Deja Vu

I ran a call yesterday--a priority black cardiac arrest. There really wasn't much to do by the time we arrived on scene. The medic unit was already placed in service, and we ran a strip just to confirm asystole; not a surprise really, given that we had a 15 minute ETA to the scene and the estimated down time was close to 30 minutes or more by the time we arrived.

But what threw me on that call more than anything else was a missed turn on the ride back to the building. Lost in conversation about the call, we missed the road for the most direct route back to the building, so we continued on down to find the nearest driveway to turn around in.

It was pure luck that I looked out my window as we pulled out away from the driveway to head back down the road, and I gasped at what I saw. An eerie feeling made its way down my spine. There was a black fence at the end of the driveway, with horizontal three slats, and the house number running down the corner post.

The last time I saw that fence and house number, there had been a body wrapped around the corner post, and a motorcycle in the ditch. And I had proceeded to work another code, with similar results: priority black.

Deja vu, no?

And as we rode back to the building, I couldn't help but notice only that they had repainted the house number, but left the crack in the fence.

The Involuntary Commitment Dilemma, cont.

So...have you been pondering? Come up with anything exciting? If you did, I hope you'll consent to sharing...

But until I hear back from you, I shall now commence a monologue on my own thoughts.

The first thing that I would do is finish assessing my patient and going through my own checklist for getting a refusal. The patient, comes first, and Officer Congeniality may need a subtle reminder of that. Secondly, don't engage with crazy; coming back with a snarky, "You do realize that what you're suggesting amounts to kidnapping, Oh Officer of the Most Sacred Law?" won't get you anywhere productive. If there's one thing that I've learned in my two years in EMS (sparkie though I may be), it would be that you want to be friends with as many people possible that show up to a scene. (Especially if you run in a rural area like I do, and there's only one or two golden guns in town that regularly show up to bail you out when you get the call for "domestic violence, scene not secure"). So this is where I would remind you to play nice.

And now that you've consciously reminded yourself to choke back that witty, sarcastic rejoinder that would have felt so fricken' good, I would suggest that you invoke the inherent usefulness of your partner in distracting the patient while you request a word with Officer Congeniality out of the ear shot of said patient. (If the reasoning behind this is unclear, refer to above point: play nice and make friends). There is nothing you want less than to embarrass an officer of the law who is wrong about...well, the law...in front of a patient. Calm and cool is the way to play this one, and hopefully you will get lucky and Officer Congeniality will see the error of his ways.

Should this not come to pass, you do have options. In our jurisdiction, medical command is always a viable option. Explain the situation, and most doctors will come back with a "Really?! Yes, you have permission to release the medically stable drunk man." On the off chance that your fail to get such a doctor with common sense, you may be told to transport regardless. In this case, put on your salesman hat and try for the transport one more time. If you fail yet again, go back to Medical Command and state your case. However, under no circumstances should you transport the patient without their consent. Even if the officer says that they will follow you to the hospital, that is going beyond your scope of practice and beyond his scope of the law. The officer, in order to properly invoke and ECO (emergency commitment order), MUST have legitimate proof that the individual is either a danger to himself or others without medical intervention.

So I've managed to muck things up for you and answer fewer questions than you thought I would, right? Well welcome to the world of refusals. Rarely is there an easy answer, and some of the most interesting ethical questions in EMS (I think) arise out of situations involving AMA and the art of the refusal, as well as the role of ECOs. So to pose a new question to you: has there been any questions or debates that have sprung up among you and your colleagues after a refusal or ECO?

Til next time, CW

A Bit of Background, Part 2

I essentially stumbled my way into EMS. The winter of my senior year of high school, I was bumbling through a job interview for the summer camp I had worked at the two previous years. I use the term "bumbling" because the camp director is quite possibly one of the most intimidating 6'7" giants I know, and I don't think my answers were ever more eloquent than "yes, sir" or "no, sir". So of course, when he asked me if I would like to take on the additional responsibility of becoming a trip leader for the camp sponsored hiking trips I was left with two options: "yes, sir" or "no, sir". Given that I happen to love hiking and the great outdoors, I went with the former. The director then proceeded to inform me that I was to come up to camp two weeks earlier than the majority of the other counselors and partake in a mandatory training class for this new part of my job; I was to become a Wilderness First Responder.

The reasoning behind this training made perfect sense; given that I would be venturing into a formidable mountain range with eight campers (who were for the most part under age 16), it would make sense for me to have a reasonable knowledge base of emergency medical skills and situations in a wilderness setting on the off chance that something actually went horribly wrong. SOLO Wilderness and Emergency Medicine School was the group that provided our training, and if you are ever looking for an extremely professional, knowledgeable and well run wilderness medical training class, I would highly recommend SOLO above all else (http://www.soloschools.com/). The WFR class is an 80 hour long class and provides an amazing foundational skill set for anybody who is an outdoors enthusiast or interested in pursuing an outdoors-recreational line of work.

