The Job

I am guilty of complaining about my job. The rare occassion occurs
when I get to use the skills I spend countless hours maintaining.

Today, if you haven't heard, we had a rain event that produced wide
spread flash floods in the metro. I am a swift water rescue technician
and it is one the the more fun diciplines in technical rescue. I was
call in to assist with evacuations.

These are the days when I feel like I can make a difference. I
assisted with the evacuation some medically fragile people who were
trapped in high water. I am not a hero and no lives were directly
saved by me or the crew I was working with. Most of the day was spent
checking calls to 911 hours after the initial storm. Most of the water
in the areas had receded by the time we got to the low priority calls.

I would still do it all again. Today I love my job.

Bored,

I am bored with my job. I want more from my profession. I trained for two years to become highly trained in emergency medical care. Ever since obtaining my license I have been relegated to ambulance driver.

I tried to get a part-time job with a 911 service. No one in my area wants a new paramedic in their service. Yes, I said part-time job. My full time job with the fire department pays well, and there is no EMS job in this state that can come close to competing.

So I am screwed. I want to be able to make a decent living, but I also want to use my hard earned skills. I can't have both and that is sad. Do we need to let EMS in the US fail so we can have a better system? The gang over at EMS garage have another lively discussion on this very topic. Every week they get together and talk about EMS, often how bad the pay is for our workers. They never find a solution and I am not sure anyone who runs EMS wants a solution. Listen to their shows and email them with ideas. We need to all be on the same page, in the same room and stand up for decent wages.

Why are YOU here?

What is the reason you got into EMS? I ask most new EMT and Paramedic students this question. I really want to know the motivation behind their entry to this profession.

Me? I wanted a career change. Like most people I thought EMS would be a 24/7 adrenaline rush. Saving lives and gathering praise from the families of the patients. I had been in the fire service as a volunteer for nine years before committing to my EMS education. Firefighter are always getting positive attention (unlike police officers), they have the public fooled, kids of all ages, races and sizes want to be a firefighter at some point in their life.

No one says "I want to work on a ambulance when I grow up". During my EMT class we all thought our future jobs would be similar to a firefighter, saving lives. My first job was with the fire department, we ran in a tiered system with third party EMS. I did not work on an ambulance until a few years later.

My paramedic friend convinced me to apply for part time work with a private service ambulance company. The government EMS service had just gone through a merger and my new job was covering trucks for the local 911 service. Just like the fire department we made only 911 calls. I learned a lot, including how to get to all the area hospitals. Eventually the city got their act together and no longer needed private service to cover for them. Being an EMT-B I was sent to a BLS transport truck. This began my true education in EMS. Gone were the days of driving with lights and sirens, rapid assessment of patients and having a paramedic to do all of the paperwork. Gomers and Chuck runs are all I saw for a few months with the occasional stint with a part-time paramedic.

I left that company, they treated EMT's like dirt and were not afraid to tell you exactly that (in fewer words). I went the second largest private ambulance service in my area and worked there part-time. I am still working for the F & B ambulance company as a part-time paramedic. I wish I could say that the EMTs and Medics are treated the same, but you know that is not the case. EMT's are still dirt and medics are a precious resource (unless there are six medics, then you are just meat in the seat). I try not to use this to my advantage or abuse my status. F & B actually fired a part-time medic recently for several reasons, but mostly he was an arrogant jerk and actually told a facility that they would never fire him, because he was a medic.

I advocate for the patient. We have older ambulances and sometimes things break. I try to return only when it is a safety issue or it would interfere with patient care (like the A/C in the patient compartment not working on hot days). I enjoy working the streets and helping new EMT's (and not so new) learn how to properly assess a patient, take vital signs, lift with their legs and improve their bedside manor. I remember being the Basic who always had to take all the runs and the medic just wanted to drive (lazy medics, we all know some) no matter the patient condition.

I am here to help. The patient, my partner and the company I work for (in that order mind you). I like what I do and I wish others (general public, government officials, allied health care providers) would respect my career choice and treat us all like the professionals we are.

08:34am

Shift starts at 09:00. I like to arrive early, check my truck &
equipment. The adage when I worked in theater was 'early is on time,
on time is late' as it should be even for emergency services.

Dispatch supervisor greets me at the supply officer's desk. "How soon
can you go available?"

