tag:blogger.com,1999:blog-90815079351458856102024-03-13T06:45:59.891-04:00The Lonely EMTA view of the life of a rural volunteer EMT. Out here in the boonies.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.comBlogger175125tag:blogger.com,1999:blog-9081507935145885610.post-49188996784703613802018-06-26T01:02:00.003-04:002018-06-26T01:02:57.936-04:00All or NothingIt's an odd thing out here.<br />
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It seems like the calls happen either when we're all out here, available to respond, or when none of us are.<br />
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Just recently, we had both situations the same day. A call where we were practically tripping over responders, and later, one where none of us were out here, and no one from our agency responded at all.<br />
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I wish there was a way to make that balance better.<br />
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Instead, it seems to work a lot like call frequency itself. We'll go for days without a call, then have three back to back. Or even a couple of weeks without anything, then two simultaneous calls.<br />
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It would make sense if the cause for the higher number of calls was obvious. In a storm, if we get more calls for trees down, that makes perfect sense. Or if it's snowing heavily, to have more cars slide off the road wouldn't be unexpected.<br />
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But instead, we get a sudden rash of sick people, with conditions that are unrelated, on the same day that there is a structure fire. And not only that, but the rest of the county has a similar pattern. There are days when every agency in the county is running calls right and left, for things that couldn't possibly be connected.<br />
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Strange.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com3tag:blogger.com,1999:blog-9081507935145885610.post-20790195407801580292018-06-17T14:06:00.000-04:002018-06-17T14:06:05.660-04:00What If I'm Gone?One of the educational sessions I attended this past week had to do with ethics in EMS. The instructor said something that butted right against an issue I already have.<br />
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He pointed out that attending a training conference is, in part, a decision based on ethics.<br />
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What?<br />
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He went on to ask how it had been decided who would attend the conference, whether their agency was paying for it, what was included in what was paid for (are people going out drinking on taxpayers' money?), and- most importantly- if the people who are the most motivated and most interested in continuing their education are at the conference, who is left behind to take care of the community?<br />
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And boy, did that hit one of my triggers.<br />
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One of the things that became extremely apparent early on is that working with a small volunteer agency in the middle of nowhere, whether or not I was home when we got a call could potentially made a HUGE difference to patient care.<br />
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I had an instructor tell me not to worry about it, that if I didn't go, "someone else would."<br />
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Well... not so much. There have been times when we have had only two active EMTs, and if we weren't home, then there would NOT be "someone else" to go. We are in a slightly better position now, with three. Yes, the transporting agency that takes our patients to the hospital will eventually show up, but they are coming from further away. On a good day, when they have an available ambulance that is at their base, and when the call is for an address on the "near side" of our town, they can get to the call in about ten minutes. But if they are coming from the hospital, and the call is on the "far side" of our little town, it can take them over half an hour to get there, even going hot. I'm sure I don't need to tell you that a response time of half an hour (or more) is simply not acceptable in a true emergency.<br />
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I had to learn to deal with the fact that while I have no personal legal responsibility to stay home in case there is a call, I need to consider the implications of delayed patient care if I'm not able to go to a call. For most calls, it isn't such a big deal. There's no immediate life threat, and while I'd still like to be there and provide superior patient care to someone in my community- many of whom are people I know- I can trust that they will be cared for appropriately and adequately. But sometimes, it DOES matter, and it can matter a LOT.<br />
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Consider this last academic semester.<br />
Of the three active EMTs, all three of us worked well outside our response area at the same time on one day a week. That meant that during that time, our town had NO COVERAGE from our agency, and relied only on the transporting agency, coming from further away. There was nothing any of us could do about it. And yes, there were some calls during that time slot where I really wish at least one of us had been there.<br />
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So now, here I was at a training conference, being reminded that the simple fact of my being there, and not here, could mean that someone in my community would not have access to care in their time of need. Fortunately, that didn't happen.<br />
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But a couple of months ago, two of us went to a training conference together.<br />
And in between, we had a period of several weeks where there were only two of us available, and I ran into the other one at the grocery store in the nearest real town, when we suddenly realized no one was minding the hen house, so to speak.<br />
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Can an agency provide effective EMS with only two responders? Or one, much of the time?<br />
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Do we need to stay in constant contact, letting each other know every move we make so when one of is at the store, or goes to a social event, or visits family elsewhere, the other can clear their schedule and stay in town? Do we need to forget about that glass of wine with dinner, because then, by company policy, we need to stay out of service for several hours, and it might leave the town without an EMT?<br />
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The answer MUST BE that no, we cannot be expected to bear that level of responsibility.<br />
And yet...<br />
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Part of me wants to send out a mailer to the people on the far side of town, making sure they understand that if they have heart problems, they better get them taken care of because if they go down, it's likely no one will get to them quickly enough to make any difference. To suggest that older people not live alone past a certain street address. To put signs along the main roadway that say "Caution: delayed EMS zone. Please drive carefully!"<br />
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I don't see a solution.<br />
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Some people say we need to change to having paid providers out here, but there are significant barriers to that idea, only one of them being the expense.<br />
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The local town board has apparently bought into some "study" nearby students have done, that spell out "the problems in EMS," focusing on issues that aren't really the problems we have here. They want to put effort into "educating the public" so that they don't "abuse the EMS system" by calling 911 for non-emergent things. For the most part, we don't have that problem, We need to educate the public to CALL SOONER when they are in trouble. Call 911 before calling your son, your neighbor, your childhood best friend, and anyone else who isn't in a position to actually help you. Get help rolling towards you before it's too late.<br />
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I think our only reasonable path has to be better recruitment and retention, with perhaps some legislative action that provides some sort of incentives or benefits for volunteers. We can't raise taxes enough to pay for 24/7 coverage where by far, most of the time, those employees would sit there doing nothing for days at a time- but maybe we can find enough financial support to encourage more volunteers to share that load.<br />
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If we don't, the simple truth is that people will die.<br />
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Maybe even me, if the other 2 EMTs aren't home.<br />
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This is not only a national problem, it's very much a PERSONAL one.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-52761948641033994082018-06-16T12:48:00.001-04:002018-06-16T12:48:14.945-04:00Day Two: Still Not DeadTwo posts in a row! Woo hoo!<br />
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I'm working on the training for Monday, and one of the things I want to do is help people in the department who are not EMTs, but who go to calls to support what we are doing, be better able to provide that support.<br />
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There are a lot of parts to this.<br />
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One of the things I want to address has to do with being able to help family members make sense of what is going on, what the EMS providers (both from our agency, and from our automatic-mutual-aid transporting agency) are doing to and for their loved one.<br />
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Those of us who have been doing this for years, with a variety of levels of training and opportunity, get pretty accustomed to some of what happens on scene, and it is easy to forget that it can be entirely unfamiliar to others.<br />
