Reader Meter

Nearly a year ago, as I was sharing supper with The Lovely Helen at a beer-and-burger pub on the outskirts of Music City, we started getting all dewy-eyed about our early EMS careers as partners, best friends and late-night revelers. I asked my wife of six years if she remembered her first call. She did: a hanging in 1996 that her preceptor (not me) wouldn’t let her observe because he thought it might upset her. Without thinking, I said something like, “That was nice of him.” Big mistake. Helen gave me one of those “Are you crazy?” looks, then told me how angry she’d been at being excluded.

On our way home I shut up and counted my blessings:

1. I hadn’t been the FTO on that call.

2. We’d just enjoyed an evening together, despite Helen’s claim she doesn’t go out with married men.

3. I had a fresh idea for a column: Ask readers to describe their first calls, then print the best of them.

By the next morning, I’d decided to expand the scope of my survey to include reader feedback on any of the following:

• Your first EMS call.
• Suggested improvements to prehospital equipment.
• What you’d do differently if you could start over in EMS.
• Something you learned during the past six months that made you a better practitioner.
• Your favorite EMS memory.

You responded to my May request with lots of provocative comments and entertaining stories. Rather than exclude good material, we decided to make this month’s Life Support a two-pager. Hey, you’ve spent almost three years listening to me; the least I can do is return the favor.

First Call

Forty-five minutes into Lindsay Muirhead’s first shift as a paramedic, her 85-year-old patient arrested during transport. Muirhead slammed the head of the stretcher back to start CPR. “The patient converted back into a sinus rhythm, and all this brown stuff came out of her mouth,” the Washington, DC, native says. “I think she might have choked on her chew.”

Amanda Armstrong was a new EMT in rural Alabama, assisting on a transfer to a metropolitan hospital. “I started feeling flushed, dizzy and faint,” Armstrong recalls. At the hospital, her crew suggested she might have motion sickness. “Sure enough, that’s what it was. At first I was worried if I’d be able to do this job, but I’ve adapted pretty well.” Now a paramedic and FTO, Amanda tells rookies, “If you can drive me and not make me sick, you can drive anyone.”

A month after New York EMT Sheryl LaDelfa told her cardiac patient, “This is my first official EMS call,” she met him at a party. He confided, “When you said it was your first call, I just knew I was going to die.”

Martin Hernandez did his first call with an EMT-I “who thought he was God’s gift to EMS.” After a transport from McAllen, TX, to San Antonio, the Intermediate informed Hernandez, “You’re driving back home. I’m going to sleep on the stretcher. If I wake up with any movement, it means your driving sucks!” He also announced, “If I tell (the boss) to fire you, he will!” Twenty years later, “God’s gift” approached Hernandez about a job. “I told him to fill out an application like anyone else,” Martin says.

John Spicuzza’s first call as a paramedic—a cardiac arrest with ROSC—was going well until it was time to move the patient to the ambulance. “First I tripped over my own IV line and pulled it out while we were walking downstairs,” Spicuzza remembers. “Then we outpaced the EMT bagging the patient, causing my tube to come out. That wouldn’t have happened if I’d taped it right. Oh, and the EKG leads came off, too. We had to redo everything at the bottom of the stairs.”

Making It Better

Improving the ability to diagnose MIs in the field is on Hernandez’s wish list. “I’d like to see cardiac enzymes and basic metabolic panels added to our standard of care. Those tools exist, but they’re expensive.”

Armstrong wants more flexible hardware and software. “It frustrates me that my LifePak won’t sync to my tablet, and the LifePak cables won’t connect to a Zoll,” she says. “Also, I shouldn’t have to pay thousands of dollars to pull custom reports from our PCR database.”

Paramedic Charles Herbert of West Bangor, PA, wants “a magical device that will carry our patients for us…wait, that’s a firefighter!” Charles says he’s kidding, and would be happy with safer ambulances.

