Saturday, June 21, 2008

Time To Do A Little Bit of Writing....

It's been nearly 10 days since my last entry. However, I have a valid excuse. I've been extremely busy - I've started the new job, plus we've been packing up the house for the move this coming Thursday. So at least I haven't been a total slacker.....

I got through orientation this past week at Cataldo. It was pretty grueling, just like the pre-hire stuff. But I got a lot of great information. Plus, I took the Massachusetts credentialing exam for regions 3 and 4. It wasn't horribly difficult - certainly not as bad as their pre-hire written exam. Nonetheless, I still had to think. And most of the time when I think, absolutely nothing happens.

Ride time starts this coming Monday. I have to do 96 hours spread out over 6 16-hour shifts during two weeks. It shouldn't be too tough; at least I hope not. I remember when I did my ride time for RRA; it was all on transfer trucks, and it wasn't bad, but I remember asking the question why none of it was on a 911 truck. Nobody could give me a good answer for that at the time. Now, everyone does at least 2 shifts on a 911 truck there. On the other hand, I will do all of my ride time on 911 trucks, between Malden and Everett. It is likely that my regular shift will be in Boston, working on one of the dedicated transfer trucks. That was of my choosing; it's not that I don't want to work on a 911 truck, but I figure I can do more good on a CCT truck, given the background with critical care medicine that I've gained over the past year or so. And it's what I want to do.

I remember there was a day that I would have given anything to do 911 shifts only. However, since then my views have moderated considerably, and I am certain of a couple of things that I wasn't even aware of when I first started doing this:
  • First, all transports, whether it's a transfer from hospital to nursing home, an inter-facility hospital transfer, or a 911 transport, it doesn't matter - they all boil down to the same thing. It's about a patient who needs to be taken care of from point A to point B.
  • Second, the vast majority of "emergency" calls are not emergencies in the traditional sense. We get a large number of "unknown medical" calls, "sick person" calls, and "psychiatric problem" calls that are not true emergencies. That doesn't mean these people don't need help - in fact, they are probably more in need of help in some cases than those who would qualify as "true emergencies." But those truly emergent calls are really low in number in comparison to those that aren't.
  • Third, if I'm transporting a patient from one hospital to another because there are services at the receiving hospital that the patient needs, chances are that the patient is really, truly ill or has injuries that can't be fixed at the sending hospital. A good example of this is the young lady I took from Concord Hospital to the MGH in Boston recently. She was in deep trouble in terms of her injuries, and she needed services that weren't available in Concord. And she was messed up enough that she really should have been flown, but for some reason the birds weren't flying that day.
  • Finally - and this goes along with my previous point - the sickest people I've ever taken care of weren't those I got on a 911 call. They were patients going from hospital A to hospital B for whatever reason. Probably the worst one of these I've ever had was an 11 year-old male involved in an MVC. His mother was driving, and they were hit head on by a dump truck. Guess who lost..... Anyway, we took the boy from the Elliot Hospital to DHMC in Lebanon. He'd been intubated on scene, and his injuries included a lacerated spleen and fractures to C2-C5 plus a femur fracture. The major complication was a head injury that showed a sub-arachnoid bleed on a CT. And again, for whatever reason, nobody was flying that day.... I had a nurse and a respiratory therapist in the back of the ambulance with me for that trip. It was probably the scariest 70-80 minutes I've ever had as a medical provider, as he started to buck the tube about halfway to Lebanon. So he got Versed and Fentanyl to help put him back down. In any case, he ultimately survived his injuries. His mother, unfortunately, did not; she died later on that day at the Elliot. I don't know the extent of her injuries, but they were obviously severe enough that she couldn't live with them.
I will write about the things that happen as they happen, or soon afterward. Plus, I still will work shifts at RRA once I'm settled at Cataldo. That should happen within the next few weeks.

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