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Case in point: I found a video online of someone putting in an IO. A real patient (it only shows their leg, but it's a real person.) And... that is pretty uncomfortable to watch. More uncomfortable to watch than to do, I think, which is interesting. But I want our people to know what to expect, what it looks like, what it sounds like, and what it is for, so they can explain in layman's terms to someone else, who is more than likely completely unaware that such a thing is even possible.<br />
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A LOT of what we do can look terrifying to someone unfamiliar with it, especially when it is happening to someone in their family. It would be nice to help things be a little less scary, and easier to do that if we practice some actual words to say.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-47964049183777912012018-06-15T20:28:00.001-04:002018-06-15T20:28:33.263-04:00I'm not dead. I think. I'm pretty sure.My gosh. Just when I thought I wasn't going to ever write anything here again, I came home today from a training event, ready to jump right back in and start posting.<br />
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A lot has changed in the past few years.<br />
A lot hasn't.<br />
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For a short while, we had several EMTs, but now are back to... very few. At least the ones we have work well as a team, which beats the heck out of always going to calls alone.<br />
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My life has taken some interesting twists and turns in the past few years, one of which is that I'm a CLI now, working with a local training center helping with brand spanking new EMT-lets. It's delightful. For one thing, the first couple of semesters kicked my butt. There's nothing like needing to teach something, to get you to focus on your own skills. If you want to be any good at it, I mean.<br />
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I came home from the last few days of training with a brain full of great stuff, and some ideas, to go with some ideas I have already been working on. I'd really like to up my game and work on some positive changes around here. I think it's possible now, and important always to strive to improve the service we provide.<br />
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I've been creating powerpoint presentations for several years now, for EMS and for my "real job," and find that (shhh, don't tell!) I enjoy putting them together. (I also enjoy doing my taxes, but I digress.) I have NO interest in making them all text, and just reading it out loud. Who enjoys that? Anyone? Ever? Didn't think so.<br />
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I'm working on one over the weekend for company training Monday night, and if it turns out well, I'll see if I can find a way to make it available, if anyone is interested. It will come with notes, (including notes I'll take on responses and contributions people make during the training) because otherwise, just looking at the pictures isn't going to help you very much. It's based on an excellent presentation I saw a couple of weeks ago, adapted to specific circumstances and concerns we've run into, with some additional thoughts and information, and is about dealing with calls where the patient dies. Stuff people don't often talk about.<br />
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So...<br />
I've tried kickstarting this thing a couple of times. We'll see if it sticks this time! I know some of you who used to read it are still out there. :-)Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-29863079285196364552015-04-08T12:32:00.001-04:002015-04-08T12:32:23.791-04:00Coming Out<span class="Apple-style-span" style="font-family: Helvetica;">Remember dragnet?</span><br />
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"The stories you are about to see are true. The names have been changed to protect the innocent."</div>
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About that…</div>
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Recently, I made the decision to include my :::gasp!::: real name on my blogs (of which I write several, on different topics).</div>
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I did so because on one of them, it's fairly important that people know who is writing it, and when someone I know recently commented on a post somewhere, it became clear that she had no idea I had written it.</div>
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I knew it would make the change to all of the blogs associated with the same account, and rather than go through contortions to move any, I decided to just use my name.</div>
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So all two of you who read this blog- and the one of you who might not have already known who I am- now you know.</div>
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I'm pretty comfortable with my decision, largely because I don't post stupid stuff online that would cause me, or anyone else, problems.</div>
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But just in case it worries anyone, I thought I'd make a brief (ha!) post about it.</div>
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HIPAA.</div>
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Yes.</div>
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That.</div>
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When I write stories for my blog (or anywhere), I'm not about to violate anyone's privacy. I wouldn't do so, even if there wasn't a law prohibiting it.</div>
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My stories are "loosely based" on real stories, in the same way many movies, TV shows, and novels are, with one important difference.</div>
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The question here is, how do I retain the "heart" of a story, while making it absolutely unidentifiable? Most "based on" situations don't have that requirement, but I do.</div>
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Fortunately for me, I learned a lot about this years ago, from a friend who is a television writer. She used to share with me all the revisions of a particular script, so I could see all the change it went through. Maybe they can't get a particular actor that week, so can't use that character. Maybe they can't get a location to match what was written, so need to change it. Maybe they can't afford a certain special effect. Maybe the director or actors have ideas they want incorporated into the story. And so on.</div>
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It was very interesting to me to see that through all the many changes, for many different reasons, the MEANING of the story stayed. The emotional content remained. </div>
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That is what I try to do.</div>
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I write stories because of how they affect me. The story is about what I learned, or what I felt, or what I think is important, rather than about the patient or their specific medical situation.</div>
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So I make a lot of changes.</div>
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I change ages.</div>
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Change locations.</div>
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Change seasons.</div>
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Sometimes, I change genders, but not always- because if I always did, that would be the same as never changing!</div>
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I may add, or take away, family members.</div>
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I may add, or take away, pets.</div>
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I may add in specific details that weren't actually there.</div>
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I may even change the medical condition, or the signs and symptoms, sometimes almost entirely. Often, they aren't the point, at all.</div>
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Sometimes I combine several stories into one, as if they all happened to one person.</div>
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I never post about anything close in time to when it happened.</div>
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I live in a small town.</div>
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Tiny.</div>
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Even leaving out names and locations, it would be far too easy for some of my patients to be identified, so I don't write about those, at all. It means there are good stories I can never tell, but that's the way it is.</div>
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It is not possible to read any of my stories and identify any specific person or situation.</div>
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Sometimes, I go back and read through earlier posts, and even I can't recall what call or patient was the catalyst for the story.</div>
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Just sayin', in case anyone plans to go all HIPAA on my ass, or something. :-)</div>
Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com2tag:blogger.com,1999:blog-9081507935145885610.post-44440149114429750662015-03-03T17:44:00.003-05:002015-03-04T09:44:41.350-05:00Snowstorm<span class="Apple-style-span" style="font-family: Helvetica;">She died of a snowstorm</span><br />
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her broken heart<br />
even slower </div>
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than the ambulance could travel</div>
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too late</div>
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to shock her back</div>
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Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-23055197390040933192015-03-01T23:31:00.003-05:002015-03-01T23:31:19.685-05:00Wishful Thinking<span class="Apple-style-span" style="font-family: Helvetica;">I've learned a lot from being involved in Emergency Services.</span><br />
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One of the things I've learned is that most people OUTSIDE emergency services have absolutely no idea what we do, how, or why.</div>
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Many of them don't WANT to know. Too scary.</div>
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They just want to be able to call 911, and have someone come solve their problem for them.</div>
