Keep Your (First Aid) Skills Sharp

I wrote my masters thesis in 2012 on the relationship of knowledge, first aid, and the moral requirements of rescue.  The thesis argued that 1.) if you have special knowledge or training (first aid), you are morally required to render aid, even if there is no pre-existing legal requirement; and 2.) everyone should be trained in first aid.  While it is the case that I have to keep my first aid certificates current in order to work at the bar, I believe that it’s important to keep these skills fresh and sharp regardless of your occupation.

You never know when you’ll need to draw upon the skills, so frequent practice is important if you want to be effective.

There have been two instances while working at the bar where a pedestrian was struck by an automobile while I was working.  The first was New Years Eve a few years back, and the second was this past St. Paddy’s Day.  Thankfully, in both instances the person did not seem to be critically harmed in the incident, and both were conscious when they were loaded into the ambulance to be taken to the hospital for further attention.  I suspect that while both had some degree of recovery ahead of them, they thankfully won’t likely experience prolonged physical suffering.

In both instances, I was working on the door, so I was the first responder on scene to start treatment.  In the case of a traffic collision, the most important steps are to protect yourself, and start control of the scene.  I can confidently say that I’m terrible at the first thing, and half-decent on the second.  This is why consistent practice is important.

Protect yourself

I fail on this in two regards.  I have a tendency to run out into the street to reach the pedestrian quickly, meaning that I put myself at risk of getting hit by a car while on scene.  The other thing I’m bad at is getting to the pedestrian and starting treatment before I finish the scene survey (which includes putting on medical gloves to protect myself).  These are big no-no’s.  I expose myself to unnecessary risk while trying to be first to the injured, when realistically I should take an additional 15-30 seconds to stop, take in the scene, and put on my gloves.

Control the Scene

I am adequate at this because I tend to default to immobilizing C-Spine and trying to talk to the pedestrian if they are conscious.  I could do this better in a number of way, such as having a fellow staff member control the spine while I assess for additional injuries and control the scene (directing people around me, updating EMS, taking notes, etc.).  In regards to the staff at the bar, I am probably the most experienced first aider, so removing myself from the decision-making portion of the response has benefits and drawbacks.  I am the best person to perform first aid until advanced medical care arrives, but I also have enough experience to understand the dynamics of the scene.  At this point, it’s best that I trust my fellow staff to respond appropriately.

Responding to a traffic incident is chaotic, noisy and confusing.  On top of this, adrenaline courses through your body, making your hands shake and your limbs jittery.  Your brain feels like mush because your thoughts are lightning quick.  Time seems to slow down, and that ambulance that is 5-8 minutes away always takes an eternity.  You are hyper-focused on your patient, but aware that there is a light din of noise at your periphery.  It’s like a bubble is around you, and you are hoping like hell that you don’t mess anything up under the spotlight of the gawking mass of people encircling the scene.

This is all normal.  It (sadly) gets easier the more you do it.  You become calmer each time you respond; it’s happening to me already.

The lesson to take from this is to always keep your certs current, and find time to meaningfully practice your skills.  Someones life may depend on it.

Stay Awesome,

Ryan

 

 

 

 

 

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New Year and New Updates

Happy New Year!

I hope you had a fun and safe weekend.  This year’s celebration was the smoothest we’ve seen at the bar in a long time.  No fights or accidents, and everyone left before close.  From the staff’s point of view, it was a great way to ring in the new year.

A big bit of news happened for me in early December – I got engaged!  After months of scheming, everything came together and my fiancé and I are busy with wedding plans.

The decision to pop the question also forced me to think more about my future, specifically the next 3-5 years.  While we are not planning to wed until late 2018, the added commitment of marriage raised some questions in my mind about what I need to focus on in terms of priorities.

When I started this blog, it was meant to help me focus on my learnings on my way to becoming a paramedic.  A lot has happened since then, and it would be bad if I ignored the contexts at play.  In the beginning, I was a bit down on myself, felt aimless, and I didn’t like work.  2016, while a crappy year for the world, was a good year for me in that I focused a lot on improving myself.  In that time, my conditions at work have markedly improved, and I feel better about myself and where I am in life.  The only thing that hadn’t shifted was my career – I was still running under the assumption that I would be applying off for a paramedic program and would restart my career in two year’s time.

Getting engaged, however, forced me to think critically about this.  With my fiancé just starting out on her own professional career, us moving in together in the near future, and planning for a wedding, it seems like a bad decision for me to drop the security I currently have and take several steps back for the sake of a new vocation.

Maybe if I were a few years younger (I turned 30 in December), I could have pulled this  gamble off.  But for the present, I will be putting my paramedic aspirations on the shelf to focus on building what I have in front of me.  Down the line, there is always a chance that I could make a pivot into medicine but for the interim, this is not a good choice for me.

Which now raises the question of what is happening to this blog?

Short answer: nothing.  I will keep the blog for the foreseeable future.

Long answer: a change in theme will need to be made.

