Blood, Guts, and Butts

By Anal Glaucoma

A look into the life of a paramedic. The training, levels of care and the calls. See what a paramedic deals with in their profession. The good and the bad as well as the absolutely crazy!

• Language: English
• Publisher: Lulu.com
• Release date: Jul 14, 2015
• ISBN: 9781329381407

Book preview

paramedics.

The Levels of Care

Where I'm from, we have three recognized levels of care. Primary Care (or PCP), Advanced Care (ACP), and Critical Care (CCP). These are further separated in land EMS versus flight EMS (and trust me...the versus is real on occasion). Each level has their own scope of practice and are all regulated by a base hospital. All paramedics operate under a doctors' license and are required to be certified by a doctor every year. We have mandatory yearly recurrent training that is put together by physician (for air ambulance, it's twice a year along with monthly training). The one bonus we have...we absolutely, never again, have to take a standard first aid course. For those of you who read this and work as medic, you understand the mind-numbing pain of sitting through a three day course of basic first aid. It's usually taught by someone who has never done CPR (so they haven’t experienced the cracking of ribs followed by the squishing and grating of the bones together and the muscle tissue tearing) or been in contact with an actual patient rather than a theoretical one with theatre make-up on. You sit there and think of how much fun it would be to jab a pen through your eyeball, instead of listening to someone yap about how to bandage a cut or survey the scene. ANYWAY....back to the levels of care.

The Primary Care Paramedic: is capable (generally) of doing the usual first response, but can give seven medications or eight...depending on where you are working (because, God-forbid we had someone to regulate that crap for all of the services). The drugs for this level are usually limited to Nitroglycerin, Glucagon, Epinephrine (but only for asthma, croup, and allergic reactions), Gravol (if you're lucky), baby Aspirin, Ventolin, Narcan, and a beautiful thing called Toradol. They can run a cardiac arrest (without medications) and if you have one of the chosen ones, they'll be able to start an intravenous (I.V.)but unfortunately will not be able to run anything through it (seems appropriate, right?). At least they'll be able to do CPR and defibrillate (no, we absolutely, under any circumstance DO NOT...I repeat...DO ABSO-FUCKING-LUTELY NOT perform mouth to mouth). That shit does not fly (possibly if it was someone you knew really well...but even then, the chances of getting vomit in your mouth that doesn't belong to you is so high...and I mean explosive stomach acid vomit that could rival an active volcano). I would probably call you a complete frigging idiot if you tried it. For those who have actually done it...l shudder at the thought...WHAT THE HELL WERE YOU THINKING?? Ugghhh...on to the next level of care.

The Advanced Care Paramedic (the Demi-God; still partially human, but has the beginning of the God Complex): you are awesome and can do whatever you want! Just kidding, but that is pretty much what some people (medics with douchetard syndrome) seem to think. This is where the free-for-all of I know everything which goes hand-in-hand with the my shit doesn't stink starts (aka. God Complex) until that baby medic gets a call that causes complete pucker factor (meaning their butt cheeks clench so hard that their asshole retracts up into their diaphragm) and they realize that they know absolutely nothing, and they need to take it down a notch and ask for help.

It's in this level that the air ambulance medics and land medics make a big split in scope of practice. Land medics (I may be a little off here, since I've only worked Advanced Care for air ambulance) can give a variety of medications, intubate, start I.V.'s, insert I.O's (intra osseous­ meaning they can drill a needle into a large bone to give medications if they cannot start an I.V.); perform and read ECG's (electrical pictures of the heart); and pronounce a death in the field. Primary can pronounce as well, though some physicians are more comfortable with the higher level of care doing it instead (we tend to have more contact with the doctors-so they know us better).

For air ambulance, Advanced Care Paramedics can do the above items as well as run I.V. infusion (continuous medication), give a shit-ton more medications (including clot busters for heart attacks), perform emergency stab a hole in your neck so you can breathe cricothyrotomies, use a ventilator (on the patient...preferably), use an external pacemaker, run blood transfusions, and a bunch of other crap that doesn't sound as cool as the ones listed above (though still important).

And then there is Critical Care: this level of care is only available through air ambulance. The only time you will see this level in the back of a land ambulance is: 1.We are getting a ride from them; 2. We are using our own land ambulance to transport a patient; or 3. We've done something atrociously stupid when we were off and required an ambulance ride to the hospital. This level of care is the ultimate and final level. This is what a lot of paramedics aspire to do. It is the elite...there are not many Critical Care Paramedics floating around. You have to work your ass off and be the best medic you can be, to get there. The doctors place their ultimate faith in you, and allow you to do whatever (in a slightly restricted sense otherwise known as the grey area) you need to do. They place a lot of trust in you and your capability to assess, recommend, fix, and treat the sickest of patients.