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That sounds good to me.</div>
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Or it would, if it really worked that way.</div>
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There are two separate problems, which often overlap.</div>
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One is a lack of understanding, and one is a lack of resources.</div>
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When people have no understanding of their medical problems, and/or no understanding of what is or is not really an emergency, and/or no understanding of what an EMT, Paramedic, or the ER can do for them, it's not such a great fit.</div>
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In the other case, even if they do understand, if they can't afford medical care, and/or live by themselves without anyone to help them, that's not such a great fit, either.</div>
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Here is my wish list:</div>
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1. Everyone would know enough about their own bodies, how they work, what can go wrong, and how to deal with it, that they could take care of most issues themselves, and be able to evaluate when that is NOT the case, and call for help in a timely manner.</div>
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2. Everyone would be able to afford medical care, both routine and emergencies. No one would ever delay getting help, or checking up on something, because of not being able to pay for it.</div>
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3. There would be more options for providing care. At night, there would be somewhere else to go besides the ER. Families would have access to more levels of care besides "do it yourself" and "put them in a home."</div>
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I can't make these things happen.</div>
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I CAN try to have some beneficial influence where possible.</div>
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I teach a class I call "functional first aid."</div>
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It provides no certification.</div>
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It has no set curriculum.</div>
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Instead, we look at the specific needs of the people there, and help them understand those needs and learn more effective ways to manage them.</div>
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There may be people with chronic medical conditions.</div>
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There may be someone who works with a population that has a higher risk of certain kinds of illnesses or injuries.</div>
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I've helped people put together a First Aid Kit for a month long summer fieldwork trip, where they would not be within easy reach of medical care.</div>
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We put a priority on early recognition of true emergencies, and on self-reliance for as much as possible.</div>
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I also teach people HOW to call 911, not just when to do so.</div>
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Most people don't know how that all works, and can be hesitant to call when they don't know what to expect.</div>
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I talk to people about what paramedics do, and why, in some cases, calling an ambulance is MUCH better than trying to drive themselves, or a family member, to the hospital. It's not so they can effectively "cut the line" and not have to wait in the waiting room; it's because for some conditions, treatment can be started in the ambulance. Many people, especially older people, don't know this, and do, in fact, see an ambulance as only transportation.</div>
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I'd like to be able to do more to help connect families with elderly family members, who need more care than they are getting, but aren't quite in need of full time care. We have a number of families in town, where either the elderly or ill person is refusing a higher level of care, or the other family members don't quite realize that they aren't able to provide what is needed any longer. Or maybe both.</div>
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I don't think I'll ever run short of things for my "wish list."</div>
Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-46173719880016511722015-02-28T07:58:00.003-05:002015-02-28T07:58:51.074-05:00One of My Favorites<span class="Apple-style-span" style="font-family: Helvetica;">Had one of my favorite things happen at a call recently.</span><br />
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It's a simple thing. A small town thing.</div>
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We got a call to an address where I had been before, but the patient description was not even remotely familiar, even though the location was.</div>
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We don't have a lot of rental property out here, but we do have some- and this was one, so I thought maybe the previous patient had moved or something, and that was why this wasn't ringing a bell.</div>
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But when I walked in, something happened that clarified everything.</div>
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The patient recognized me. </div>
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Remembered that I had been there before, six months ago.</div>
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When the patient's FRIEND was staying there while recovering.</div>
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THAT was why nothing sounded familiar.</div>
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Same address; different patient.</div>
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At the call months ago, I assumed I'd never know how things turned out, because that patient doesn't actually live in my response area, so it was unlikely we'd meet again. It was a somewhat uncommon medical situation, so I had wondered, more than once, how things had gone.</div>
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The friend was happy to give me an update, and let me know the former patient was doing very well, indeed.</div>
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So nice to hear!</div>
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I was somewhat surprised to be remembered.</div>
Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-82793035240521733342015-02-27T10:25:00.000-05:002015-02-27T10:25:11.023-05:00One Small Post<span class="Apple-style-span" style="font-family: Helvetica;">It has been forever since I've posted.</span><br />
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No excuse for that, other than life being life, and things being things.</div>
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As usual, after a long break in posting, it's a bit of a challenge to decide what topic is "good enough" to be THE post that starts up the blog again.</div>
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Also, as usual, my decision ends up being that it doesn't matter. This isn't about the big, important topics, it's about the daily, small things. The insights. The experiences. The learning process.</div>
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Since my last post, I've gotten to do something that is near and dear to my heart.</div>
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I've become a lab instructor, with a great crew of other lab instructors, and help teach EMT classes at the local community college.</div>
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Not only that, but one of the primary instructors has a different take on how best to teach the class, since the state changed the curriculum. We're running a class that is heavily lab-based, with much less powerpoint and much more hands-on. We're currently in our second run of this concept, and I have to say, I think we're heading in the right direction. Still some stuff to work out in order to make it the best it can be, but we've seen many advantages to this model, and on top of that, we're having a great time, as are the students.</div>
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The first semester I was doing this totally kicked my butt, in a GREAT way. To be able to present didactic material in the lab setting, while keeping the hands-on part engaging, not spending too much time talking OR skipping any of the critical information, requires the instructors to be on top of our games, and has been SUCH a great learning opportunity for all of us, not just the students.</div>
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Instead of the typical lab structure of setting up stations that the students then rotate through, we have "teams" of students, each assigned to one instructor for the whole lab, and then change which instructor they work with from lab to lab. This means much of the instruction is done in a small group setting, which has done wonders for encouraging students to ask questions, and to keep up with the reading, since they really are expected to participate and contribute to discussions (and they DO). This ALSO gives the instructors a lot of one-on-one time with every student in the class, and our post-class review highlights any student who is having trouble keeping up.</div>
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For me, this way of teaching is a "natural" fit, since it is so connected to the teaching I've been doing in the rest of my life for the past 15 years.</div>
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I think this is enough for coming back to this blog. Lots of other stuff to say, of course.</div>
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Updates on our "medical mystery." (Solved? Maybe.)</div>
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Lessons learned from calls.</div>
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Maybe an update on not being so alone out here anymore… or am I?</div>
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Or maybe… I'll end up not posting again for a couple of years. It could happen.</div>
