be celebrating my birthday in the hospital right now.  But I got lucky, God must have been looking out for me.  

It was such a stressful event, I remember breaking out into tears when my boyfriend came to pick me up and he gave me a hug.  Just the thought of all the possibilities that could have happened.  It was too much to bear.

I suppose the accident gave me a new perspective.  In life, you just never know.  I’ve driven in way trickier conditions.  Driven on roads where there was snow, ice, poor visibility.  Yet it wasn’t in those conditions that my vehicle decided to slip, it was on a relatively good visibility day, with light rain, no snow, relatively warm temperatures.  I had snow tires on, I was driving within the speed limit, I had enough sleep…what happened was so unpredictable.  It really made me appreciate everybody close to me, everybody I love and cherish, so much more.  Life can change in just a split second, it was a good reminder to never hesitate to do a good act, or to forgive someone, or tell them how much you love them or care about them.  

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I want to thank the crews that came out to help me that day.  They were all very professional and fun people.  I look forward to working with them on the street in the near future, as a fellow paramedic and not as the patient.  

Beautiful day at work

Yesterday was my blog’s third anniversary and it also happened to be my Primary Care Paramedic convocation  Although it was kind of strange having my convocation nine months after I’ve finished my course, it was really nice being able to catch up with my classmates and to have that hard earned diploma in my hands.  I can’t thank my family and friends enough for having supported me through those stressful yet fun times at school.

I can’t believe it has already been three years since I’ve started this blog and how far I’ve come.   Normally for each anniversary I try to do something special with my blog or something new.  This year is a little different.  January has proven to be a difficult month for me.  I’ve been very busy with work and other things going on in my personal life that I have not had the time to write as much as I used to.  Along with a friend passing away, I also had a bad call on the same day which had exhausted me emotionally.  I’m happy to say that I’m feeling a lot better now, but I will be taking a break from writing for a little bit.  (I do have a lot of ideas and thoughts in my head for new posts and don’t worry, I will continue to write sometime in the future.)

Before I end this post, I want to say a quick thank you to my partner, boyfriend, unit chief, supervisor, and the CISD team for being so supportive of me during that bit of rough patch.  You have no idea how much that meant.

Cheers

Going Code3 with the Scottish Ambulance Service

So I’ve been MIA for a bit, that’s because I took a good three weeks off and went on vacation  I’ve been meaning to write a post before I left, but I never found the time.  In fact, I still haven’t written that post I have in mind.  It will eventually pop up sometime this month though

For vacation, I went to the UK, spending five days in London, ten days in Scotland, two days on a surprise mystery trip and another two days stuck in commute.  During my stay, I was lucky enough to learn a bit more about the EMS system in London and Scotland.  In London, I did an orientation in dispatch as well as the ambulance station (yes, even on vacation I couldn’t get away from paramedicine ).  Whereas in Scotland, I rode third with two paramedics in Inverness for a 12hr shift.  It was a real neat experience seeing the similarities and differences between the UK and BC EMS services.  At the end of the day though, the job is essentially the same if you minus the differences in technology, ambulance paint jobs and designs, protocols, and layered responses.

Highlights/Interesting Facts:

• Favourite part of UK ambulances: No lifting of stretchers since they have ramps instead!
• Best policy:  No lifting.  Stretchers have either leg pumps or are hydraulic.
• Paramedics hike up a new coolness factor by being on motorcycles.
• Nice ambulance interior design with loads of work space and natural lighting.
• 85% of the calls at the station in Inverness that day I rode third were chest pain calls (heart attacks is the number one killer in Scotland due to diet and lack of exercise).
• Scottish jail tour via ambulance?  Check.
• Use of community paramedics and nurses for non-emergency calls = freeing up/reducing ambulance crews for actual emergencies and preventing backlog in hospitals.
• Head dispatch officer tried to kidnap me for the day when I said I had to go after spending 8hrs there.
• In his excitement, a Scottish paramedic took off his XXL uniform for me to take home as a souvenir (which is an awesome souvenir even though I wear small and look absolutely retarded in XXL). 
• Learned a new paramedic protocol in London: In the case of a dirty bomb, put a black mask over your face for protection, run away while stripping your clothes off, stand stark naked and draw a line at 100ft and radio in to dispatch…hmmm sounds like an exciting protocol to practice in front of your coworkers huh?
• Was up in dispatch and watched as they sent a helicopter to pick up a chest pain patient, then 40 minutes and a jail visit later, I went out via ambulance to the helipad to pick up the patient to take the the hospital.  Chances of witnessing a dispatched call and then actually being involved the same call?  Usually, zero.
• You think Code3 in BC is fast?  Wait till you go to Scotland.
• In BC, we have first aid courses for dogs, in Scotland, they have first aid courses for sheep.

