SonoOpinion: Does absence of cardiac activity predict resuscitation failure? #FOAMed

Categories: EMS Mastery

Writing Contest Winner — THE LANGUAGE OF MIDNIGHT, by Nancy Gwillym

September 21, 2015 1 comment

I am pleased to announce the winner of Paramedic Mastery Blogs writing contest. The winner is Nancy Gwillym from Brooklyn, NY.  This story tells the unique story of life in EMS on the Midnight tour. Congratulations Nancy.  You have won a HD Action Cam Digital Video Camera.

THE LANGUAGE OF MIDNIGHT – 

The elderly woman leaned on her cane and with her other hand shook her fist at me yelling that not only should I die a slow miserable death but so should my parents who were responsible for bringing me into the world. In her flowery summer dress on this hot summer night she, in many ways, resembled my sweet, late grandma with her grey curls and large glasses. She could have been anyone’s grandmother, standing at the corner bus stop trying to catch the last bus home in time to watch some late night talk show. And here she was yelling expletives at a small paramedic over loud diesel engine noise.

What was the great infraction that warranted this unsolicited criticism? My ambulance was parked in her bus stop and when she had demanded I move it I told her that although we would be quick, we had a critical patient we needed to stabilize first. To be fair this may have been insulting in that we told her what she already knew- she had been standing at the bus stop and had watched all the emergency personnel bring up the bloody mangled body out of the subway station adjacent to her bus top. I was exhausted, sweaty and dirty after carrying our man (along with several pieces of bulky equipment) up the stairs in the hot sauna of the NYC subway system in July. Now being berated by an angry bystander who cursed like a sailor, I was drained both physically and mentally. I asked if she was going to let the police and firemen, who whose vehicles were also in the way of her bus, know how she felt as well. That’s when granny spit out the “F” and the “C” word at me. I guess I just have one of those faces. The darkness of night brings out the best in people.

Anyone who works the overnight has, in some way or another, belittled the work environment of the day people. We’ve mocked, however insignificantly, their endless runs to clinics and schools, the traffic, the crowds and all that incessant ambient noise. We’re inwardly proud of the way we can do things they do while fighting our circadian rhythm. We haven’t changed or adapted our sleep cycle, no one really can, we just deal with it- a happy trade-off to emergency medicine done under the romantic glow of moonlight. Everything at this hour is more intense, more angry, more honest. It feels as if people tend to show less restraint, more emotion. It’s not always a good thing. But the dialog is often entertaining.

After our train job we went in search of refreshment, We worked in one of the highest crime areas of Brooklyn. A major disappointing factor in that is that there are no decent places to get even a snack when it gets dark out. Most of the high end choices for us were found in places attached to a gas station. We lingered around the extensive convenience store selection of power bars when a commotion was heard outside.

“Shot Rings Out!”

“Two shots were suddenly heard and my partner and I made sure to stay behind the flimsy metal shelving. It was a weeknight and late but it was hardly an anomaly.

We called for assistance on the radio and when it all seemed to calm down a few minutes later, we left the safety of the candy bar aisle for the uncertainty outside. In the middle of the street lay a large man on the ground. He was in between street lamps and it wasn’t easy to make out much except for his size. He was the only one not running around so we started to head his way. Before we got there a door opened and made an audible slam. A large woman, clad in neon yellow active-wear, an ironically smart fashion choice for this darkness, ran into the street towards the man between the street lamps. She was mumbling mostly to herself “Oh-my-god-oh-my-god-oh-my-god.” We were approaching the man at around the same pace but she got there first and threw herself upon him. “Baby! Was you shot? Oh my God you is!” Holy shit! Now, now Julio,” she said, “Whatever you do, don’t panic. You got to be STRONG. You hear me? STRONG! Just like I was when I was shot, just like Uncle Joe was when he was shot, and also like my father, you know, when he was shot. Even though he didn’t make it he was strong right up until the end. Now its your turn. You gotta represent the family. You gotta be STRONG!”

We interrupted the inspiration speech and asked Julio where he was shot. “My arm” he said. We checked out his left upper arm with my partners flashlight and indeed, there was a little bullet hole near his shoulder with some minimal blood. I asked if he had gotten hit more than once. He shook his head and started to cry. Typical thug. I sighed. I’m sure I rolled my eyes. Here was this big tough guy laying in the street, crying. I was embarrassed for “Gangsta” culture. A quick cursory once and twice over with the flashlight and palpation revealed nothing else. He completely ignored us cutting clothes and touching him as he spoke to his family member. My partner, a man of few words, gave me the nod and went to move our ambulance as I took his pulse. I tried to solicit some information from Julio who continued to ignore me for the most part, trying to tell his family member who he needed to talk to in terms of vengeance, I surmised. The woman, thankfully, told him not to worry about all that at that moment, that the most important thing was remaining STRONG.