Me: "I just walked through the door, my partner is not here, I don't
know what truck I'm assigned to and I have to check my equipment &
supplies. After that I'll be available as soon as possible."

DS: "Methodist Hospital has a vent patient who is crashing and the
other medics are on runs."

Me: "Find me a partner and give me a minute to check my truck."

I am sensitive to emergent runs and meeting requirements of our
contract with the facilities. If someone needs my help, I want to meet
that need. I notice a paramedic graduate who was in my class and I
asked if she had a partner yet. The scheduler screwed up and did not have her on for the day. I told her I needed a partner immediately (get schedulers permission) for a priority 1 run. I grab the ventilator (LTV 1000) do a quick once over on my ambulance and we head towards Methodist Hospital.

The CCU unit was a flutter with activity. Nurses racing around trying to get orders. The patient's nurse told me that the patient coded last night, they got her back after 20 minutes and she is being paced TCP (trans cutaneous pacing). We are transporting the patient from Methodist to Metro Hospital CCU for pacemaker implant. Levophed drip, Epi drip, Sodium Bicarb drip ventilator and TCP. A lot going on with this patient. First trick was to switch from their pacer to our pacer. Could have been easy, but we did not have the same brand and the connections are all different. Three people helped, lift the patient, turn off their pacer, my partner slapped our pads on the patient and I started pacing again. I studied the lifepack 12, looking for signs of capture. Finally got capture. The nurses combined all the drips to one multi pump, and we transferred the patient to our stretcher. I set my LTV and transferred to my ventilator. After a minute or two of letting everything settle, and checking to see if the patient was stable, we headed for the ambulance.

Code 3 to Metro Hospital, luckily it was less then 3 miles away. We arrive, give report to their CCU nurses and reverse the procedure. The had the same brand of monitor/pacer making that transfer easier. Vital sign check BP 86/52. Very not good. At this point the patient is in the care of the nurses I offer to help in all ways I can. Unit secretary places STAT pages for the patients doctors. I am released by the nurses, I leave the room to complete paperwork. Several minutes later they get a doctor to the floor and he is not happy that the patient was transferred in this condition. My partner, after cleaning our cot & monitor, watches the activity inside the room. She comes over to me and tells me that Doc has taken the patient off the pacer four times to see the underlying rhythm. Easy guess, it's asystole (didn't take me long to figure that out). I finish writing, get my signatures and head towards the elevator. We stepped on the lift with one of the CCU nurses, going to pick up a patient from the ER, and hear "Code blue CCU, Code Blue CCU" to the same room we just left.

Preception of perfection

Only two dialysis transports do far. The A/C in the cab of the truck
was not working well, the 85 degree atmosphere was heavy. My partner was edgy, waiting to get results from the NREMT-P (National Registry of Emergency Medical Technicians) written test. She was waiting for an email, I told her to just check the website. Her eyes, widened, and she read aloud the statement of passing the test. She even made me read the results, just to be sure that she had not misinterpreted what she read.

Dispatch: "Medic 42 copy priority 1 to Farthest Nursing & Rehab for respiratory distress"

I have seen more respiratory distress patients in the months I have been working than any other kind of ALS patient. We head over to Farthest, code 3. The pager stated that the patient was to be transported to St. Other end of the County Hospital. This is mostly the patients family making these decisions in written form for the nursing home. I always keep the option to transport to Closest ER when necessary.

The patient's room was filled with staff members (and they even had their crash cart out), they had the patient on oxygen 8 liters per minute via a non rebreather mask (I didn't know nursing homes had these things, they always give nasal cannula). I could hear the fluid in the patients lungs from down the hall. LPN reports the patient has an axillary temperature of 103.4F bilateral Rhonchi SpO2 77%. The patient looks pale and moist. I'm told that he has become this way within a few hours. He's definitely hot to the touch and not looking well. We scoop him up, get the paperwork and head out to the truck. I like to do my work in the ambulance when I can. His pressure was 118/60 heart rate 110 (ventricular pacemaker) restorations 34 shallow lungs bilateral rales (NOT Rhonchi). First thought, I need to breath for this guy, my partner gets the BVM (bag valve mask) and begins assisting restorations. I prepare to nasally intubate the patient. I have already decided we are going to Closest Hospital, will have my dispatch notify the patients family. First attempt, sounded good, looked promising, not good (damnit). Bag the patient for a little bit, get new tube and try again. Second attempt, no good, screw it, let go I'll just bag him (we are 3 miles from ER).

