Note: There has been an update to part of this story. The paramedic referred below as being stabbed to death did in fact die from a myocardial infarction when he ran after the patient. Although I am posting this update, I feel the information in the post is still relevant in terms of scene safety. My condolences to his family, friends, and co-worker.

How many times have we heard this during training, re-training, and when we are teaching new EMTs? How many times have we ignored it?

The news today included two articles, one detailing a paramedic who was punched by a patient (Read the article here: http://www.wivb.com/dpp/news/crime/Paramedic-tries-to-help-gets-punched), and another who was apparently stabbed to death by an emotionally disturbed patient (Read the article here: http://firefighterclosecalls.com/fullstory.php?103256).  The latter article doesn’t elaborate on what exactly happened, and in the next few days I assume we will hear more, but it is a stark reminder that we all need to remember to keep our scenes we work as safe as possible. Some things to remember:

• Don’t go into a potentially dangerous situation until you have been cleared to enter.
• Stage appropriately for issues involving potential violence or emotionally unstable patients.
• Always approach a scene (any scene) with caution. Look around. It might not be a patient that is dangerous, but something or someone else around. I work around moving vehicles (primarily bikes, but cars as well), but I have been hit by a bike while working on a patient before. I could have approached that scene more carefully, and avoided the problem.
• Know your agency or provider’s protocols. Adhere to them.
• Ask for backup or PD involvement  if you feel you need it.
• Always keep your eyes on an emotionally unstable patient. Even if you have a good relationship with a patient, they can turn on you in a heartbeat.
• Watch your partner. Remind them if they are doing something that places them (or you) in potential danger.

Stay safe out there!

Things are getting busy again, EMS-wise. Been working A LOT lately, especially as mountain biking season is really here. People are getting on their bikes again, ready or not, and having fun in the hills riding around at MTB races. Its great to see! Problem is, mistakes happen, riders crash, and we are there to find them, stabilize their injuries, and then either have them transported by a nearby agency or provider, or they go to the hospital themselves sometimes. Then there are those who won’t go no matter what. Yes, they are hurt, but they will self-treat.

Last weekend, I saw both of the first two types of patients. Had a patient with an injury from a bike crash that I felt really needed transport to the hospital by ambulance, but he “AMA’d” (Against Medical Advise) on me. Basically, we have a document that explains that we feel he should be transported, but that he declined, knowing it could cause worsening injury or illness. It happens. And it is his right to do so. I had no reason to believe that he was not able to make his own decisions at that time. I did let him know that if things got worse, he could still be transported. He went to the E.R. with a family member driving.

The other was also a bike crash, but in this case, due to his injuries, I assumed control of this patient. In essence, he didn’t have a choice about going. Certain criteria, such as a positive loss of consciousness, or being under the age of 18, among others, allow us to make decisions for a patient. He wasn’t in a position to argue, unlike my first patient. We stabilized him, and transferred care to the transporting ambulance service, who delivered him to the hospital for further emergency care.

The third type of patient is one that causes me some angst. Many times, I know they don’t have insurance, and really cannot afford to get seen, yet they need to be. I’ve seen some self-treat HIGHLY SUSPECTED fractures. As an adult, they have this right, unless I have cause to make decisions for them. It still leaves me with an uneasy feeling when it happens. Sometimes, even weeks later, I manage to convince them they need to be seen. With the type of EMS I provide, I see many of my patients at multiple events (and yes, even treat them multiple times… we have our own “frequent flyer” (no pun intended) club of sorts. So, frequently, I get followup on many of my patients, either through them, or friends who are racing with them. I have to admit, its odd being on a first name basis with a lot of them. But a good sort of odd.

So, a question for you… Do your patients who AMA or self-treat get you thinking, and yes, worrying? Or do you put it out of your mind once you are done?

My arm is better and better every day. I worked this past weekend, and didn’t even give it second thought when we lifted a patient that we had c-spined. I just sent an email to my ortho asking if I can start riding and strength train my arm again. Here’s hoping for good news!

I miss being on my bike.

I miss the wind in my hair.

I miss the feel of the trail as I ride.

I miss the sounds all around me.

The stationary bike just doesn’t do it for me.

Soon, we will be reunited.

And I will ride again.

Maybe tomorrow.

Definitely tomorrow!

GREAT!

Fantastic!

Incredible!