She turned to me with great concern and sternly said “You ain’t takin’ him to no Woodhull, are you? You can’t take him to Woodhull. They’re the ones that killed my father. You CAN’T take him there.” Woodhull wasn’t a trauma hospital and not even a consideration for us so I assured her that no, we wouldn’t be taking her to the hospital that had apparently “killed” her father. She turned back to Julio, “Get through this, you gotta get through this. Help the lady out, she asking you questions she gonna need to tell the doctors. Talk to her!” she said. He made a face that clearly indicated this was not his priority. My questions about his bullet wound, now that the tears were dry, were more of an annoyance. “Please, all my shit is in my wallet, in my pocket” he told me and then went back to telling the woman who she needed to contact. I went through his front pocket and found his wallet. His pants were super tight and it took me some time to wiggle it out. I opened it up and found his Medicaid card and some kind of ID for a school bus operator. One of them gave me some pertinent information which I scribbled on my glove. I struggled to squeeze the wallet back into a pocket it didn’t seem big enough to fit in and then thankfully my partner pulled up with our truck. I asked him for some medical history and he seemed to be annoyed that I was interrupting his conversation.

After a few of the standard questions about medications and surgeries he turned, exasperated and said “Bitch” though not in any kind of derogatory manner, really. It seemed more of his way of addressing females he was not familiar with. I didn’t take it personally. Sometimes its an accurate term, I suppose. “Bitch, it’s all in my wallet everything you need to know.” He became impatient and told me to get his wallet already, what was I waiting for? A small alarm went off in my head recalling how difficult it had been to remove and then replace his wallet into pants that were straining with the bulk that was already in there. I went over to his leg and gave it a little squeeze. Nothing. “Did you feel that?” I asked. He looked at me confused and it didn’t seem to click for him what was going on. I squeezed again. Nothing. Great. Let’s check out this little bullet hole one more time. His arm was rather large and very soft and fleshy. When you first looked at the hole as he lay on the ground and his arm was pressed against his body and the ground, if you looked directly down on it, it would have appeared to be the front. But if he had sat or stood up and gravity had let everything fall to its usual placement the hole would have been more to the side. And at the correct angle, that wasn’t evident during our initial assessment, there a clear path for the one single hole to point towards his spine. There was no exit wound. The bullet could have been anywhere. And before it stopped it had transected his spinal cord. He’d probably never walk again. It looked like he really did have something to cry about in the middle of the street. I guess the cursing would happen later.

The sun began to rise a few hours later and we handed off our radios and equipment to the incoming relief shift. There was a third person with them, a new intern riding with them for the day. (This was yet another perk denied to those of us at night.) The well rested trio smiled at us and asked us how the night went. “Get anything good?” one asked. “Some old woman yelled at us. You’ll probably read about it in the papers,” my partner answered with a wry smile. The older of the day shift crew shook his head and with a wry smile of his own turned to the intern “These guys who work the overnights are just different. One of the first things you will learn out here is that nothing good ever happens after midnight. But these two, they seem to like it.”

Categories: EMS Mastery

Thank You to My Readers on the 14th Anniversary of 9/11!

September 7, 2015 2 comments

“How Did I Move Forward From the Loss of “That Day?”

I appreciate my subscribers to http://www.ParamedicMastery.com.  This week reminds me of the great people I have worked with in EMS, many of which are still good friends.  As this week starts our brothers and sisters are changing their Facebook Profile pictures to flags and eagles.  It is great to see that people remember and will not forget.  EMS is really about the community and those we work with.

We should care as much for the person next to us,as the patient on the stretcher.

September 11, 2001 was a huge disaster which stopped New York City, the United States and most of the world for a few days. The magnitude of the disaster was huge; 7 buildings, 2 airliners, 10 EMTs and paramedics, 343 fire department members, 79 police officers and some 3,300 civilians. When the disbelief turned to acceptance the struggle was to understand the parts the stories, the events and the whys.