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At any rate, if anyone out there cares, this is just a short post to show that I haven't quit, haven't disappeared, haven't become one of the many, many people who burn out.</div>
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I am, however, intensely jealous of everyone in Baltimore right now for EMSToday. I couldn't afford to go, in time or money. :::sigh:::</div>
Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-71632953387592825642013-03-11T23:24:00.002-04:002013-03-11T23:24:59.205-04:00GrievingSome calls stand out.<br />
<br />
It might be because of the patient's condition, or it might be that things went particularly well- or not well. It might be the weather, or who was there, or where it was, or almost any other detail. There's no question, some stay with us longer than others.<br />
<br />
If the reason that the thought lingers is that it was an emotionally traumatic event, there are a variety of ways that people deal with that. There's even a process in place, to bring help to anyone who is having a hard time.<br />
<br />
I've been doing this for a few years now, and have seen more than a few things that most people never see. I've had calls go extremely well, up there near the "miracle" category. And I've had some that didn't go well, necessitating much thought and re-assessment and some researching and pre-planning for the next time.<br />
<br />
I've had calls that might make most people stressed out not cause me to be so, and I've had some that weren't particularly "bad" stay on my mind for a long time.<br />
<br />
I get attached.<br />
<br />
This shouldn't come as a surprise to anyone who knows me. I get emotionally attached to inanimate objects, like my car, or my computer, or the house I lived in as a child, so attachments to actual people isn't much of a stretch. Even if I don't know them.<br />
<br />
Through all of this, I've learned what helps me process things, what helps me cope, what helps me stay human, without staying sad.<br />
<br />
I recently had a call where the patient didn't make it.<br />
It wasn't a surprise, given the situation at the time.<br />
I would really like to have been able to do something more helpful, but it was not to be.<br />
<br />
I read the obituaries every day.<br />
Partly to see if anyone I know died, partly to notice the ages of the deceased, but also, to see if any of "my" patients are in there. Sometimes, we get called to a patient and we don't find out directly what happened, but they never go home again.<br />
<br />
It is in those obituaries that I sometimes begin my healing process. I read about their lives, their families. Sometimes the things they have done, or the dreams they had. I see how they were- and are- loved.<br />
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I "get to know them," just a little. Enough to say goodbye, and to mourn them as a person. Enough to be sad for their passing, and to remember them.<br />
<br />
And then, I can move on.<br />
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Goodbye, my short-term friend. May your smiles be remembered, and lighten the hearts of your family and friends.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com4tag:blogger.com,1999:blog-9081507935145885610.post-28822226677502220362013-02-07T11:33:00.002-05:002013-02-07T11:33:44.152-05:00In the Middle Of ItSo we're taking this class, and having a great time. Learning a lot. Working with some great people. And now, cardiology. What we've been waiting for.<br />
<br />
Sounds great.<br />
<br />
Except for one little detail...<br />
We are also right in the middle of our very own Mystery-Diagnosis-worthy medical situation.<br />
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As in, I wouldn't be surprised if we actually DO end up on that show.<br />
<br />
So far, we're on Dr.visit #7, and medication #9.<br />
And no one really has a clue what is wrong.<br />
Lots of theories.<br />
Conflicting theories.<br />
Most of which don't match the signs and symptoms.<br />
<br />
Some tests are being ordered, and I'm bouncing back and forth between "Oooh, cool!" and "oh, crap!"<br />
Hopefully they will shed some light on the situation, and we'll get things figured out and fixed and life will go on.<br />
<br />
In the meantime, this is wreaking havoc with any ability to do clinical or ride time, and the future of staying in the class is somewhat doubtful.<br />
<br />
As much as I find the entire subject fascinating, I've been telling people that what I'd really like is for no one in my family to ever have anything medically "interesting" happen to them.<br />
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When we get to the other side of this, I'll write it up as an exercise, and see what people think. Until then, good thoughts would be appreciated.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-11527402875198663322013-01-27T15:22:00.000-05:002013-01-27T15:22:11.692-05:00Where Has the Time Gone?Haven't found the time to write here for a while. Again.<br />
<br />
Life is busy.<br />
That's not a complaint, but it does make it challenging to keep up with everything.<br />
<br />
I'm taking a class that takes a lot of time, for the class itself, studying between classes, and now, substantial ride and clinical time.<br />
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These are good things. I'm learning a tremendous amount. Excellent instructors. Plus, I've been doing this long enough now, and doing enough additional learning, that many things are starting to come together well. That's interesting, a little exciting, and very useful on scene.<br />
<br />
We've had interesting calls.<br />
We've had more small town, small agency, politics.<br />
<br />
I'll work on sharing more of the good stuff here. Learning opportunities. Stuff I've been thinking about. At least SOMETHING, rather than nothing.<br />
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Appreciating all of the support from those of you out in the blogosphere, even while I've been mostly absent.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-11222048599614013932012-10-23T15:17:00.000-04:002013-04-05T01:25:30.309-04:00The Tough Women Club<span class="Apple-style-span" style="font-family: Helvetica;">It was nearly Christmas. We were just sitting down to watch the Grinch, and tradition in our family is that if you want to see the major Christmas specials- Rudolph, the Grinch, and Frosty- you have to catch them when they are shown. No taping allowed.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">Not five minutes into the show, the pager went off.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">I knew where the house had to be, being familiar with our response area. It was back behind trees, at the end of a long driveway, with no obvious numbers. WE knew where it was, but the ambulance likely would not.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">Sure enough, they missed the house. Twice, at least. We could see and hear them go by, but since I'm not allowed to carry a radio, we had no way to contact them to give them directions.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">Meanwhile, we were inside, with the patient, listening to her story.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">She told us about her cardiac history. About her stroke history. About being diabetic. About her asthma. She talked about tiring more easily than she used to. And oh, by the way, she casually mentioned she also has cancer. All of this relayed with no apparent distress, like discussing the weather, or a television show. She was, as she described herself, "a stubborn old lady." Certainly tough enough to kick whatever this was that made her feel "a little off." We had a good laugh together, the three of us, the "tough women" club, before anyone else arrived on scene.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">She reminded me of another patient we had seen, another tough old lady, who made me smile more than once over the years. I wondered if they knew each other, if, perhaps, they had been close friends, they seemed so alike. I could easily imagine the two of them as youngsters, turning heads and causing trouble. This little town seems to grow some tough women, women who live long and well. Women who are good workers, and even better friends. The kind of person you can count on, no matter what.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">I just now saw her obituary. She died a few days ago. I'm absolutely certain she was tough to the very end, and probably had friends and family chuckling over some joke, or tall tale. If I had to guess, I'd bet she was comforting family and friends, rather than the other way around.</span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;"><br /></span><span class="Apple-style-span" style="font-family: Helvetica;">Godspeed, Alma. Keep everyone wherever you are in line, until the rest of the club gets there, okay?</span>Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com1tag:blogger.com,1999:blog-9081507935145885610.post-36646355146530742492012-09-25T15:24:00.000-04:002012-09-25T15:24:04.237-04:00Connection/SeparationThere is a patient we have seen many times over the past few years.<br />
I like her.<br />
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She has a rare chronic medical problem, one I had never heard of before meeting her, and am now almost an expert on. When she calls, I know what to expect, where her pain will be, and what I can do to help alleviate it. I love knowing those thing, knowing that I am able to offer her at least some relief before the ambulance even gets there.<br />
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It is an intimate thing.<br />
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When a person is in a lot of pain, they are rarely at their most sociable best. Anytime someone is very ill, they tend not to be fresh as a daisy and ready to entertain, to say the least.<br />
That we are allowed into that world is an awesome privilege.<br />
She and I have met enough times that she trusts me, at least enough to allow me to be there, to touch her, to comfort her. She knows I care, and I know that she is grateful.<br />
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Living in a small town, it is inevitable that we would have friends in common, and we do. We don't "run in the same circle," but we do see each other from time to time at events, or in passing.<br />