A CCP can perform all of the ACP scope, adding in any medication known to mankind, along with an aortic balloon pump (balloon that is inserted into the aorta to help with the pumping action of the heart); an internal pacemaker (has external wires to hook up to). A CCP is also a neonatal and pediatric specialist...that's right, a CCP has to know and do EVERYTHING to be a mobile ICU for any type of patient.

This is, by far, the most complex and insanely stressful level of care to be at. But to go with that is the ultimate feeling of accomplishment. You are the highest level of care available without having to go to medical school (F.Y.I., our scope of practice majorly beats out the nursing scope of practice by a long shot...though some don't like to believe that).

I am a Critical Care Resident (which means I have completely the CCP program and I am being preceptored by another CCP medic). I get to rock out shifts to get certain things signed off by my preceptor to make sure I won't kill anyone. After the preceptorship is over, I will enter Mordor and try not to through myself into the pit.

As I have said previously, I have been a medic for eleven years and I have worked both land and air (my preference being air...sorry guys, but I needed to stretch my brain a bit more, but I didn't want to go to medical school!). I pride myself on being a a mellow, calm and collected individual, especially in the shit storm situations where losing your shit tend to make people panic. I have seen some really fucked up shit (there is really no other way to describe it) and I've done some pretty strange stuff (well, non-medics will think it's strange). I will hopefully entertain you with some of my most memorable moments in the past eleven years (or scare you, possibly both).

The Training

THE TRAINING

Training for the levels of care and for yearly certifications, varies widely across the world. We have tried repeatedly to get a college, but it hasn't appeared for us yet. The basic level of care takes two years to complete. That one is pretty much standard. Unfortunately, the didactic portion (the book work) varies from college to college. Some certify their medics with I.V. starts and other allow for 12-lead ECG's. Everyone comes out as the same level of care. Your service tend to up-train you, if you're severely lacking on any aspect (or they feed you to us...and we tend to eat our young). Not lacking in the sense that you're really shitty at what you do (this would be a sign that you shouldn't be a medic). Nothing can really fix that. Some people try to coast, others are keen and eager to be the best.

What I've noticed over the last five years or so, baby medics are coming around as newbies that have a serious sense of entitlement. It drives me crazy. These kids (and some are way older than me) have horrible attitudes and expect everything to be handed to them on a silver platter. Well, guess what, Buttercup...you are gonna eat shit faster than you could ever think possible. I love when these guys punk out on their first bad call, then proceed to skulk around the base after with their high and mighty tail tucked between some really sore ass cheeks.

I graduated from a small college after two years...two years of HELL. The local EMS service was hellbent on cutting anyone they didn't see fitting into their service. By cutting, I mean they would try their hardest to fail you. I had such a pleasant experience. I am a small person (small stature...not quite a midget, but small enough to be considered an elf), but I like to think that I am pretty strong. I haven't dropped anyone in eleven years, at least not by accident (that's a whole other story). Our fitness testing ended up being the police Fit-For-Duty test. It was a 2.5 kilometre run  followed by push-ups,  sit-ups, flexibility,  dead-lifting, and the Grand Pooba of carrying a three hundred and fifty pound stretcher up and down two flights of stairs without stopping. Now, there's a huge issue with that last lift. If you want to throw your back out, that is certainly the way to do it. This is why the paramedic  god created the stair chair...not the stair stretcher. My first go at it, the girl that I was lifting with  managed to let go of the damn stretcher. I caught the complete weight on my forearms  and tore right through the muscle. I almost fell backward down the stairs. Awesome-sauce. I had two large dents in my forearms for over a year, before the muscles healed. The medic that was running the test, took me aside and told me that I was too small to ever be a big, bad paramedic. Which was funny,  since he wasn't much bigger than I was.Well, I showed his ass and completed the test without a hitch. The best part, after I graduated and was being precepted to be an ACP (six years later), karma bit him in the ass and he fell off of a cliff while mountain biking (I know, right?) which left him physically incapable (for the time being) of completing  the ACP program.  Gotta love karma...she can be a  real bitch  sometimes.

Back to the rest of the program. You participate in scenario testing which is done in a human simulator with insanely creepy mannequins that rival Chucky; with a couple of people breathing down your next as you try to save a rubber doll. This is also where they try to fail people. I’m not quite sure why. There are critical errors that you can get, most of which come with giving the wrong dose of a medication, the wrong type of medication, or giving a medication so someone