Especially for me the information was important.  I went down to the World Trade Center at 1:00 pm on 9/11/01 and did not go home until 3:00 pm on 9/13/2001.  We were in news blackout working hour to hour, bucket to bucket, hope to hope. In the years since I have transitioned from understanding to asking myself, “How do we move forward, not forgetting, but not stuck in the moment.  I vividly remember nights at Ground Zero with the American Flag hanging above the Pit.

Call to action: Please leave your American flag out the night of 9/11, well lit, to honor the emergency responders and military who have given so much on 9/11 and in the years since.

I enjoy doing acts of kindness and generosity in the name of EMTs that died on 9/11.  Somehow, this helps me and makes me feel good about the loss on 9/11.

I have been giving a presentation that called, “After The Siren Stops, Taking Care of our Own.”  I have received excellent feedback on this lecture.  As many of you know I have written the only EMS Book about September 11, 2001 in the world. The Downwind Walk: A USAR Paramedic’s Experience’s after the Terrorist Attacks of 9/11.

I will continue to teach EMS the lessons of 9/11 and how to take care of our own. I plan on speaking at conferences next year and doing book signings.

To show my appreciation to my subscribers I plan to do the following:

  • Ground Zero Tours: I am available for tours around Ground Zero and New York City for EMT’s and Paramedics who are visiting The City. E-Mail me for details.
  • I am planning on recording a book reading this week about what it was like on 9/11/01 to 09/12/01 at Ground Zero, excerpts from my book. I will post this on my web site. http://www.paramedicmastery.com for free.
  • I will be scheduling lectures around the country and world in the next couple of years as we approach the 20th anniversary of 9/11 to share the EMS lessons of 9/11, the great people we lost and how to take care of our own going forward.

Please e-mail me @ StevenKanarian@Gmail.com  if you are interested in a tour in The City or sponsoring a book reading/ signing.

Have a great week as we approach September 11 2014.  Honor those EMTs and paramedics we have lost through your caring and professionalism.   Do something in name of a person who died on 9/11, through you they will live on.

Travelling Is My Passion

Well travelling is one of a my passions at least. I  love living, dining and travelling.  In a nutshell I enjoy living life and experiencing the world.  Through travel we can meet new people and see interesting things.  Sometimes travel gives us a break from everyday life, other times travel gives us a comparison so we may appreciate what we have.  Often i feel travel gives us perspective on our lives and helps us see what is really important.I want to start this blog so I may highlight the great people I meet on the road and the best experiences I find so you too may enjoy  life and all the treasures the world offers.WP_20150325_15_16_22_Pro

Contest For My Subscribers – Free HD Video Action Cam

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I appreciate the fan base that reads my blog.  I have a HD Action Cam with digital video (value $100.00) I would like to give it away in a contest.

The contest consists writing an article for my blog with the theme Nothing Good Happens After Midnights.  Write a story about a call you had that meets the requirements of being Nothing Good After Midnights. The article length should be about 500- to 700 words.  You can include a picture of yourself if you like. Please include a short description about your level of training, and what your career goals are. This is a great way to get started as a writer. I will be glad to give a reference for the aspiring writer that wins.

All submissions need to include a statement in your e-mail that I have permission to publish your article. All submissions will be judged on the story,and its meeting the theme of the contest.

Contest deadline is April 15, 2015 at Midnight.   I wish each of you good luck.  I am glad to be giving back to my blog followers.E-Mail submissions to StevenKanarian@gmail.com, Title- Contest Submission.

Good Luck, Good Skill.

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Fit For EMS Bit By Bit

January 22, 2015 1 comment

http://youtu.be/bKmbPu3UfXM

Like many EMS professionals I have struggled with getting in shape.  Hell, it is hard even to set a routine for exercise when you are doing s shift work and overtime.  Our eating habits are not always the best either. How many times have you brought food only to succumb to the smell of fried food when tired or stressed out?  True there are those that set aside time to run, lift weights and eat right, but they are in the minority in EMS and the general population.

I can remember those times I was exercising or bike riding and found the job more enjoyable.  Above all EMS providers need to have tone to lift people and a diet that keeps our blood pressure at acceptable levels.

After being threatened by my doctor and him listing the risks of being overweight,  bought a Fit Bit for myself this Christmas.  I am pleased to see how much activity I get during the day walking around from location to location at work.  By walking for 45-90 minutes a day I have been racking up 4 to 5 miles and feeling more fit.

There is more to getting in shape than walking. What successes or challenges have you had getting in shape while working in EMS?

How To Become A flight Paramedic, Interview with Jason Hums, MPH

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