I know it’s a bit late, but I hope everybody had a wonderful and safe Christmas and New Years  As for the sheep comment above, I can’t say it’s completely true, but I sure as hell wouldn’t be surprised if there is.  It’s not a stereotype afterall, sheep are everywhere in Scotland!  

I just want to quickly thank the paramedics and dispatchers in London and Scotland for their time, they were amazing and wonderful people.  If you ever get a chance to check out EMS in another state/province/country, I say definitely do it, because it’s a great eye opener.  Cheers!  

Different emergency vehicles lined up outside the ambulance station from NHS lunch room.

Ambulance Motorcycle outside NHS HQ in London

One of the Scottish Ambulances in Inverness

Interior view of the Scottish Ambulance

Waiting at the helipad for the helicopter to come in with the patient

Helicopter crew and paramedics

Just heading out from the Scottish jail. You can see the police cruisers and a couple of officers in the background

Beautiful scenery during the day

It’s not often that the only thought that crosses my mind is for me to make it home safe and sound to my loved ones.  Yet this unpleasant thought has crossed my mind more times than I wish while driving along the dark, twisted, lonesome highway where I work.  

There’s no avoiding that particular highway as it is the only road that reaches one town to the next.  At night, the road transforms from a pleasant drive with a magnificent scenery into a treacherous place.  

Fog shifts in from the mountain sides making it impossible to see more than a few feet ahead.  You toggle with the fog lights but it only causes the beam to reflect off the clouds and shine straight back at you.  Darkness cast shadows across the whole road, no street lights are there to illuminate the way.  While you play the guessing game of making out the faded traffic lines that twists and turns along with the highway, you also battle the oncoming semi-truck lights as they blind you with their fierce light.  One false twist and you’ll fly off a cliff or over a bridge into the raging cold river.  Mix heavy pounding rain, slippery snow, black ice, occasional rock slides, and the flashing red and white lights to the combination and it’s utterly disastrous.

There’s no room for error.  You know you can’t make an error, it is out of the question.  Your patient’s life, your partner’s life, your life, it’s all in your hands.  

No pressure.  

There have been many numerous motor vehicle accidents along this twisty road, many of which have been fatal.  It’s sometimes impossible not to think if I could be the one next.  It’s never a pleasant thought.  It’s why I have complete empathy for the two paramedics who passed away last year when they rolled off a highway on a night shift.  It’s why I slow down, because at the end of the day, I just want to make it home.  Safe.

You ever had a call where you wished you could have done more?  Where after a call you can’t help but have this nagging feeling that just doesn’t leave you?  Where you feel bad inside, guilty, like you owed your patient something, something more than what you have given.  But deep inside you knew you did what you could at the time, that your decisions weren’t incorrect, it just could have been better.  Yet despite knowing this, you can’t get rid of that horrible feeling inside.

I absolutely hate that feeling.

There’s a call quite a while back that stands out in my head.  We were dispatched to an elderly lady, who was having shortness of breath (SOB).  When we got there, she was clearly having SOB, but she was also having discomfort in her chest.  She had a nasal cannula on, but I found out that the O2 she had was out.  So I asked my partner to swap it.  All that time I see her eyes, pleading, fear filled.  I remember she got super distraught when I started inquiring a bit more about the situation; I was trying to figure out if the SOB was causing the chest pain or if the chest pain started before the SOB.  She squeezed my arms, saying she can’t breath, she can’t breath.  I tried to calm her down by talking to her, but she was panicking and wasn’t answering my questions properly.  It must’ve only been 30 seconds (although it felt way longer) since I introduced myself when I asked my partner to put a normal face mask on.  She still says she can’t breath.  I don’t know if she was staring death in the face or not, all I know was that she stared at me like I was the only one there that could save her and I wasn’t doing enough.  To her, help had come, but help is not helping her.  

Her lungs were tight on auscultation, and decreased on one side.  It was difficult to hear clearly.  We got her onto the cot switched to a NRB (non-rebreather) mask and into the ambulance quickly.  En route, I decided to assist her breathing using a BVM (bag valve mask) because she clearly was not getting better and needed assistance.  I talked her through being assisted to breath.  She resisted the BVM initially, it took quite a bit of encouragement and coaching before she realized it was helping her.  I could tell she was getting tired and I did my best to keep her awake and breathing.

I continued bagging her into the hospital until we transfered her over to a bed and the nurses hooked her over to a BiPAP (bilevel positive airway pressure) machine.  The patient was exhausted from the efforts of trying to breath.  I later found out she had a collapsed lung on one side (spontaneous pneumothorax), I also noticed she had a masectomy.  It’s clear that she’s gone through a lot in the past, and I wished she didn’t have to go through what was going on now.  