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It is always good to see her when she is feeling well, when she is out being happy, being a whole, comfortable person in the world. To look at her then, you'd never imagine that she has any medical problem at all. She is vivacious, smiling, confident.<br />
<br />
But not once, in any of the times we have run into each other outside her home, has she said hello, or acknowledged me in any way. And not once have I gone up and spoken to her, either.<br />
It is an unwritten agreement, of sorts.<br />
Although there are times when we are as close as people can be, sharing sweat, tears and pain, the rest of the time, I do not belong in her life. I am forgotten. Unacknowledged.<br />
<br />
It is not that I expect her to run up to me and thank me every time she sees me.<br />
That would be horribly awkward, at best, and isn't at all necessary.<br />
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I just find it interesting that there can BE such separation of connection.<br />
<br />
I like how I am able to be there when she is having difficulty, and not have that spill over into a semi-social relationship, just because we live near each other. That we are not "friends" does not lessen the intensity or value of the relationship we have. It may well enhance it by removing all social awkwardness, or any obligation to each other outside the narrow window of emergency situations.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-37617475866553359782012-09-15T09:54:00.000-04:002012-09-15T09:54:31.510-04:00What the Heck is Going On Here?I'm having a few thoughts this morning, so I'll share them.<br />
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Class is going very well. We have a good group of people, both students and instructors, and I'm enjoying this very much, and looking forward to hanging out with these folks for the best part of a year.<br />
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I've found a very useful resource for the class. An obvious one.<br />
The text we're using has an associated website, with lots of study-stuff. Some is more useful; other stuff somewhat less.<br />
I've been taking advantage of the "flashcards" they have set up for each chapter.<br />
After going through them a couple of times, I realized that they are set up to match exactly with the vocabulary list.<br />
<br />
Memorization is not, in general, the best tool for learning. It provides no context, and that means much of it will be remembered short term, but not long term. I'm going for long term.<br />
<br />
So if the flashcards were FACTS, I think they would be less useful.<br />
But they aren't facts.<br />
They are LANGUAGE.<br />
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Perhaps you have noticed that your language, the vocabulary you frequently use, has changed somewhat since becoming involved in EMS. We talk about stuff that no normal (read: "not an EMT") person talks about.<br />
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Being comfortable with the language helps to avert those "I know what it is, what it does, and why it is important, but I just can't remember what it's called" moments. More than that, it brings the medical field into daily thoughts, rather than something in a class, on a test, or during a call.<br />
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One of the things that knowing the language has helped me do is be an advocate for friends and family who are having some sort of medical experience. This is not a small thing.<br />
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Have you ever noticed that the average person has no understanding whatsoever of hospitals or medical conditions? I thought so. They often don't know what is happening, or why. Mostly, they ALSO don't really care to know all the details past "this is going to make me (or a loved one) better so we can get out of here."<br />
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I don't know about you, but I have found friends and family to be fabulous sources of medical education. I have also found that it's better if I don't mention this to them directly. The person having the A-fib typically does not find the monitor NEARLY as interesting as I do. The person just out of brain surgery has no actual interest in knowing about the effects of intracranial pressure.<br />
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If it's a situation where I have fairly direct access to the medical staff, it works well to have them explain to me what the situation is and what they plan to do about it, and I can make sure it is understood by the patient. I tend to know what questions to ask, and can explain procedures and options. I have found hospital staff very open to this, and willing to provide more accurate, less "dumbed down" information, once they realize I understand what they say.<br />
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If I don't have access to the medical personnel, it gets even more interesting. I get to play the "what the heck is going on here?" game. There is great challenge to be found in taking what the average layperson says about a medical situation, and figuring out what is really going on. Especially in the early stages of diagnosis, when no one really knows yet, in the investigative stage. Tests, descriptions, differential diagnoses- these are all rich with the potential of a layperson getting things very confused.<br />
<br />
I once had a distant family member describe someone's condition as "she has a wiggly thing in her head." Hmmm. Where to go with that?<br />
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I find that I'm pretty insatiably curious about all the various ways a body can fail to function correctly. There is no end that I've ever found. It's no wonder doctors specialize- there are simply too many variations out there for anyone to be well versed in all of them.<br />
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I get to specialize in "whatever odd conditions find their way into my awareness" through my friends, family and patients. I look them up. Any time I hear about some medical condition I haven't dealt with before, I create my own "crash course" in whatever that is. Google is the most amazing thing. I can no longer fathom trying to learn about things without it.<br />
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I learned a lot of cardiac stuff when my father had an arrhythmia. I've had patients with spinal abnormalities, very rare kinds of cancer, rare diseases named after some combination of people with fascinating combinations of signs and symptoms. Right now, I have an acquaintance recently diagnosed with an unusual type of non-malignant brain tumor.<br />
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All of these are not only opportunities to learn about the condition, but to learn about how people respond when they discover they have a serious disease. The whole mental/emotional process is as important as the physical process, and often overlooked. I find this aspect as compelling as the physical part. It's probably where I can actually provide the most help to someone, rather than any of the technical skills I can perform. It's unfortunate that there is so little focus or training provided for this.<br />
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Then again, if we were experts on everything, an EMT class would take approximately a zillion years to complete. In essence, it does. Anyone who thinks their learning is complete when they pass the final test, is missing the point entirely. Anyone who thinks a class can "cover" everything we need to know hasn't spent much time in the field.<br />
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It's a fascinating world out there.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-13372281119250486662012-09-14T00:34:00.000-04:002012-09-14T00:34:39.538-04:00No Experience Necessary?As promised, some comments on <a href="http://www.ems1.com/ems-education/articles/1340853-EMT-experience-not-needed-for-paramedic-certification/">this post</a>, about a study showing that having a year's experience as an EMT-B before taking a medic class makes no appreciable difference.<br />
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<br />
I think a LOT depends on the situation, and there is a huge variety of experiences.<br />
<br />
I understand what people are saying, about how there is so much more clinical and field experience required IN the medic class, that what little someone may have had in a year before then doesn't make a whole lot of difference. That is probably true for someone in a small agency, with a low call volume, who doesn't go to many of the calls that there are, who have little in-house training available and who doesn't pursue a continuing education on their own. I know people in that situation, and they really don't have enough experience for it to matter much at all.<br />
<br />
But not everyone is in that situation.<br />
<br />
Some are in active agencies, with great mentors.<br />
Some spend that year not only going to calls, but availing themselves of every learning opportunity they can find.<br />
<br />
For those people, that year of experience will make a huge difference. Not in whether they PASS a medic class or not, but in the experience they have during the class, what they get out of it, and their overall maturity and comfort level working up to a leadership role.<br />
<br />
The problem is it is difficult to tell which of those people someone is, before observing them for a while.<br />
<br />
I do think some things should change.<br />
<br />
If it were up to me- and it isn't!- I wouldn't have a flat requirement of having been certified for a specific length of time. I also wouldn't depend on recommendations from that person's agency, because I know firsthand that that may not mean ANYTHING at all about the candidate.<br />
<br />
I'd use an interview, a pre-test, and an essay.<br />
Talk to the person, get a feel for who they are.<br />
See how they do on a basic-level written exam.<br />
I'd ask them to write about why they want to be a paramedic, and why they should be accepted in the program. They can list whatever experiences or education they have. They can talk about their work ethic, their commitment, their willingness to work hard.<br />
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You can fake a lot of things- but not heart.<br />