Well, maybe not incredible, but great and fantastic. I saw my orthopedist today, had more x-rays of my elbow, and I found out that:

• The bone spur (called an osteophyte, by the way) is resorbing (going away).
• The contusion was significant. I saw the MRI myself today. It takes time for that to go away, especially in an area that isn’t known for a good blood supply.
• It will take another 6 weeks for this to completely heal. It IS, after all, a fracture!
• By being compliant and staying in the brace until he let me out last week, I really made it possible for my elbow to heal the fastest and the best. In fact, the MRI and most recent x-ray PROVE I was compliant. It was in not moving my elbow that it began to remove that fractured bone spur. The doctor was quite impressed that I didn’t “cheat”.

So, the upshot is, I am clear to work EMS now. I still have to build back muscle and strength, especially in the triceps muscle. My arm will continue to improve, and should be “normal” by the end of the next 6 weeks. My doctor was impressed with my mobility and that I didn’t jump off the table in pain this time. I did let him know that it is hard to sleep at times, and that it still seems “stiff” (remember, I am normally extremely flexible). That will improve. and go away. I need to encourage blood flow to my elbow (i.e. heat and massage), and use ice massage after exercise. I need to keep working my arm out, and can now start using weights (slowly increasing them). I want to get back on my bike, but I do need to follow what my doctor tells me and continue to be patient. Within a week or two, maybe.

Thank you to everyone who has been so supportive during this time for me. It really is nice to know how many people really care! And it is very much appreciated.

For a while now, I have been meaning to move my blog from Blogger to Wordpress. And I procrastinated. For years. However, a recent email from Blogger made me re-think my procrastination. They let me and many other Blogger members who use their FTP function to post our blogs on our own domains that they will no longer support FTP as of March 26, 2010. I guess they figured out that it didn’t make any money for them, so that feature is being taken away.

No problem. So, last night I created my Wordpress blog, and populated it early this morning with my entire blog from Blogger. It took a few extra steps, as FTP import from Blogger is not supported by Wordpress. Some very creative individuals discovered that you can take your blog back to Blogger (use a blogspot.com domain) temporarily, then import it, and it works. Sure did for me! It looks like everything is behaving.

If you see something now functional, let me know. In the meantime, I will begin to add “sidebar” content, and make the site more to my liking over the next few days.

I hope you like the new look!

Renee

I went to a massage appointment today, mostly to get the crud out of my muscles. I picked up a bug recently, and was left pretty sore everywhere by it. But I had the CMT work on my left arm as well (not around the elbow, but all the muscles around it), and my shoulder. By the time she was done, I had more comfortable movement in my arm in a long time.

So, I fired off an email to my orthopedist, letting him know that I had really good range-of-motion, and that the massage really opened it up. I also asked if I could start going without the brace, as I didn’t think it was making much of a difference right now. About 30 minutes later… I got his blessing to remove it.

Yep! I am hardware-free! While I have it if needed, I am working slowly to get my arm back to its norm, and hope to never wear it again. I still need to wait on major strength work until I get cleared on the 11th, but this is a significant step forward for me. My mobility is really good. With increased range-of-motion, I started feeding myself with my left arm again this week (Thankfully! Try using chopsticks with your non-dominant hand!), which has improved my muscle tone a bit, and my arm is no longer shaky when I hold something.The back of my arm is still tight near the elbow, but I suspect that will improve as well. Muscle-mass… um, yeah… there isn’t any right now. Once given permission, I will be doing some serious strength training again, to get that back. My poor right arm has been a victim of overuse syndrome, so I am sure that will improve as well.

Marching onward! I will be back on my bike soon! And working more hands-on in EMS again.

On January 25, 2010, I became a student again.

No, I didn’t quit my day job; I am still working for the State of CA. What I did do was to sign up for two classes at a local community college this semester. The first is Introduction to Investigations. I have had an interest in criminalistics and forensics since before “CSI: Crime Scene Investigation” debuted on television. After all, I am a microbiologist by training. I’ve been thinking about incorporating criminal investigation into my CV, so I figured this was as good a time as any.

The second is one that is the real love… it is a pre-paramedic class. Basically, this class gives students a “leg up” with paramedic training, something that I am absolutely going to get. The program is totally different than when I got my EMT-II back in the early 1980’s… I am effectively starting over. We didn’t have 12-lead EKG. We didn’t have the autonomy that paramedics now have. We didn’t have most of the drugs that are now in the arsenal (And some of the ones we used are no longer there, or are not frontline meds.). We weren’t allowed some of the advanced airway techniques that are now in use. Yes, we did endotracheal intubation, and we had esophageal airways (Those were actually in the EMT-I scope of practice at the time).