After the call, I thought I could have done better to calm those frightened eyes.  It’s not that I didn’t give her oxygen, but I should have given it to her earlier instead of asking a few more questions.  With the slight delay I made, I emotionally tormented her.  When she called 911, she expected someone to come in, and alleviate her breathing ASAP.  When I showed up, I didn’t look after her emotional needs as much as I should have.  I asked her questions that were pertinent, but perhaps not at the right time.  In her mind she was probably thinking, “I’m dying, I can’t breath!  Stop asking me questions and help me breath!”  I don’t think I can forget the way she gripped my arms, those big frightened eyes, the soft airy whisper of  I…can’t…breath.  It rips at my heart.

I took that call, which was one of my first more serious SOB calls, as a lesson.  One that I will never forget.  It’s one thing to feel bad about a call, but another to learn from it.  Each patient, each call, is a lesson. On each call you go on, your patient is sharing a part of their life, with you.  It is only up to you to take this gift and make it a part of you, so you can benefit the next patient in a similar situation.  

The next serious SOB call I ran, it was smooth and worked like a charm.  After the call, I remember leaving the ER thanking her, thanking that one patient that had pulled at my heart strings and made me a better paramedic.

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Today, at exactly 9:00am is my first anniversary in the ambulance service. I’m now officially a paramedic toddler

I wish there’s some crazy post I can write here to celebrate, but nothing too remarkable has happened aside from some wonderful opportunities that had opened up for me recently at JIBC.

It has been a relatively smooth sailing for me within the year I was with the service. I still remember my first call, a rollover down an embankment, which I almost shit my pants and how far I’ve gone in terms of confidence, knowledge, and comfort in the field. There’s still tons more for me to learn and I welcome all the challenges with open arms.

Thanks everybody who’s been keeping up with this blog, and those who have left wonderful comments behind. It means a lot! Have a good one

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It was still early in our shift when we got called for an overdose.  We headed lights and sirens to a shady part of town, an injection site, where overdoses (ODs) were common.  Dispatch updates us that it’s a possible GHB OD.

GHB huh...GHB stands for Gamma-Hydroxybutyric acid.  It can be used as a general anesthetic or in some instances used as a date rape drug.

As we neared the site, we saw security waving us down.  We see a young lady collapsed in a corner of the concrete pavement.  It was not a good area to hang around, so we lifted her onto our cot and into the back of the ambulance right away.  She flung her arms around reflexively as we lifted her, but she was unresponsive for the most part.  Police also arrived on scene as they tried to identify our patient.

With the ambulance doors closed for privacy, we got busy to work.  We had a police officer pat our patient down and search her jacket.  They found a sharp.  Our patient’s GCS is an 8, pupils were pinpoint and barely reactive, she’s maintaining her airway well on her own, respirations were good at 12 and sats were 98%, heart rate was slow in the 30s (normal heart rate is 60-80 beats per minute), BP 130/78, and blood glucose was good.  It’s clear that she’s depressed but I have no idea what she took.  It was a sad sight, she had track marks all over her body and arms.  She looked to be about 20 years old.  Young.  

As I prepared the narcan, my partner restrained the patient to the cot in case she wakes up fighting and aggressive.  Sticking the syringe into the vile I drew up 0.8mg of narcan and gave it SQ (subcutaneous).

Only story we managed to get before heading to the hospital was that the patient was last seen with a couple of other drug users when they couldn’t wake her up.  They notified security and took off.

En route, her GCS deteriorated from 8 to a 6.  I started an IV (intravenous) and gave her another 0.4mg of narcan IV to no avail.  Nothing seems to be working.  I have no idea what she took.  We rolled her into the ER and got her onto a bed right away.  I gave my handoff report to the nurse, the doctor was also there.  There really wasn’t much of a story for me to give.

I got a second IV into her AC then attempted an NPA (nasalpharyngeal airway, which is a tube that goes up and down the nose to secure an airway).  As I pushed the tube in…it got stuck.

Huh…weird.

I pushed a bit harder.  Still it only went about two inches in.

Partner:  ”Push harder.”

Me:  ”I am!  If I push any harder it’s gonna go up her brain.”

Then an interesting thing happened.  Her heart rate started to brady (slow down), down to the 20s.  We all stared at the monitor.  Strange…needless to say, I stopped attempting to push the NPA in or try the other nostril.

Doctor:  ”How much narcan did you give?”

Me:  ”In total?  1.2mg, 0.8mg SQ and 0.4mg IV.”

Doctor:  ”Okay…give her 5.omg of narcan.”

Nurse: “What?! 5.0mg?  That seems like a lot.”

