Thursday, November 15, 2007

Wet Weather

Today was an especially wet day in this part of the world. It wasn't especially cold, but we got a good amount of rain. It's since stopped, and the temperatures are dropping slowly. The last weather forecast I saw said that we're supposed to start getting cold temps again. All things considered, I have no problem with that. After all, it is November in New England, Thanksgiving is a week from today (my God, time flies), and it is supposed to be how it is right now: cool, raw, and damp. As long as I don't have to go outside naked, I'm fine.....

Today wasn't a high-volume day, at least for my partner Marc and me; we only did 4 calls. Three of them happened during the last half of the shift. Our last one is actually rather notable: a 34 year-old male, known to us, a Type I diabetic, a number of psychiatric issues, and blind. Had a hypoglycemic episode. He was supposed to meet members of his family this afternoon, and when he didn't show up for whatever it was they were doing, his family got concerned when they tried to reach him and couldn't. So they called his caregiver, who went to his apartment and found him on his bed, respirations snoring, unresponsive, and soaked. She called 911, and we got an engine company that got there before us. They checked his blood sugar and got 43. One of the crew members is an EMT-Intermediate, and when we got there he was attempting to get IV access with not a lot of success. Mike, my medic student, was with us, and he did a nice job taking charge. He wanted to give the patient Glucagon, which we carry. Glucagon is one of the two hormones that the pancreas secretes, the other being Insulin. The rationale here is that even though Insulin isn't being secreted, it's still possible to get Glucagon into the body to start working on the glucose stores in fat. So we gave him 1 mg of Glucagon while we still hunted for IV access. Once we were able to get access, we gave our patient 1 Amp of D50, which started to wake him up. When we re-checked his blood sugar about 10 minutes later on board the ambulance, it was up to 85, which is in the ball park. Certainly it is better than being in the 40's. He was having some other problems, though; he had a soft blood pressure at 90 Systolic, and his oxygen saturation levels were only at 88-89% on 4 liters of oxygen. So we treated both, with a non-rebreather and a fluid bolus. By the time we got him to the hospital he was awake and talking to us quite coherently. I couldn't ask for more than that.

To address a question I noticed from some of the commentary posted, I was asked about CCEMT-P programs and where they are taught. Probably the best place to check for course locations and dates is at the website of the University of Maryland at Baltimore County. They have a comprehensive listing of courses, locations, and course costs. And UMBC's CCEMT-P program is the gold standard for critical care transport for Paramedics. The curriculum is offered at a number of places - Medical College of Georgia Center for Operational Medicine, where I was, probably is among the most economical at a tuition rate of $800.00. Quality of education is dependent on the abilities of the faculty, the resources available, and whether or not the teaching is dynamic. The other part of this is dependent of the learner; you have to really want to be there to get the most out of the course. Plus, once the certification is in your possession, you have to consider the continuing education requirements: 36 hours over 3 years for CCEMT-P's, 100 hours over 4 years for Flight Paramedics who have the FP-C designation.

As far as I'm concerned, it's worth it.

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