Do-Over

Paula Miller, a Pennsylvania RN and PA, wishes she’d started in EMS earlier. “The guys from the ambulance corps who came to talk to our (high school) health class had a bad reputation,” Paula says. “My mother didn’t want me to join. It took me another six years to volunteer.” Miller also would have preferred more training in emergency-vehicle operation. “I just showed up one night and was told to drive the ambulance. Afterward, it took me about four tries to back it into the garage.”

College would be a higher priority for Armstrong if she were starting over. “I really wish that between EMT and medic school, I’d taken all the other requirements for the associate’s degree in public safety,” says the Escambia County, FL, medic. “Now I recommend a degree to all my EMT students.”

Herbert would have applied to medical school sooner: “I had an epiphany last week after dropping off a patient and explaining to the doc-ling how to manipulate the ETT with the GlideScope.”

Lessons Learned

“I’ve been repeatedly amazed and humbled by my junior volunteers,” says Miller. “If you think the youth of America are going downhill, you’re dead wrong. I’ve seen 14- and 15-year-olds do excellent CPR, put anxious patients at ease and communicate effectively with the hospital. These kids suck up knowledge like vacuum cleaners and are so willing to help, even with the less glamorous aspects of EMS. I only wish more of our adult volunteers had similar attitudes.”

Delaware paramedic Robert Sullivan questions how we handle pain management in the field. “Instead of trying to decide if patients are in enough pain to get fentanyl, now I simply ask if they’d like some.” Sullivan prefers administering analgesics before, rather than after extricating patients in severe pain. “It’s a little more work and takes a little more time on scene, but I’ve found satisfaction in helping people feel better.”

Herbert echoes what many of us have learned: “Sometimes less is more.”

Good Memories

Herbert’s favorite memory? “My first arrest save. Our patient was having the big one and went into VF. I grabbed the paddles, but I wasn’t cleared to do that yet. My partner took over, zapped the patient at 200, and he woke up. He stalked us for two weeks to thank us.”

Vermont RN and former EMT Patrick Delaney almost became a patient on his most memorable call. “I was responding from across campus on my bike,” Delaney writes. “I knew I had only three minutes before the ambulance would leave. I was pedaling so hard, I nearly went past the station. I jumped off the bike and did a full face-plant in front of the ambulance. I regrouped so fast, the crew chief thought I’d slid under the truck and come out the back. That’s how I got my nickname: Skid.”

A chance meeting at a hospital gave John Spicuzza something to smile about. “I held the door open for a family leaving after visiting hours. One of them—a middle-aged woman—got all excited when she recognized me, then told her family I was the medic who’d saved her husband a few days ago. The guy had been in cardiac arrest. He was doing so well, they expected him to be discharged in about a week.”

Hernandez would prefer to forget one of his “stupidest” calls. “It was an OB patient I had as a basic,” the paramedic/RN narrates. “She was crowning, and it was just me in back. The mother was on a non-rebreather, but I wanted to make sure the baby got oxygen too, so I got a pediatric NRB and put it right over the mother’s vagina. Both patients did fine, but it’s a good thing I had only one portable O₂ tank.”

Illinois paramedic John McReynolds tells us about a special patient he transferred many years ago: “She was about 90. As I entered her room, she said, ‘Tommy, I’m so happy to see you.’ I’d never met her. I knew she had dementia, so I introduced myself and told her we were taking her to a local nursing home. She said she’d be happy to go anywhere with me, and she missed not having seen me ‘in ages.’ Once we were underway, she reached across the bench seat, took my hand and said, with such a sweet look in her eyes, ‘Tommy, I just want you to know how proud I am of you.’ I sat there and fought back the tears as I accepted praise for someone I wasn’t. All I could manage was, ‘Thank you.’

“As we said good-bye at the nursing home, my little old lady said, ‘I love you, Tommy. You’ve made me so proud.’ The rest of the day I don’t remember. This is the first time I’ve shared this story.” We’re glad you did, John.

Thanks to all of you for your support. Have a healthy, safe new year!