Twice now, the part-time program I wanted to take was canceled. One way or another, this WILL happen. I will find a program. Somewhere.

I don’t normally share other blog’s posts here, but this one deserves a special place:

http://6yearmed.blogspot.com/2009/05/quiet-place.html

She gets it. She REALLY gets it.

Last Friday, I contacted my orthopedist, because I was concerned about some things with my elbow. These were:

• Could not bend my elbow more than 90 degrees without pain (I have been doing exercises per my orthopedist for mobility, not strength). I wasn’t sure if the pain was due to the tendon tear, or due to it needing to be stretched.
• An odd “ache” that had started, with no known reason
• No major improvement since I saw him on January 11th.

 During my last visit, he offered the opportunity to MRI my elbow if I had increased pain, or no major improvement within a few weeks. So, after sending my email to him on Friday morning, I was surprised to get a phone call from him in the afternoon.He decided it was a good time to get that MRI done. He sent off the request, and gave me the number to call to followup ASAP. So, after getting off the phone with him, I did just that. I left a message for the MRI scheduler, figuring I’d hear something in a week. I did mention in the message that my doc had just put the request in for an ASAP MRI.

Surprise! I got a call 20 minutes later. And an even bigger surprise… an appointment at 5:30pm that night. I took it.

I showed up, and was taken to the MRI trailer. I’ve had 3 other MRI’s, so this one wasn’t a concern. Some people have real issues with the noise and the claustrophobic feeling the tube can cause. I’ve actually found the sound almost soothing. I know… I’m wierd. You can’t have magnetic metal at all in the MRI tube. I removed my glasses, elbow brace, put my keys and ID on the counter next to my brace and glasses. Hearing protection was given to me, and I was placed in a modified “Superman” pose, prone (on my stomach), with my left arm straight out past my head, my arm locked into a tube with wedges placed inside (stuffing material) for the machine to do its magic on and scan my arm. My head was cocked to the right a bit, with my right arm bent and under my head. I had a pillow also. The scan was expected to take 30-40 minutes.

Initially, it wasn’t a problem. About 20 minutes in, my deltoid and biceps muscles (shoulder and upper arm) began to cramp and spasm. I tried to not move, and succeeded for a while, but after 10 minutes, the pain from the spasms was too great, and I couldn’t help it. MRI’s are very sensitive to movement. So the last 2 scans didn’t come out. They needed to be repeated. I mentioned to the tech what was going on, and I had two choices… hold still no matter what, or come back another day after taking a prescribed muscle relaxer. I thought about it for a minute, and decided to just get through it. I did a little repositioning of my head, and rubbed the muscles for a second, then tucked my head down and went somewhere else for the next 10 minutes. Where did I go? I went to the beach; walking on the wet sand at the water’s edge in Huntington Beach in my mind. Great trick I learned years ago when dealing with pain. Doesn’t always work, but most of the time. But the pain was mounting…

I was just about to say I couldn’t do it any longer, when the tech announced he was done, and he got the last two scans. Whew! He pulled me out of the tube, and initially I couldn’t make my left arm work. It was like a limp noodle. Started wriggling my fingers, then wrist, and finally could get my shoulder to cooperate enough that I sat up. It still didn’t want to move much. And a good part of my shoulder had actually gone numb. Got my brace back on after a few minutes, and then was escorted back into the medical center, where I then left to go home.

I sat in my car for several minutes before leaving. My shoulder was twitching and cramping constantly. It plain HURT. But, the scan was done, and I hoped it would tell what the orthopedist and I wanted to know: How bad was the carnage in my elbow?

When I got home, I emailed my orthopedist to let him know the scan was done. He emailed back to me that he would check on it first thing Monday morning. I took some pain meds and went to bed.

Sure enough, on Monday, I got an email from him around 8:40am.The MRI confirmed the fracture in the bone spur, and I have a helluva contusion (bad bruise) on the triceps tendon, BUT THERE IS NOT A TENDON TEAR! WOO HOO! YEE HAW!!! We emailed back and forth a bit, with him warning me to “behave myself” (in other words, don’t be working EMS directly – still supervisory only). Of course! I want this to heal NOW.

So, I can deal with a fracture. Bones heal eventually (usually). This is a bone spur, so it might not behave. If it doesn’t there are options. So, I am still allowed out of the brace for minor range-of-motion exercises, and to shower. That’s it. No lifting, tugging, or pulling on the arm (Not that I have anyway… I’ve been good.). My next appointment is on 2/11/10. Here’s hoping it is healed by then.

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