A few thoughts on Emergency Medicine

I served as a medic in the Singapore Armed Forces for 2 years; I served as a New York State Emergency Medical Technician for 3ish years while serving at my college’s emergency medicine squad. I just wanted to write about a few weird things we do in EMS and just a few things about EMS in general.

Sacred things that do not remain so while on call

Eating, sleeping, showering, pooping. These are all things that many people deem too precious to be interrupted – I like to think of it as “me time”. Something that should be done in one sitting or session. Right? When you work emergency medicine, those things suddenly lose their “me time” holiness and their time is stolen away by your patients.

Generally, this is how we feel when this “me time” gets cut into:

Don’t get me wrong – many of us do what we do to be able to help our patients and this is just one of the side effects. Any momentary annoyance is (hopefully) never directed at them, but what these little interruptions do is instill a sense of fear in us every time we sit down to do these activities while on call.

I try to do all of these things before and after my shift – never during. I’m petrified of that one day I have to sit down and do my number 2 while on call…it’s happened to a friend of mine before and apparently, it wasn’t pleasant. If I do eat on shift, I inhale all of it without really chewing or tasting. Sleeping while on call is sometimes necessary because it’s an overnight shift or because you’re working such a long shift that it’s impractical not get any sleep. Does that mean you sleep well? Not at all. You never quite fully fall asleep because your peripheral senses are listening for that tone and vibration for your radio/pager and the always seemingly awake voice of your dispatcher.

No, these things are no longer sacred as soon as you don your uniform and check out for the shift.

Taboo words: Quiet, slow, boring, peaceful, other similar words (the first two are especially bad)

Examples: I hope you have a quiet night! Man, what a slow night. Gosh this shift is so boring. Look, it’s so peaceful outside with all that snow.

When you are on call, there are some things that you and/or those around you should not say. The first two examples will get you a severe glare and lots of swearing when, inevitably, the shift takes a turn for the worst. Extra hate points if you utter “Wow, it looks really quiet outside. I hope you have a quiet and slow night!” It’s basically like inviting that one pregnant woman to have her kid early or for a 30 car pileup to happen because of that “peaceful snowstorm” your partner or your friend was just commenting about. Hate. Them. All. Some people like to tempt fate, like those saying “Macbeth” in a theater setting. Don’t do it.

I read a short story once about a young intern who was doing his first night in the ED and asked one of the nurses why it was so quiet. Within the next hour, a patient came in with the ambulance with so much bleeding that the entire receiving area got blood on it. Guess who was given a mop and cleanup duty?

So please, the next time you see a friend on call for the police/fire department/emergency medical services, do not utter these words. If you are a new member of any of these teams, remember this and don’t be that rookie on the job that utters any one of these words.

Yes, the paperwork REALLY doesn’t end

Even as agencies slowly transition to electronic databases, documentation and paperwork really never end. For starters, you have your basic demographic information for you patient: name, age, gender, address, phone number, birth date. Then, you have a bit of their medical history: current medication, allergies, past medical history. And then finally, we can talk about why we’re there to see them in the first place…I won’t even begin to go into the documentation that goes into that. Pertinent negatives, filling out all fields in the document even if they are not relevant, that takes time and ink.

I understand the need for it. We are told to document so that in case we are ever summoned into court with only that patient’s documentation that we provided, we would be able to remember all the details of that call just from that paperwork. Still, we can complain, right?

Black cloud, white cloud

Some people who have heard me and my EMS friends talking about this think we’re being racist. We’re not. The color cloud that we are referring to just talks about the number of patients that person gets while they’re on shift – a sort of “hot streak”, as it were. For example, my senior year, I was the biggest black cloud on the squad. Every shift I was on basically had a call. At the end of the school year, I had about 20% more calls than the next leading crew chief behind me (we keep score…don’t ask). To contrast, someone who became a crew chief around the same time as me had 4 calls on year despite the number of shifts. White cloud.

Easy enough, right?

I think that’s all I’m going to write on the topic of emergency medicine for now. I’ll make a post about funny and/or patients (HIPAA compliant, of course) at a later date. Until then, as always, thoughts and comments appreciated!

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