We roll into the ER, give report, the nurses do their work up, get IVs, respiratory arrives. The Doc takes one look and says Aspiration Pneumonia. Patient has a PEG tube (and a foley cath that looked like mud, a PICC line that had not been flushed in days). Doc orders Etomidade, Succinylcholine and intubates the patient. Sure would be easy if I could have done that. RT suctions out the ET tube, and the contents look a lot like feeding tube goo.

Minor Leagues

Today I feel like I am in the minor leagues, trying to make it to the
majors. I work for a private ambulance service as a paramedic and a
rural 911 service as an EMT-B. A former class (paramedic class) mate
of mine was recently 'upgraded' at the 911 service to medic.

I was happy to see that he got his due, he works for an ALS fire
department full time. A few people have encouraged me to speak to the
operations person at the rural service about getting upgraded myself
to medic status. I have only had my license for a few months (January)
and I'm just not sure if I'm ready for the major league.

What are you reading?

I have been following a large variety of medical blogs. Most of them are related to emergency medicine, but a few are not. Here is my current list of medical blogs I follow (and so should you).

Crass-Pollination Nurse K is absolutely funny, and very sarcastic. You can follow her on Twitter also @ernursek

A Day in the life of an ambulance driver Funny and insightful, he has recently published a book called En Route .

The EMT Spot a great learning resource for all levels of prehospital medicine. You need to subscribe to this one.

Paramedicine 101 I shouldn't really need to describe this blog, it is exactly as the name states. Very useful information here. Read daily.

Street Watch: Notes of a Paramedic I really blame Mr. Canning for my interest in EMS. I read his book Paramedic back in 1999. I am also from Connecticut and I knew the areas he was writing about. You really need to read both of his books.

Rouge Medic This guy knows his science. Don't try to argue a point without your facts and the foot notes to back up your statements. Excellent use of science based medicine.

Doctor Grumpy in the House Dr. Grumpy is a neurologist. His patients are freaking hysterical. I had not idea people could be this senseless. Make a friend, bring the good Doctor a diet coke.

Random Acts of Reality a Paramedic from across the pond, Tom Reynolds has a very interesting outlook on life. His first book Blood, Sweat and Tea, was a gem. His follow up should be available any day now More Blood, More Sweat and more Tea.

On the Clock moving stories from an English major in college who also enjoys the thrill of riding in the back of the ambulance. She really is a good writer.

That's all for now. It might take you a few days to read enough of the blogs to get a feel. I'll add them to my 'Blog Roll' and more when I get a chance.

Do we need Paramedics?

I was listening to the EMS garage podcast #27 the other night, when they got into a heated discussion about Columbus, OH looking to be a Basic Life Support (BLS) only service. San Antonio Fire Department in Texas has just started running six BLS only ambulances in addition to their thirty two ALS (Paramedic) ambulances.

I work for a private ambulance service in Kentucky. I am a new paramedic with only a few months under my belt on the streets. My ambulance service does not have any 911 contracts, but we have many with nursing homes and rehabilitation centers around town. Today (like many days) was extremely slow, and the three paramedic trucks were relegated to dialysis runs and doctor appointments, all of them BLS in care level. I began to think are paramedics really needed in urban service areas?

The OPALS Major trauma study as reviewed by Dr. Keith Wesley on JEMS.com showed that ALS intervention in major trauma patients had little to no benefit to survivability. Also it stated that when a trauma patient had a Glasgow Coma Scale (GCS) score of less then 9 and ALS intervened, the mortality rate INCREASED. Yes, this is only one study, but more and more studies are arriving showing that ALS procedures do not increase survivability for the patients. Trauma is the realm of surgeons (paramedic students are told that Trauma is a surgical disease, and the only definitive care is surgery), control the bleeding, apply oxygen and increase the diesel flow exponentially (all BLS skills by the way).

