Trauma: Jesse’s Life in the ER

ems, emt, firefighter, firefighting, jesserobbins, lessons, stories

Date: May 25, 1999 12:37:47 PM PDT
From: Jesse Robbins
Subject: Trauma: Jesse’s Life in the ER

In my last entry, I was describing the pride and confidence being in my EMT uniform inspired in me.  As I pulled into the parking area for the ER and passed 3 ambulances cleaning up after a call that confidence rather quickly changed to excitement and fear.  Over the past months of training we have been given a practical set of skills, most of which we have been told will be useless on a real patient until we get hands on experience.

What was quickly becoming apparent to me was that this was going to be when I get that experience.  Even if closely supervised, anybody that isn’t a little shaky when they realize that responsibility for the care of another human being is about to be placed in their inexperienced hands hasn’t quit grasped the fullness of the situation.  A lot of what-if’s and oh-shit’s go through your head, mostly questioning yourability to operate smoothly under stress.

I met with the charge nurse and another Mission college EMT just finishing up her rotation.  She had done 7am-3pm, I was set for 3pm-2am.  I got a quick rundown on her day, and then was sent off to triage in the ER.  Triage(French for “to sort”) is the process that you go through in the ER to determine treatment priority for walk-in patients.  If you arrive via ambulance you will be at least given a bed right away.  The nurse working triage that shift was a wonderful woman with an Irish accent.  After a quick acquaintance we let the first patient in.

Here’s what I learned in Triage:

  • About Infants:
    1. Unlike the plastic infants we train on, and unlike the books description and instructions for taking vital signs on infants, they do not hold still nor can the be bribed or otherwise convinced to stop. Palpating a brachial pulse on a wiggling infant is a joke.
      To get around this, I learned to use my stethoscope to simply listen to the heart and get a pulse that way.
    2. Using a stethoscope on a crying infant to get a pulse is harder than getting a brachial pulse on a wiggling infant.  Infants also, apparently, wiggle and wave their arms about when crying.  Sometimes they can be convinced not to cry by giving them some part of your person, clothing, or more importantly stethoscope to examine or play with.  This does not  stop the wiggling.  If you have given them the piece of equipment needed to perform the assessment in order to bribe them to stop crying, you have made an especially large mistake.
    3. Once an infant has hold of any part of your person, clothing, or stethoscope dangling off of your neck, it may be necessary to use a vehicle extrication tool such as the jaws-of-life to get them to release it.  21,000 PSI hurst spreaders are recommended.
    4. There is nothing more appealing to an infant than a stethoscope dangling from your neck.
    5. There is nothing less appealing to an infant than having some mean man in a uniform try to take away the shiny thing with blue tubes coming out of it.
    6. Once an infant grabs the head of your stethoscope in it’s clutches, it will soon have the head of the scope firmly in it’s mouth.
    7. Replacement diaphragms for Sprauge-style dual head steths come in the little box it came in.  There are 2.
  • About adults:
    1. The general level of calm exhibited by a patient with a feeding tube that has been unintentionally removed by a family member providing care is proportional to the level of hysteria exhibited by that family member.
    2. If at first your attempts at speaking Spanish to a patient fail, seek a translator.
    3. The term “Student” strikes fear into the souls of the ill and injured. Therefore:
      The proper way to answer the question: “Are you a doctor?” is “No, but I’m going to help you until a doctor can see you.” and NOT “No, I’m only an EMT student, but I can help you until a nurse or doctor can see you.”

I then did 8 hours in the actual ER.  Here’s what I learned…

  • About the airway:
    • A human being, unlike the airway model we use to learn suctioning,    has fluids, objects, and a movable, muscular tongue.  Also, unlike the model we use, things don’t always just fit or slide in.
    • Don’t look into the mouth without a face mask on.
    • DON’T look into the mouth without a face mask on.
    • DON’T LOOK INTO THE MOUTH WITHOUT A FACE MASK ON.
  • About humor:
    • Hard as it is, you must not laugh at or tease the drunk student with scalp lacerations who fell through a mirror while urinating.  Even when he asks you “You probably think I’m pretty stupid, Huh?”.
    • Nurses, on the other hand, can be as cruel to the patient as the situation warrants.
    • Hard as it is, you must not tell the friends/girlfriends/concerned frat-persons that despite the best efforts of the ER, their friend    will live.
  • About the Police:
    1. The number of times a patient will explain to you that he didn’t do anything is directly related to the number of police officers in     the room.
    2. Once the second ambulance arrives, and the victim of the first patient is put into the vicinity of the first patient, his assertion that he did nothing will become an exponential function of the number of cops in the room.
    3. Although a nearly infinite number of Police Officers can cram themselves into an ER, there will never be enough x-ray shields to fit them all behind.
    4. Once the police have positioned themselves in a room, the doctor will then arrive and not have enough space to get to the patient.
    5. Once a patient has been arrested, the number of times he will say    “Thats f***ed up” is twice the number of officers in the room.    Also, every time an officer enters the room, he will say it again.
  • About equipment:
    1. As a firefighter, we are trained to trust our equipment.  Hospital workers are trained not to trust their equipment.
    2. The more a patient is bleeding, the less time it will take to get a CT scan completed.
    3. The more critical the patient, the more likely the respirator will fail.
    4. I had a wonderful time in the ER.  I have a newfound respect for the people who work there every day.

Up next… How to remove the roof of a car in 2 minutes with only a hack-saw and a lift jack.
Hope this finds everyone well.

-jesse