Needless to say, I fell in love with my WFR class. I loved the content, I loved the practicals and I loved the sense of knowing that I could be useful in a crisis situation. The class didn't just teach you how to do medical things in the woods. It taught creativity; how to use what resources were available to you; how to manage under stress; how to interface book knowledge with practical application; how to work as a team; and how to be a leader. And luckily for me, all of these lessons came at a incredibly formative moment.

That fall I shipped out to university. University is this amazing opportunity for self-discovery, self-definition and finding direction. In all honesty, those were three areas in which I found myself greatly lacking upon arrival at the school of my choice. Sure, I knew what I kind of wanted to do with my life, but other than that I was S.O.L., to put it quaintly. Cut to gracious stumbling act, part two.

When I arrived at university, I found this amazing wilderness oriented rescue group that was a perfect fit for my interests. My savior complex was satisfied (*grin*), as was my love for the great outdoors, and I finally had a practical application once more for the knowledge I had accumulated during my WFR class. Less than a month into my membership of this group, I was presented with a new option for pursuing what was quickly becoming an evolving passion: EMT class.

Getting my EMT was the best thing that I have ever done. It opened up a whole new world to me that I quickly fell in love with. It was a brand new body of knowledge for me to explore and master, and once again social media played a really big role in my new found passion. In fact, social media only fueled my "sparkie-ness". I was (am?) insatiable, and attempted to get my hands on every POV and piece of information that I could that dealt in some way or another with EMS.

And now we come to today, where I am making my own attempt--minor though it may be--to make a contribution to this world that I have come to love so much, and that has welcomed me with open arms. This blog may be graceless at times, and my ideas or questions might be rough at best, but like the start of my career in EMS, I am not afraid to stumble.

The Life I've Chosen

About two years ago, I had that moment that most people can go a lifetime without feeling. It was that "So this is where my life has been heading all along..." moment--a moment of elated epiphany--that of course was followed by an overwhelming sense of "Oh sh*t. This is where my life is going. Now what am I going to do about it?"

How did I get to that moment, and what exactly was my realization, you ask? Well, let me introduce myself first and then we'll get to that.

My name is CW. I'm country girl at heart (read: reformed Yank), living in the great state of Virginia. I'm a university student working towards a bachelors degree in history and a masters degree in Secondary Education, and with all that oh-so-rare-and-spare free time that I have, I'm a volunteer EMT in a rural community just outside of where I go to school.

From the time I was old enough to have an opinion, I've shared it. From the time I was old enough to know what a goal was, I've had one. While the goal was always changing when I was younger (because god forbid a 7 year old actually have a set opinion on what she wants to do with her life), in recent years I've settled on wanting to shape America's future. I want to help people. I want to change a life.

Now you're probably thinking, "THIS is the goal that she settles on?! How on earth are wanting to save the world, and that pivotal epiphany she talked about one and the same?" Well, truthfully, it kind of just happened. And by kind of just happened, I mean one day I realized that everything I had ever truly been passionate about was related to affecting change and helping people. Go figure, that I found an outlet for that in becoming an educator and an EMS worker.

Education and EMS are a life I have chosen, and that I love. But in choosing two such fields, I have inevitably found myself being plagued with this impending sense of responsibility to humanity (read: this is my "Oh sh*t" moment). How do I ensure that my contribution to education and EMS are not solely for selfish purposes? How do I make what I do matter? How can I channel that enthusiasm that "sparkies" are so fondly known for into something productive and generative? And this blog became part of the answer to those questions.

When something takes over my interest I like to ask questions, I like to share my passion with others and I like to learn as much as possible about a given subject. Luckily for me, social media has taken a strong root in both EMS and education. I have found some great individuals and resources in both fields that have inspired my foray into EMS and education, and I have come to a point where would like to add my own knowledge, experience and questions to what is out there. I claim no expertise, no finality or even a semblance of brilliance in regards to my contributions; however, I hope that someone out there might find a morsel of meandering thought that is of value to them.

This blog is primarily about EMS and American education, but you can expect to learn a bit about me outside of those two realms of my life. As I said, this is the life I've chosen--in more ways than the two fields I see myself dedicating my life to. I've chosen the southern way (but darn if I give up fresh NE seafood and my Boston Red Sox), country livin', and the music to which I geek out. These will be making an appearance among my musings, and I hope you enjoy.