Cardiac Arrest, the American Heart Association (AHA) has been promoting more high quality CPR (cardiopulmonary resuscitation) and less time interrupting chest compressions while trying ALS interventions. Ok, I can hear the pundits (and old school medics) but we NEED an IV line and we NEED an endotracheal tube to secure the airway! Well, modern science along with a few industrious people have come up with several blind insertion airway devices, like the venerable Combitube or the King Airway. Both these devices are BLS level skills in many states (the number is growing and it should). Any decent paramedic, would not remove one of these devices as long as adequate ventilation are being performed (and you can even add capnography). What about electrical therapy? Semi-automatic External Defibrillators (SAED or AED) BLS skill. There is even a thought from Dr. Bryan Bledsoe in the recent JEMS magazine about giving too much oxygen. Summery, high quality chest compressions, not hyper oxygenation and a king airway with a bag valve mask (on room air of course), all BLS level skills.

Stroke (Cerebrovascular Accident, CVA), unless you work for a service that allows the administration of tPA (Tissue plasminogen activator) , you are just a glorified BLS transport truck trying to get the patient to a stroke center within the three hour time frame. Sure you can start and IV, but can you provide definitive care for that patient? If you could why would you be transporting them in the first place? Treat and release (yes I know this is extremely unlikely that a paramedic could EVER treat and release a CVA, but the question is still valid).

Asthma/Anaphylaxis, again modern science has given us the Epi Pen auto injector that many BLS services are now carrying. Even in the Metro are I live, BLS trucks administer albuterol nebulizer treatments. Then just transport them to hospital of choice.

Congestive Heart Failure (CHF), what about that smart ass? Again more medical directors are adopting protocols that involve less invasive treatments in the field, like CPAP (Continuous positive airway pressure). A BLS ambulance is trained to listen to lung sounds, they can identify ralse (crackles) and use the CPAP, during transport to the hospital of choice. Diuretic medications are also being studied closely, and some doctors want to stray away from excessive use of lasix in the field.

Angina and chest pain, Nitro glycerine (NTG) and asprin (ASA) along with a little oxygen and get thee to a hospital. There is talk in the EMS community of reducing the use of morphine for chest pain. Oh, you want to address the twelve lead ECG stuff also? Much of 12 lead ECG transmitting to ER's in my area is still in the pilot program stages. Yes, this can reduce door-to-balloon time but the study in my metro is still under way. If I can get a patient to the ER under 30 minutes and I did not transmit an ECG to the hospital is the door-to-balloon time really that much greater? We all act like transmitting ECGs to the ER is something new, but as I recall Johnny & Roy were doing that in the 1970's.

I believe that if your transport time is less than 30 minutes to definitive care in a hospital, then you really don't need paramedics in your service. Maybe I am just a new medic and I don't know what I am talking about, but the studies are out there. I became a medic to help people, and I find that I am just another ambulance driver. You can send your hate mail here: joelneild@gmail.com but you will only get a response if you can format a sentence correctly and use proper grammar.

Speak to me

Stop what you are doing. Read this story from Ambulance Driver blog. Don't come back until you have read the whole story. I'll wait for you.





While listening to the EMS Educast episode 6, Dr. Joseph Weiner, a psycologist was talking about how to teach EMTs compassion. He had a few really good ideas, including just simply talking to the patient. Ask the patient about their life, inquire about what interests them.

During my induction to transport medicine (chuck runs), the goal was to finish all your paperwork prior to arriving at your destination. Rarely did I engage the patient in conversation (save for the few talkers we would transport, then I usually faked listening while completing paperwork). I did not consider myself as the dispationate burnt out EMT, I was just trying to get my work done. After a while I would engage the patients, try to brighten their day, or just pass the time (although I would try to multi task and I would write while talking).

Now, I find that I either don't have the time to do paperwork, or (especially after listening to the show) I just try to show a little more compassion towards my patients. Most of the people are from nursing homes and rarely do they get to talk to new people outside their circle.

I have always been interested in sociology (albiet from a distance) and the history of the individual people who live through historic times. I have been transporting these people for years now and I have only just begun to truely listen to them, and learn what I can. There are some very depressing stories. A few patients don't get to talk to anyone, until the ambulance picks them up for their dialysis appointment, and after they return to a house, void of human interaction, they turn on the TV and wait until we return.

A few stories have left me sadder for the day, but I hope that the patients gain from our short interaction.

