All or Nothing

It's an odd thing out here.

It seems like the calls happen either when we're all out here, available to respond, or when none of us are.

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.

I wish there was a way to make that balance better.

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.

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.

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.


Strange.

What 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.

He pointed out that attending a training conference is, in part, a decision based on ethics.

What?

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?

And boy, did that hit one of my triggers.

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.

I had an instructor tell me not to worry about it, that if I didn't go, "someone else would."

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.

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.

Consider this last academic semester.
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.

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.

But a couple of months ago, two of us went to a training conference together.
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.

Can an agency provide effective EMS with only two responders? Or one, much of the time?

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?

The answer MUST BE that no, we cannot be expected to bear that level of responsibility.
And yet...

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!"

I don't see a solution.

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.

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.

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.

If we don't, the simple truth is that people will die.

Maybe even me, if the other 2 EMTs aren't home.

This is not only a national problem, it's very much a PERSONAL one.

Day Two: Still Not Dead

Two posts in a row! Woo hoo!

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.

There are a lot of parts to this.

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.

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.

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.

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.

I'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.

A lot has changed in the past few years.
A lot hasn't.

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.

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.

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.

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.

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.

So...
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. :-)

Coming Out

Remember dragnet?

"The stories you are about to see are true. The names have been changed to protect the innocent."

About that…

Recently, I made the decision to include my :::gasp!::: real name on my blogs (of which I write several, on different topics).

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.

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.

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.

I'm pretty comfortable with my decision, largely because I don't post stupid stuff online that would cause me, or anyone else, problems.

But just in case it worries anyone, I thought I'd make a brief (ha!) post about it.

HIPAA.

Yes.

That.

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.

My stories are "loosely based" on real stories, in the same way many movies, TV shows, and novels are, with one important difference.

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.

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.

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. 

That is what I try to do.

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.

So I make a lot of changes.

I change ages.

Change locations.

Change seasons.

Sometimes, I change genders, but not always- because if I always did, that would be the same as never changing!

I may add, or take away, family members.

I may add, or take away, pets.

I may add in specific details that weren't actually there.

I may even change the medical condition, or the signs and symptoms, sometimes almost entirely. Often, they aren't the point, at all.

Sometimes I combine several stories into one, as if they all happened to one person.

I never post about anything close in time to when it happened.

I live in a small town.

Tiny.

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.

It is not possible to read any of my stories and identify any specific person or situation.

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.

Just sayin', in case anyone plans to go all HIPAA on my ass, or something.  :-)

Snowstorm

She died of a snowstorm

each breath

blowing drifts across the road

her broken heart
even slower 

than the ambulance could travel

too late

to shock her back

Wishful Thinking

I've learned a lot from being involved in Emergency Services.

One of the things I've learned is that most people OUTSIDE emergency services have absolutely no idea what we do, how, or why.

Many of them don't WANT to know. Too scary.

They just want to be able to call 911, and have someone come solve their problem for them.

That sounds good to me.

Or it would, if it really worked that way.

There are two separate problems, which often overlap.

One is a lack of understanding, and one is a lack of resources.

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.

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.

Here is my wish list:

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.

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.

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."

I can't make these things happen.

I CAN try to have some beneficial influence where possible.

I teach a class I call "functional first aid."

It provides no certification.

It has no set curriculum.

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.

There may be people with chronic medical conditions.

There may be someone who works with a population that has a higher risk of certain kinds of illnesses or injuries.

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.

We put a priority on early recognition of true emergencies, and on self-reliance for as much as possible.

I also teach people HOW to call 911, not just when to do so.

Most people don't know how that all works, and can be hesitant to call when they don't know what to expect.

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.

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.

I don't think I'll ever run short of things for my "wish list."