That's what I'd be looking for.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-81929072964791149142012-09-12T09:19:00.000-04:002012-09-13T23:52:59.252-04:00A Million Years Later...Best laid plans, and all that. I meant to get back to blogging, but my available time has been at a premium. I'm not complaining, mind you. It's just that the longer I go without a post, the more it starts to feel like something has to be a Big Deal in order to be the first post after that long time, and I never seem to find the time to sit down and write up the big, complex stuff.<br />
<br />
So forget that.<br />
<br />
An update, of sorts.<br />
<br />
It's time for me to re-cert.<br />
Not a big deal, right?<br />
Well... it wouldn't be, if for once the world would simply go along as it should, instead of managing to throw roadblocks up nearly every step.<br />
The state has decided to CHANGE EVERYTHING.<br />
Change what levels of certification there are.<br />
Change the curriculum.<br />
Change protocols.<br />
And... the nearest place to take classes decided not to have a re-cert class and test for the level I am now, since that level shortly will no longer exist, and anyone certified at it would be required to take more classes and certify at a different level within the next year.<br />
<br />
Which is great, and stuff.<br />
Excepting for that "I need to recertify NOW" part.<br />
<br />
What to do?<br />
The short version of a long, frustrating process is that I'm going up to the next level (which ALSO will shortly no longer exist, but that's another story) and somewhere in the middle of that, they're going to manage to find me a test to recertify so I don't end up with NO certification for six months.<br />
<br />
Definitely digging the "go up another level" part.<br />
Still not entirely clear on how this all fits in with all the level changes- and neither is anyone else.<br />
Not surprised AT ALL that I ended up smack dab in the middle of the changing, considering all the curveballs that got thrown at me to certify at THIS level in the first place.<br />
<br />
Why not just take a medic class?<br />
I'd love to.<br />
But.<br />
I'd have to pay for it out of pocket and I simply can't afford it.<br />
Long term plan is to actually get paid for this, and work up to medic once I'm doing that, either by saving up, or by working at an agency that will spring for it.<br />
<br />
Best part of taking the EMT-CC class?<br />
My daughter is taking it with me! What a team!<br />
<br />
We had our first lab last night, and it was great. Excellent instructor team. Good bonding experience, what with the sticking each other with needles part. And to top it off, no one passed out.<br />
<br />
Ah, now that I've broken the ice and started writing, there is so much I want to say. Guess I'll have to save it up. The class ought to give me lots of stuff to post about.<br />
<br />
Before I go...<br />
There is something I need to mention.<br />
<br />
It finally happened.<br />
Something that I knew would happen, eventually.<br />
<br />
This here blog is quasi-semi-sort-of-anonymous.<br />
I don't use my real name, although it's easy enough to figure out.<br />
I don't mention my agency, although, again, it's easy enough to figure out if you have any online skills at all- and you likely do.<br />
I'm very careful not to post any HIPAA violations.<br />
<br />
And yet.<br />
There are probably some folks who would not be happy about me blogging at all.<br />
Especially because I post some truths that they'd prefer <strike>to hide</strike> not to acknowledge.<br />
<br />
The question has long been how long it would be before someone locally finds this blog and figures out who and where I am.<br />
<br />
It won't be long.<br />
How do I know?<br />
<br />
For the first time locally, I came across someone who reads the same blogs I do. (That is a pretty funny story, in and of itself.)<br />
And if they read THOSE blogs, it is somewhat likely they will stumble across THIS blog.<br />
I know he's looking.<br />
And it isn't hard to figure out, at all.<br />
<br />
So...uh...yeah... if you found me, you're right, this is the one. :-)<br />
<br />
Next up... more training opportunities, of course.<br />
And some comments about <a href="http://www.ems1.com/ems-education/articles/1340853-EMT-experience-not-needed-for-paramedic-certification/">this post</a>.<br />
<br />
Hopefully, sometime sooner than a million years.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com2tag:blogger.com,1999:blog-9081507935145885610.post-29153704535199011662012-05-25T11:14:00.000-04:002012-05-25T11:14:51.280-04:00Busy WeekHad a very busy week this past week. Lots of interesting stuff and now my brain is full.<br />
<br />
An attempt at chronicling my week:<br />
<br />
It started out last Tuesday, May 15, with a webinar titled "Fifteen Months in Baghdad ER" presented by Dr Todd Baker and hosted by <a href="https://www.centrelearn.com/default.asp">centrelearn</a>. The thing that struck me the most was how YOUNG the ER team was. A bunch of kids with no experience, thrust into a very stressful environment. Doesn't seem like the best plan in the world.<br />
<br />
On Thursday May 17, I made plans to set aside my regular schedule and spend the entire day attending the <a href="http://emswebsummit.com/">EMS Web Summit</a>, and I'm glad that I did. It was exhausting, between listening and taking notes without a lot of down time from 10:00-20:30. I learned something of value from every session, even those I had thought weren't going to be particularly useful. Much of what I learned applies to my non-EMS life as well, which made it an even more valuable experience.<br />
<br />
I was glad to see good attendance at the event from other folks in this area. Looks like my effort to spread the word was fairly successful. I sincerely hope this becomes a regular event.<br />
<br />
After an extremely busy weekend, between working, going to calls, and helping out with a benefit, on Monday May 21, we spent the day in Syracuse at a day-long EMS Seminar. Some good sessions there, including a fabulous one on Pediatric Cardiology that really needed about three weeks to cover everything instead of an hour. The presenter- Dr Harry Wallus- was great, and I now have a huge amount of information to do some follow-up research on. If I thought cardiology was fascinating before, pediatric cardiology is even more so.<br />
<br />
Also saw a presentation on new treatments for stroke that include a method to go in and remove a clot physically. Similar in some ways to placing a stent for a STEMI. Open up the artery, problem goes away. The best part is that there isn't the same time-after-onset limitation of tPA. Worst part is that it is still in the research phase, so it's not widely available. I hope they hurry up with that before I have a stroke.<br />
<br />
Spent Monday night trying in vain to catch up on some much needed sleep.<br />
<br />
Tuesday May 22, we spent the day at the <a href="https://www.facebook.com/pages/Albany-Med-EMS-Outreach/283468443427">Albany Med EMS</a> Teaching Day. More great stuff. They hosted a nice variety of speakers, gave out a lot of great door prizes, none of which I won, and even gave us a "goody bag" with a few things apparently donated by sponsors. They also had prepared a notebook ahead of time with the schedule and some of the powerpoint slides. Wasn't overly fond of the lecture hall, though. With all the construction going on up there, I hope they'll find a way to provide better facilities for the med school. They are doing some great work there, and deserve something that doesn't have the feel of a mid 20th century insane asylum.<br />
<br />
Here is the list of topics during that week:<br />
<br />
"My Fifteen Months in Baghdad" <a href="http://www.amazon.com/BAGHDAD-ER-Fifteen-Todd-Baker/dp/057806992X/ref=tmm_pap_title_0">Dr Todd Baker</a><br />
What You Don’t Know, Might Hurt Them! 15-lead ECG <a href="http://multileadmedics.com/www.multileadmedics.com/Welcome.html">Bob Page</a><br />
Use Social Media to Market Your EMS Agency <a href="http://everydayemstips.com/">Greg Friese</a> <br />
The EMS Mentor <a href="http://emtreview.com/blog">Dan Limmer</a><br />
How to Earn Your Flight Crew Wings <a href="http://flightsafetynet.com/">Troy Shaffer</a><br />
Say This, Not That | Critical Elements Of Patient Rapport <a href="http://theemtspot.com/">Steve Whitehead</a><br />
The Silent Majority: Geriatrics in the New Millennium <a href="http://www.romduckworth.com/romduck/ROM_DUCKWORTH.html">Rommie L. Duckworth</a><br />
Abandon The Ambulance This Is EMS In Remote Areas <a href="http://www.exmed.co.uk/">Jamie Todd</a><br />
Belly Busters: Abominable Abdominal Trauma <a href="http://www.romduckworth.com/romduck/ROM_DUCKWORTH.html">Rommie L. Duckworth</a><br />
Can Patients Survive Epinephrine After ROSC? <a href="http://roguemedic.com/">Tim Noonan</a><br />
Dazed and Confused: SNS Stimulation in EMS <a href="http://www.distancecme.com/index.php">Evan Feuer</a><br />
Granny Has A Fever: Sepsis <a href="http://ambulancedriverfiles.com/">Kelly Grayson</a><br />
EMS Changes <a href="http://medicscribe.com/">Peter Canning</a><br />
Cardiac Arrest Management Updates for the EMS Provider <a href="http://www.emsworld.com/contact/10342173/sean-kivlehan-md-mph-nremt-p">Sean Kivlehan</a><br />
Primary Coronary Intervention for Acute MI <a href="http://sjhcardiology.org/caputo.html">Dr Ronald Caputo </a><br />
Heartmate II: LVAD<br />
Evolution in Stroke Care Dr Michael Jorolemon<br />
Blue Babies: Critically Ill Children <a href="http://www.upstate.edu/emergency/faculty.php?empID=wallush">Dr Harry Wallus</a><br />
What's New in EMS panel<br />
Reducing offload time in ER panel discussion<br />
The Difficult Patient <a href="http://mariacollege.edu/news/charles-o%E2%80%99donnell-brings-a-lifetime-of-experience/">Charles O'Donnell RN</a><br />
Seizures/Epilepsy <a href="http://www.amc.edu/physiciandirectory/index.cfm?event=showPhysicianDetail&med_prof_rec_no=300">Dr Anthony Ritaccio</a><br />
LIVE Cardiac Cath <a href="http://www.capitalcardiology.com/delago.htm">Dr Augustin DeLago</a><br />
Designer Drugs Dr Tilney<br />
Trauma Notification/Communication Dr Tilney<br />
Trauma Case Review <a href="http://www.amc.edu/PhysicianDirectory/index.cfm?event=showPhysicianDetail&med_prof_rec_no=12173">Dr Daniel Bonville</a><br />
Pediatric Traumatic Brain Injury <a href="http://www.amc.edu/physiciandirectory/index.cfm?event=showPhysicianDetail&med_prof_rec_no=16062">Dr Christopher King</a><br />
Renal Failure and Dialysis Sue Fallone, RN<br />
Stroke Deborah Jewell, RN (Stroke Care Center Coordinator)<br />
<br />
Can't beat that with a stick!! Seriously.