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• 06:06 Working @ OCEMS for 12 hrs.
• 06:07 OC is next to @buckman hollar. With any luck we won't meet today.
• 10:29 BTW I am playing BLS today. I can't be ALS at OC. They don't hire new medics. We just took a possible MI to the ER ( ALS onboard)
• 10:36 Just FYI - use of a whizinator is a class A misdemeanor. (via @dancanon)
• 10:39 #followfriday @weebeefire is my major at the firehouse. He's new to Twitter
• 12:05 On the move. We're rotating back to the center of the county.
• 12:07 Any one in Louisville taking part in the Humana Festival? Wondering which plays I should see.
• 12:28 4 people have been shot and up to 41 people have been taken hostage at the American Civic Association in Binghamton, NY. (via @BreakingNews)
• 14:12 RT @gfriese: welcome EMS magazine editor @NancyEPerry #followfriday (via @dengerin)
• 14:18 URGENT: Jumping out of moving cars on the highway is not a good idea. Carry on with your day
• 17:07 The Walt Disney Co. says it has cut 1,900 positions at its U.S. theme parks due to the slumping economy. (via @BreakingNews)
• 17:13 That last tweet is true. Many managers lost their jobs at Disney World. Luckily my friends survived the cuts.
• 17:18 Returning from BLS transfer from urgent care to hospital.
• 17:28 Shameless #followfriday plug for @medic_ray he's a good read, and inventive. No power failure stops him!

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• 04:24 Awake. 5 hrs sleep. Entire crew going to gym @ 5am. Maybe an aftenoon nap in my future!
• 05:50 Finished workout. Waiting for the rest of the crew. Basketball last night wasn't good on my knee. It's not happy today
• 10:39 At the sound of the tone the time will be 10:39 EDT. I've been awake for 7 hours. I get to nap now.
• 10:42 @funambulator
• 10:42 Nice use of negative space . @funambulator.
• 11:03 Ok, maybe no nap just yet. Rain is coming and I need to mow the yard. I hate grass, the way it grows continuously. It's evil incarnate.
• 12:23 RT @funambulator: If you remember or have a story about the '74 tornado, we want to hear from you today around 1:20 502-814-TALK or @soatalk
• 12:32 RT @toddmundt: Cutting the Coax: an update bit.ly/iP6Ll (I like the concept, and we thought of dumping cable but we would miss UK BB)
• 14:39 Watching Bottle Shock. Knee still hurts, I knew I shouldn't have played basketball last night
• 16:23 Everyone says I'm a wise ass. I'm waching Talidega Nights, I feel my IQ lowering already.
• 20:24 Going to sleep. Have to get up @ 4am for a shift at OCEMS

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• 06:24 When everything is wrong... I'm trying to just move along. Need mental health day off work.
• 08:12 This day is proving to be a worthy adversary but I have won the battle thus far. The war is still being waged. More reports from the front
• 08:36 I have to take my V02 max test again today. This FD doesn't understand that you can't really change a VO2 max number in 3 months.
• 08:38 Technically it's not a real test. It's a mathematical estimate of what my VO2 max should be given BMI & max heart rate over time.
• 09:34 Got 29 and change on m VO2 max test. Dept. Standard is 38. Ask me if I care.
• 09:37 Anyone want to hire a medic full time? Prospects need good health plan and pay.
• 09:40 I lie to the public when they ask if my job is exciting. It's not, and I wish we had more fires to fight. I'm bored
• 10:12 I am feeling Verbose today, and this is Tweet 3000 for me. Thanks for putting up with me ;)
• 11:09 What's worse than killing a patient? Trying to hide it: is.gd/pWUy (via @kevinmd)
• 13:00 Training at Nortons Commons. Preplan strategies & tactics. Yawn.
• 16:57 Back from gym. Truck washed. Last shift left us with nothing to dry the engine so it will hang on the line for an hour or more.
• 17:05 Congradulations on the new Class. Who did you get for lead instructor?
• 17:23 Dear Facebook iPhone App, Why can't I share links? Easy, simple add to next update. Ok, thanks.
• 18:11 Why the Monkey? 091/365 Nortons Commons tinyurl.com/d7ef3d
• 18:38 I have determined that the Submaximal VO2 max test is a joke. Tried to convince department to get a real VO2 Max test. No takers yet