Obviously this won’t be a medic blog anymore.  At the very least, this blog has been very broad, so I don’t see a lot changing in terms of content.  I’ll still post on topics that are relevant to me and my interests, such as personal development, teaching, etc.  I don’t know what the changes will amount to, but if you are enjoying my content now, then you can rest assured that things won’t change materially.  In time, you may see a new coat of paint and a some rearranging of the furniture.

However in the mean time, check back in each Monday for a new post.  Let’s keep this thing going!

Stay Awesome,

Ryan

 

Drones and Improving CPR Time

A friend of mine wrote a great piece last week on recent developments in making response times faster and more efficient through technology.  Drones can be outfitted with portable AED units and can be flown to the scene of a cardiac arrest to save precious minutes while advanced medical assistance is en route.   Check out Blair’s article here.

I also highly recommend visiting his blog for musings on medicine, journalism and anything else he’s got on his mind.

Stay Awesome,

Ryan

 

 

Video – Dangers of the Job

Despite my recent spate of posts on teaching and education, I still want to use this blog as a platform for self-improvement as it relates to medicine.   I don’t know, yet, whether I will follow the path to paramedicine to the finish.  Teaching is occupying a fair amount of my time, so I will give priority to the things that seem most pressing.

Having said that, this video came across my social media feed last week and serves as a painful reminder that no matter how noble your job is, no matter how badly you want to help people, those very people you serve are also (sometimes) your greatest threat.  Crisis and trauma cause people to react in wildly different ways, and if you are not prepared for it, you could very easily fall victim to its chaos.

I have many medic and security friends who have their own horror stories from getting caught flat-footed on shift.  I’m glad to see agencies are seeking to remain proactive in arming medics with the tools and experience to protect themselves.

Remember, you’re no good to anybody if you are incapacitated, so watch your back.  That’s why the first step you are taught as a medic and responder is to mind your environment.  Constantly scan and re-assess for danger.  No one will look out for your well-being better than you.

Stay Safe,

Ryan

Blog: Preparing for the Worst

My journey towards becoming a paramedic is not without its significant doubts.  I suppose I can take comfort in knowing that many people feel similar doubts when embarking into new career/life-paths.  Kevin Hazzard’s book “A Thousand Naked Strangers” opens with several chapters of how anxious he felt at the idea of being a medic and the responsibility it entails (book review forthcoming).

My fears are certainly not unique.  I have the typical worries around imposture syndrome, whether I can hack it physically, mentally, emotionally, and whether I’m good enough to get accepted into a very competitive program.  I also have spin-off worries concerning whether I will achieve a work-life balance with a future family, what toll my experiences will have on me, whether I can leave work “at the door” when I come home, whether I will be affected by mental health issues caused by work, etc.

Heck, I even worry that I won’t be able to stomach it because I’ve never seen anything graphically bad.  The three worst things I’ve seen are: 1.) a pedestrian struck by a car that I had to then treat; 2.) that time I broke my ankle with a hairline fracture; and 3.) that time I treated a guy who put his elbow through a window in rage.  In each of the cases, there was some blood (and bone from the window), but overall the outward injuries were fairly tame.

I’ve tried to mitigate this by following medical Instagram accounts that shows graphic medical procedures and injuries.  My hope is to desensitize myself from the shock of what I see so I can bypass those initial visceral reactions.  Likewise, I chose to read Hazzard’s book to learn more about what kind of horrible things I can expect to see.

But, there are some things you can’t prepare for.  Or, worse yet, there are things you didn’t anticipate being a problem.

I came across two blog posts recently  (written by the same author on two different sites) that discusses exactly this case.  I won’t spill too many of the details as I think it’s valuable to read the posts for yourself.  But the one I want to briefly mention here is where the author discusses the impact a ringing phone can have.

Imagine what it was like for the first responders at the recent Orlando mass shooting as they worked inside the club around all the deceased victims.  Keep in mind, there were 49 victims who died that night on scene.  49 people with families who likely heard about the tragedy on the television.  49 families who might have called to make sure their loved one was “ok.”  49 families who kept calling when no one picked up.  Imagine what kind of toll that might have on a person as they walk among the bodies.

It chills me just typing this.

There are things I might experience that I’ll never be prepared for.  These are things that worry me as I lay the groundwork to change careers.

Please, go read the blog posts for yourself.

The Sounds of Silence on The Happy Medic

The Worst Things I’ve Ever Felt As A Paramedic on Uniform Stories

 

Problems with EMS Infrastructure and Technology

This episode of Last Week Tonight with John Oliver aired last week, but I thought it was worth sharing as an irreverent but also serious aside.  I am still early in my attempt to navigate the world of emergency medicine, so I am broadly exploring all sorts of topics.  While my aim is to become a paramedic, I also acknowledge that taking a silo’d approach often leaves gaps that harm people.  When there are serious issues with how a service gets deployed to help people, you end up with a lot of avoidable mistakes, like those highlighted in the video.  I hope you had a great long weekend!

 

Stay Awesome,

Ryan