Time for a nap now.
If you're near enough to get there, keep an eye out for the teaching days offered by both Albany Med and the folks in Syracuse (a joint venture between Upstate, Crouse and St Joseph's). Well worth attending, even if it's a bit of a drive.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com3tag:blogger.com,1999:blog-9081507935145885610.post-50954152064316939082012-04-18T16:20:00.001-04:002012-04-18T16:29:16.732-04:00Blood Pressure SimulatorHow cool is this?!!<br />
<br />
<a href="http://www.easyauscultation.com/taking-blood-pressure.aspx?gclid=CKnutOuZv68CFecSNAodtX8bwQ">Blood Pressure Simulator</a>, complete with case studies, lung and heart sounds.<br />
<br />
Don't miss the section on <a href="http://www.easyauscultation.com/lung-sounds.aspx">lung sounds.</a><br />
<br />
Came across it by accident while trying to find the video <a href="http://multileadmedics.com/www.multileadmedics.com/Stethoscopy.html">Bob Page</a> uses for his classes, about how to take a blood pressure. I'm still looking for that. Or I would be, if I wasn't distracted by playing with the simulator!Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com1tag:blogger.com,1999:blog-9081507935145885610.post-85784854182192838492012-03-22T00:36:00.000-04:002012-03-22T00:36:58.646-04:00Medical VideosInteresting resource. A <a href="http://emedicallibrary.blogspot.com/">blog of medical videos</a>. Some live, some animated.<br />
<br />
They didn't work for me using Safari, but did with Firefox, so be warned.<br />
<br />
The one I watched (the cardiac cycle) was not great, but might have a useful bit in it. I'm most interested in the site because it is actively updated, meaning more videos are added. Something to keep an eye on.<br />
<br />
It also suggests to me that there might be other such sites out there.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com1tag:blogger.com,1999:blog-9081507935145885610.post-31868950446065675712012-03-21T22:51:00.000-04:002012-03-21T22:51:02.490-04:00Albany Med EMS OutreachLoving the folks in Albany today!<br />
<br />
First, this morning they announced the schedule and topics for their EMS day during EMS Week.<br />
<br />
May 22nd, register by May 11th. $10 pre-registration fee.<br />
<br />
The Difficult Patient<br />
Brain Injuries from Sports<br />
Trauma Case Scenarios<br />
Seizures<br />
Stroke<br />
Live Cardiac Cath<br />
Airway A&P<br />
<br />
E-mail Art Breault at breaula@mail.amc.edu or Jessica Weir at weirj@amc.edu for more information and/or registration forms.<br />
<br />
<br />
And if that wasn't cool enough, this evening, they posted a link to join in a live EMS lecture on Toxicology, which was very interesting. They invite folks to join in these lectures every week- <a href="http://www.facebook.com/pages/Albany-Med-EMS-Outreach/283468443427">like them on facebook</a> to get the announcements and links.<br />
If you want, you can get CME credit for the lectures.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-73299473036835621172012-03-10T22:51:00.000-05:002012-03-10T22:51:48.908-05:00A Case of NervesPractical Exams.<br />
<br />
Why is it that nearly everyone gets nervous?<br />
<br />
For my first practical, back in my original EMT-B class, I was very well prepared. I had excellent instructors, and ample time to practice. We went through the stations the day before, to get accustomed to the format, and have a chance to go through practice scenarios. It went very well.<br />
<br />
In particular for the medical assessment, it went like clockwork. I walked in, was totally relaxed, went through the scenario without hesitation, without missing a beat. It felt great!<br />
<br />
The next day, the medical assessment was the fourth station I did.<br />
I walked in, and the moment I walked through the doorway, my mind went completely blank.<br />
Blank.<br />
<br />
I took a few deep breaths. Took a few more.<br />
I ended up doing just fine.<br />
<br />
The next time I went through a practical exam, I had prepared extensively on my own. I went through each station in my head. I focused my practice on going through the station the same way every time.<br />
<br />
When the day came for the actual exam, I started out the morning feeling okay, but as the day went on, I was more and more stressed. There was no particular reason, but there it was. I noticed everyone else was reacting pretty much the same way. The relief at the end of the day, when I passed everything, was tremendous.<br />
<br />
Since then, I've talked to quite a few people during the time they were studying and practicing for their practical. Nerves seem to be pretty much par for the course.<br />
<br />
But why? Why is that?<br />
<br />
Most people I know have been well prepared, and I know that they know the skills. Any trouble they have with the exam itself is more from the STRESS, than from anything else.<br />
<br />
One could argue that we often need to perform skills in stressful situations, so duplicating that for an exam is a good idea. But I don't think it's really done on purpose. I think the way it's designed, we should all feel confident and prepared and float through it, no sweat. But from what I've seen, most people don't.<br />
<br />
Maybe it's simply that it's so important to us.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com2tag:blogger.com,1999:blog-9081507935145885610.post-72404686442810137152012-03-08T21:35:00.000-05:002012-03-08T21:35:46.113-05:00Pertussis on the RiseNews articles are saying that pertussis is becoming more common. Most articles urge people to get their children vaccinated, but most current information also says that the vaccine is not 100% effective, and that it wears off, so most people over the age of 18 are not immune, even if they were immunized as children.<br />
<br />
I went looking for information about pertussis that might be helpful in the field. We aren't going to be treating it, but it would be good if we could recognize it, in order to both get that information to other healthcare providers for our patients, and to protect ourselves and therefore our families.<br />
<br />
First, there is a page that has an audio file, so you can recognize the <a href="http://www.pkids.org/diseases/pertussis.html">characteristic "whoop"</a> of the disease. That said, it's important to know that not all patients will have that symptom. Once you hear it, you won't forget it. If your patient sounds like that, it is a near-definite diagnosis, but if they don't sound that way, you won't know if they have pertussis or not.<br />
<br />
The <a href="http://www.cdc.gov/pertussis/">CDC has a whole section about pertussis</a>, and Wild Iris Medical Education has a <a href="http://www.ems-ceu.com/courses/373/index_ems.html">Pertussis CME class</a> online. You can read through the class for free; it's $6 to take the test and get credit. Both of those have an extensive list of references and resources.<br />
<br />
Medscape also has an <a href="http://emedicine.medscape.com/article/803186-overview">overview of pertussis</a> information.<br />
<br />
Hopefully, you won't run into it in the field, but as the number of cases rises, it's always possible.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com0tag:blogger.com,1999:blog-9081507935145885610.post-35139459997775218892012-03-07T00:15:00.000-05:002012-03-07T00:15:58.679-05:00The End of the SearchThe search was called off yesterday afternoon, when they found her body in a field not far from her home. <br />
<br />