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• 14:04 Very busy day on the ambulance. Finally got to eat lunch.
• 14:12 Nursing home to ER all day long. We're now posting.
• 14:26 I need to improve my IV stats. All the BLS runs are making me rusty. Missed twice today :(
• 16:06 Driving past down town. Sky doesn't look so good. Maybe rain soon twitpic.com/2nh14

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• 09:12 Waiting for my partner to Show (he's late). 1 of 3 medics on the street today
• 11:11 Waiting in radiology. Our truck has no power to the box. We are OOS.
• 14:25 At least they gave us 10 minutes to eat lunch before sending on another chuck run.
• 15:17 Posting. Beautiful sunny day - bkite.com/061Fn
• 16:03 Run volume has slowed this afternoon. One ALS truck has gone home. Only two medic left on the street. We're posting still.
• 19:36 Why the Monkey? 089/365 Vulcan tinyurl.com/c82jnu

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• 09:38 24 hours of firehouse love. Teaching Hazmat to the recruits.
• 14:50 I'm getting dragged into a legal case from an EMS run more than 3 years ago.
• 14:53 The 2 Louisville fans I work with are yelling at the TV. Sloppy play all around.
• 15:45 Watching Louisville MIST game at the station - bkite.com/05ZTn
• 17:28 Sitting on the side of I-71 SB waiting to clear from an MVC
• 17:55 Finally clearing the highway. What's for dinner?
• 20:34 Everything is all cleaned up at the station (finally). Washing clothes, working Rural Metro tomorrow
• 20:41 Been on my feet since 7am. My knee does not like me at the moment.
• 21:00 A friend of mine is doing a photo project fo her masters in education tinyurl.com/d48jjv
• 21:06 Why the Monkey? 087/365 Thai iced tea tinyurl.com/carehe
• 21:07 Why the Monkey? 088/365 MVC tinyurl.com/devufn
• 21:30 My first Medical Neccessity blog: Dispatch - tinyurl.com/cqwyrs
• 21:33 Don't know if I can keep up two blogs, but I am going to try to write. Too many things to say about Prehospital medical care.
• 22:25 Listening to EMS educast. Yes, I'm a junkie. I live with my issues.

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• 09:32 RT @craigdurling: Here's one way to clean your monitor: is.gd/5msS
• 09:39 RT @gbullard: This seems pretty smart tinyurl.com/ck35fn (I can't even get Fire Chiefs to work one 24hr shift to see what it's like)
• 10:01 Morning World. Welcome to my one day off, until Thursday.
• 10:02 I get 100% chance of severe storms today. Thanks NWS. At least I am not working.,would be very busy.
• 10:03 Actually I turned down two offers to work today from the two ambulance services I work for. I needed a day off.
• 10:04 Many people around here may not voluntarily participate in @EarthHourUS but mother nature will force our hand ;)
• 20:43 Line of thunder storms approaching the metro. Tornado watch for Louisville.
• 20:49 Welcome to spring weather metro Louisville!

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Dispatch

27 March 2009
Another day on the bus. The previous day was extremely busy for my service, so I thought that this one would be busy also. I was wrong, at least for the first six hours of my eight hour tour. The day began as most days in private service EMS, dialysis transports and return trips to the nursing home. The service I work for has been increasing the number of trucks on the street recently, today we had seven medics on the street for a total of nineteen transport ambulances. With so many paramedics I knew that I would be busy with the 'chuck' run all day long. I am not bothered by chucking people.

After the fourth run for my truck (which I teched so my partner could get a brake) we went back to a posting location. We did not stay long, we finally had the chace to make a priority 1 (code 3) run. Dispatch sends us the info, elderly female with difficulty breathing, a nursing home clear across the county. My partner is driving and we hit the road, lights and siren blaring. Five minutes pass and they send another truck to a priority 1 run right near where we had been. I have not knowledge of where this ALS truck cleared from but I thought they might be west of our location. I thought about trying to swap runs with them, but I decided that dispatch would know best. As it happenes so often in private ambulance service, we passed the other ALS truck, going opposite directions on the highway.

Surely the dispatcher could have seen this error? Why do they spend so much time crossing trucks, wasting fuel and time? Most of our dispatch staff have never been on the street, however they do have CAD to assist them, and they hear us enough to know where the facilities are located. I make it a point to tell them my exact location when they call my number. I am hoping they will use their brain and send me to the closest available run, not across town, when there is a closer truck.