The nurse is refusing to give 5.0mg in one go.  While this debate was going on, our patient suddenly starts to seize.  She foamed at the mouth as I looked up from my paperwork at the foot of the bed.  I grabbed a pair of gloves and started suctioning her mouth.  The doctor was about to order some drugs when she suddenly stopped.

Now we’re really starting to attract a crowd of staff in the ER.

Well this is interesting...

Another nurse was doing another LOC test, she was getting no response.  Our patient is down to a GCS of 3 within 15minutes since we first found her.  The nurse tried the trap squeeze, then the nailbed test, then the sternal rub.  Nothing.  Next she tried the pen inbetween the nailbed.  Our patient winced then started to brady down from 40s….30s….then flatline!  We all stared at the monitor, for a moment mesmerized by the flat green line scrawled across the ECG monitor.  

Nurse:  ”Get a crash cart!”

I can’t believe she just arrested on us!

I once again dropped my paperwork to help with the cardiac arrest when my partner who was beside the bed and already had gloves on gave the patient a precordial thump (that’s dropping a fist on the chest, which delivers about 20 Joules of energy).  Instantly her heart started beating again.

Nice! 

In the end the nurses gave a total of another 5.0mg of narcan which did nothing.  Last I heard she was taken up to the ICU and tubed.  I wasn’t working out of that area that night and it was my last night shift so I wasn’t able to follow up with what the patient actually took.  It would have been interesting to know if it was really GHB or a mixture of coke and other things.  Any ideas?

I’m sure many people wonder what the workload is like as a primary care paramedic (PCP) student.  Because of my volunteering with St John Ambulance, I have kept a record of the hours I had spent in school for CME credits.  The hours listed below does not include the hours I spent at home studying, but does include the weekends I spent at school practicing calls.  

In summary, I spent approximately 872 hours for the in-class PCP program portion (~5 months), and I spent approximately 202.5hrs precepting on car.  That adds to a total of 1074hrs for me to complete the PCP program.

Is the PCP program intense?  

Yes.  It is because it is so compact and unlike university where you have a lot more time to study on your own, in the PCP program you’re in class from 08:00-17:00.  The time spent in class is mostly spent working on practical skills with a few lectures here and there, but for the most part, all the readings (which is quite a bit) is done in your own spare time (which there isn’t a lot of).  In other words you’ll have to somehow fit in the readings after class or on weekends.  What does that mean?  That means you’ll be going to school from 08:00-17:00 then from 17:00-19:00 you’ll probably be doing readings or spending time practicing calls, maybe squeezing in some gym time, and then going home to eat, then doing more readings, then sleeping and repeating.

A huge part in doing well in the course is time management and keeping up with the readings and practical skills.  If you have the chance, pre-read the materials before the course starts!  The following data isn’t meant to be intimidating but to give you an idea of the time I personally spent in the program (which of course, would vary with each individual).

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I know its been a while since I’ve posted, but don’t worry my blog has not disintegrated  I’ve been taking a long needed break.  Its been six years since I’ve been able to feel so relaxed.  Strangely enough, it’s taking me a while to “learn” how to relax and enjoy it.  I thought it was innate, but I guess having been on the go for so long, the whole concept has been beaten out of me.  Another reason for the lack of posts has to do with the lack of interesting calls recently, none intriguing enough for me to write about.  I’ll be taking the next couple of months easy and in the process hopefully pick up more shifts in the city, and perhaps write a few more posts here and there

PCP Collar Dogs

So as of yesterday, I have officially finished all my licensing requirements for my PCP (primary care paramedic) license .  It was a long day, but a perfect day for an exam (there was a rain storm with wind warnings outside, aka plain miserable).  The practical exam consisted of three full scenario calls and one skills station.  The calls were very straight forward, and the evaluators were pleasant and did their best to ease our anxiety.  Needless to say, I had adrenaline pumping the whole day from 08:00-16:30.  I’ve never been so stressed, nervous, anxious, and excited for an exam before.  It felt like all that hard work since January 2009 had all come down to one exam.  That this was it, this was the big one.  I remember after my last call, I just crashed on the couch exhausted but happy to be done.  

So I guess technically the journey this blog was meant to capture has come to an end.  From the beginning 2.5yrs ago when one story lead me down this path, to now  (I’m standing here, still stunned and in disbelief).  From the little time I’ve been out on the streets, I know I have found my calling and absolutely love every moment of this profession.  I still feel the passion I had felt two years ago and I hope for it to stay for a long time to come.  

Does this mean it is the end for this blog?  The answer is no.  I plan to continue writing what I experience out on the streets, after all, the fun had only just begun.

I want to say a big thank you to all those who had been involved in helping me reach my goals (you know who you are).  I have met many amazing people along the way, and I can’t be more thankful.  Thank you!