<a href="http://www.facebook.com/actionalz">Alzheimers Association on facebook</a><br />
<br />
<a href="http://www.alz.org/research/stay_current/cme_videos.asp">Alzheimers Association CME videos</a><br />
<br />
<a href="http://www.medscape.org/resource/alzheimers/cme">Medscape's Alzheimers Disease CME Learning Center</a><br />
<br />
<a href="http://www.medpagetoday.com/Neurology/AlzheimersDisease/">Alzheimers Disease Information Center</a><br />
<br />
<a href="http://www.mycme.com/topics/alzheimers-disease/searchactivity/20/1313/">Alzheimers CME</a><br />
For MDs and nurses, but the information is still valuable<br />
<br />
I sincerely hope this never happens to anyone again.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com1tag:blogger.com,1999:blog-9081507935145885610.post-8900330530949402532012-03-05T16:33:00.000-05:002012-03-05T16:33:01.611-05:00That Search StoryWe were out searching for a missing elderly woman.<br />
<br />
Our search team was four people, and the area we were assigned to search was fairly large, so we split into two groups of two. Mostly, we were walking along a little used road, searching fields, ditches, and some woods. It was several hours past dusk, so we were working with flashlights and occasionally, vehicle lights.<br />
<br />
However. There was a complex of buildings that were in our area, too. One building had signs on all the doors, indicating it was unoccupied and unused. The entire complex had been "abandoned" a few years back.<br />
<br />
My partner and I had the buildings to search, so we split and went around each one, one going clockwise, the other counter-clockwise, until we met on the opposite side. Most of the buildings were, in fact, abandoned and locked up tight.<br />
<br />
But not all of them.<br />
On my search, I found an open door.<br />
It opened into a boiler room. They were working, and the small room they were in was very warm. Nice, considering it was cold and snowy outside. A perfect place for a missing/lost person to get in out of the weather. The problem was that the boilers sat in the middle of the room, and I couldn't see all the way around them. I didn't want to go in the building by myself to check around the other side, without my partner knowing where I was. So I didn't.<br />
<br />
I continued on around the building until I met up with him, reported what I had found, and we went back to the open door.<br />
<br />
On the other side of the boiler was another door, one I hadn't seen. It was labeled "Lady's Room" <sic>. Kind of odd, for a door leading out of a boiler room.<br />
We opened it.<br />
It was, indeed, an old (but apparently no longer functioning) restroom. With lockers.<br />
And another door.<br />
My partner searched the rest of the bathroom, while I opened the door.<br />
<br />
The door opened into a hallway leading to the rest of the very large building.<br />
All I could see from where I stood was a long hallway in one direction, several connected hallways the other direction, and lots and lots of open doors.<br />
<br />
I chose to do a right hand search; my partner took the left hand search.<br />
<br />
And that is when things started to get weird.<br />
<br />
Down my hallway, the rooms were all very similar.<br />
Not being used, but not empty, either.<br />
Each was about ten or twelve feet square, with no windows. Most had utility sinks. A couple had desks, some had lab cabinets and counters. Most had various containers and junk scattered around.<br />
As I continued down the hallway, the last several rooms were empty, and had some sort of exposed pipes. Gas pipes? Water pipes?<br />
<br />
As I reached the end of the hallway and turned around, I saw a sign. There had been no signs going the other direction, but if I had come in the door at the end of the hallway, I would have immediately seen the sign that read "Infectious Agents. No children or pets past this doorway."<br />
<br />
Crap. What does that mean?<br />
And why did the very next room have a desk with a gas mask on it?<br />
And the next, some sort of stainless steel tables, and a bunch of oxygen bottles? Blood stains on the floor?<br />
<br />
What IS this place?<br />
<br />
I met back up with my partner, and told him what I had seen, and that I was kind of creeped out. We had been in the building maybe 5 or 10 minutes, out of communication with our other pair. When we not only saw more hallways full of doors, but a door that opened to stairs, we decided to get outside, find our other team, and finish the search as a group.<br />
<br />
They met up with us as we walked out- they had tried to reach us by cell phone, with no answer. No cell signal inside the building. We gave them a report, of what we had done so far. The crew chief called in where we were and that we would be investigating, we went back in, and split up the rest of the building.<br />
<br />
My next find, near the base of the stairs, was the first aid station, with the MSDS sheets for all chemicals in the building, and a box on the floor labeled "Emergency Kill Box." There were containers with kits in them that looked to be atropine. (Surely those rooms weren't set up to... gas the occupants??)<br />
<br />
The last room was a kitchen and laundry area, with refrigerator and washers and dryers still in place, but not connected.<br />
<br />
The whole place looked for all the world like something out of a horror or disaster movie, that had been abandoned in a hurry, everyone just up and leaving. I half expected to find an unfinished plate of food still on the counter, or a television that was still on. I was imagining the Andromeda Strain. I was picturing clandestine operating rooms for illegal human organ trafficking.<br />
<br />
It was creepifying. Seriously.<br />
<br />
Dark, silent except for the hum of the boilers, and the footsteps of people going room to room, searching. Lit only by flashlights. (Didn't even think of trying a light switch! For all I know, the power was on.)<br />
<br />
Clothing on hangers and in piles, left behind. Printed out e-mails taped to the wall behind a desk, as if someone had worked there only yesterday. Painted cinderblock walls, and glossy painted floors, all the easier to wash clean with a hose, if need be. But nothing, anywhere, alive. In the middle of the night, it doesn't take much to get the imagination going. I had the feeling that if we went back later, it would all be cleaned out, nothing left behind, no evidence of... whatever went on there that no one was supposed to know about. Right out of the X-Files, or the Twilight Zone.<br />
<br />
The truth is, we knew what the building had been. A research lab that had closed a couple of years earlier. No big secret.<br />
<br />
But if I ever wanted to film a horror movie, I know where I'd go. It was PERFECT. You could almost hear the soundtrack.<br />
<br />
Looking back on it a couple of days later, I wish I had put the gas mask on, wrapped a coat around myself, and jumped around the corner to scare the crap out of my partner. He was making fun of me for being creeped out.<br />
<br />
He said it was good that I didn't, because he might have called a Mayday before recognizing me. I asked him what he would have said. Name, yes. Location, sure. Problem and resources needed?<br />
<br />
He said he would have said "Being murdered."<br />
<br />
As creepy as the place was, I wish we had found the missing woman there.<br />
We didn't.<br />
She still has not been found.<br />
It doesn't look good.Linda Wyatthttp://www.blogger.com/profile/15502645664373341448noreply@blogger.com1