My patient required a breathing treatment and a trip to the ER (non emergency). When we arrived on scene the nursing home staff told us she had a SpO2 of 50% on 3 lpm by nasal cannula and she had an irregular heart beat. The PT was laying supine in bed. I removed the nasal cannula, listened to her lungs and administered a breathing treatment before getting her on our cot. When will nursing homes get their act together and stop placing 2 miles of oxygen tubing connected to a concentrator at 2-3 liters per minute. This does your patient no good if they are having a hard time breathing, seriously people. LPN's are useless, if they cannot understand the concept.

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• 09:14 Back on the paramedic band wagon. R/M was busy yesterday. Slow morning so far, we shall see!
• 09:44 Posting downtown. A BLS crew is here with us. - bkite.com/05VfX
• 09:46 I'm at Waterfront Park - bkite.com/05Vg6
• 09:51 #followfriday @geekymedic for all your EMS podcast needs.
• 14:12 Posted in the Audobon area. Waiting for the next run - bkite.com/05VHr
• 14:16 bit.ly/bYlv explains, FINALLY, what this "#followfriday" thing is. (Thanks, @jankabili!) (via @Pogue)
• 15:45 Billy Gillispie gone from Kentucky. Press conference @ 4:30edt.
• 18:25 Clearing from lift assist. Missed IV on last run. Only ALS PT of the day.
• 19:18 Americanized Chinese food! Yumm! - bkite.com/05WeM
• 20:35 Arizona forgot to show up to the game. Louisville is klling them 65-34
• 21:02 Going to bed. Both games are a blow out. No point watching anymore. Need sleep

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• 07:32 Back at the firehouse. Hope all my friends @ WDW survive the axe!
• 08:12 On the way to USAR team training. First one for me. Just got on the team last December
• 08:38 I'm at Louisville - bkite.com/05TfI
• 12:42 On the way back from training. Nothing exciting, keep moving.
• 16:08 I'm riding as officer until 10pm EDT. Be afraid. Seriously.
• 17:35 EMS is busy. All private svcs. are out of trucks. LMEMS are holding code 1 runs. And it's sunny & dry out! WTF?
• 18:18 Dinner, yum! Night cleaning finished. I've got a few admin. duties to finish then I get to rest!
• 20:57 Finally finished with the administrative duties. No wonder my Major never gets to sleep before 1am!
• 21:07 Why the Monkey? 085/365 Tender 1869 tinyurl.com/dasqs5
• 21:18 Waiting for laundry in washer. Bored and tired.
• 21:24 Anyone ever actually try to read Legeslative bills in House or Senate? Ridiculously convoluted or what?
• 22:08 According to WHAS 11 news Billy Gillispie may not be back for a third season. tinyurl.com/cwq4r9
• 22:11 WHAS 11 implied that Billy G. is mostly fired. No official word yet.

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Twitter Log

Follow me on Twitter

• 07:56 Just added myself to the wefollow.com twitter directory under: ##Paramedic ##Photographer ##Firefighter
• 07:57 Morning Twits. Warm and rainy here in the metro. Probably going to be busy on the ambulance
• 11:25 1st run difficulty breathing. PT was very warm. I'm thinking Pneumonia exacerbated COPD.
• 12:50 On the way to the Suburban Hosp. Area for posting. - bkite.com/05RLk
• 14:42 Clearing VA hospital. Back to our posting location.
• 14:46 Bright Kite is a neat idea but not very useful in my area. Not many users, and some haven't updated in 7-10 months #britekite
• 14:49 When will we finally have enough social media websites? Twitter, Brite kite, FB, Socialscope, plaxo, linked in. I'm going to pare down my
• 14:49 Social media web presence. Too freaking many.
• 20:36 Why the Monkey? 083/365 Lines & Knots tinyurl.com/cwl4xh
• 20:36 Why the Monkey? 084/365 Executive Inn tinyurl.com/cmu5b6
• 20:50 Kentucky proves why they never made the NCAA tourny. They can't get the little ball in the basket. #NIT
• 20:55 Horrible performance Kentucky. Lost 67-77 to ND. Please come back next year with some freaking heart and desire to play the game

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