The MacMedic

No calls and some good and well deserved sleep. I really should no better than to schedule myself for 36 hours straight. Even though I got some sleep Friday night and didn’t have a busy day yesterday I was still starting to feel it by the time last night rolled around. Could it be that I’m not as young as I used to be? Nah, impossible.

I almost feel guilty getting paid for today. I ended up being on with one of our newest paramedics and he and another volunteer took the only call that came in during the day shift. I stayed back in quarters ready for a second due call and doing paperwork to clean up another one of the projects that I had accepted. This one was the justification and recommendation for a new online scheduling service to replace our “home grown” system which, although it served admirably, is long in the tooth and no longer meeting our needs. With this paperwork done and a demo of the service mostly configured a decision is imminent. I did get a lot done so even though I did not go on the one call for the day I do feel like I was productive and the day was worthwhile.

Now that the students are gone Friday nights are quiet. Tonight was no exception. Only one call, an woman in her sixties with chest pain that resolved after one spray of nitroglycerin. Not very exciting and I was not very upset. I picked up the paid day shift today and it was really helpful to get some good solid sleep before going in to work.

My back case of Short Timer’s Disease has been reined in and I am once again able to steel myself and come in to work. Last night was another horrid night with everyone sniping at each other and doing everything in their power to throw the others “under the bus” so to speak. I stayed out of it. I just wasn’t going to play that game.

My manager was working the 24 hours shift left vacant when another of the per diem employees left recently (1 of 3 that left actually, not including me). I had the chance to sit down with her and have a very nice chat as to why I wanted to leave and what I hoped for in this new position. She let me know that I was welcome back at any time and that if there was anything she could to to help me I should not hesitate to call. It’s always nice to know that you are not burning bridges when you leave a job.

I had everything I could do to not just tell all the people that had annoyed me over the past 2 1/2 years exactly what I thought of them. Short timers disease is a terrible thing. The night sucked but I didn’t care. I can count the number of shifts I have left on one hand and that, in and of itself is very exciting to me.

Even though it is a holiday the general manager of the ambulance was in and working today and asked if I could stop down and chat for a few minutes. I generally get nervous when I am asked to come in and have a special meeting with any of my bosses. This was nervousness tinged with a bit of anticipation. Did I do something wrong or was I going to be getting a new job?

“Welcome Aboard” was what I was told after we got to the most private place in the building (the kitchen). He was offering me a full time, 40 hour a week position. The schedule was not finalized but it would be a mixture of 8 hour days and 8 hour evenings Monday through Friday.

I will get the final wording of the position description later this week but from what we talked about I accepted with out hesitation.

I went home relievedand had a difficult time sleeping to get ready for my night shift tonight at the hospital. I finally gave up trying and got up and called my manager at the hospital to break the news to her. She was surprisingly supportive and said that I could bring in my written resignation later and that she would meet with me later in the week. Only after this was done was I actually able to sleep for a couple hours.

I woudl say it was an uneventful day but it would not exactly be true. It was a day that required more preparation than any other day during the course of the year and because of that preparation it was uneventful. The University held commencement today, almost 3000 students graduated today and between the graduates and their friends and families we had several thousand extra people in town today. We staffed all three ambulances at the paramedic level, had four foot teams patrolling the stadium ready to respond to emergencies on the grounds and a joint command post with the fire department.

We were prepared and it showed. The grand total for the eight hours we were in “all hands on deck” mode was 1 transport. Everything went pretty smoothly with the exception of the police not sending a representative to the command post so we could have a bona fide unified command structure. Even so, the FD rep told the EMS rep that things had gone too smoothly and they had worked to well together and that they had “better leave with scowls on their faces before the fire chief thinks they actually liked working together”. By and large we really do like working with the fire department and it is only select individuals that try to muck that up.

Even after the commencement crews were told to stand down I was still on duty, a full 24 hour shift for me. I actually only did one call and that was only to fill out the crew to transport a chemotherapy patient who had a sudden onset of nausea that spontaneously resolved itself prior to EMS arrival.

Back again for another 12 hours in the black pit of despair. This time I was in the ED itself for the entire ngiht, no time in triage at all, and it was (dreadfully) slow. Around 0530 the charge nurse asked for volunteers to leave early. I volunteered and was home by 0615, I really need to hear about this job that I interviewed for. One way or another I really need to leave here and get a job that I can actually tolerate.

I was assigned to the intercept unit last night, a real change from my usual drone duty in the ED. What wasn’t a big change was that I did absolutely no ALS. The only ALS call done was done by my partner and the most exciting thing I did was to follow the transporting ambulance to the distant hospital they were transporting to and repack his equipment.

I still haven’t heard the results of my interview. That makes me a little anxious and worried. I really need to get out of this place before I lose what little mind I have left.

It seems like it should have been done a long time ago but tonight the volunteer ambulance finally made operational changes to improve our efficiency and ability to better respond to calls for service.

For as long as anyone can remember our operation personnel have been stratified into three  levels and our qualified crew required one of the top level and one of any other level to respond.  The problem is, when you take away all of the top tier personnel who live out of town, or are paramedics filling duty paramedic slots, you are left with 8 people covering that position. Clearly that is not enough.

A few years ago the operational guidelines were amended so that two of the second tier members could together be a crew. This helped a little but left a quirky problem. If the ambulance signed on with one of the bottom tier personnel waiting for another crew member this second tier may as well roll over and go back to sleep, they could not qualify the crew at all. Likewise, if the ambulance was on waiting with a second tier member all the third tier members rolled over again. Two classes of people who were feeling like their contributions were minimal.

The proposal fielded tonight was in part to collapse this structure and only have two classes of members, crew chief and attendant. One of each would be needed to qualify a crew.

Initially there was a lot of resistance from some of the membership. They viewed this as decreasing our standards and harming the quality of care provided. Eventually, however, as the plan was fleshed out and the new training requirements that go along with each position were made public much of the resistance subsided.

The plan was pretty comprehensive and committed to some other things as well. The purchase of an actual paramedic intercept vehicle was committed to with in 6 months. This should help us considerably as it would mean that the duty paramedic would be responding in a vehicle with equipment, radios, markings, and lights. A definite step up from responding in our own vehicles to meet the ambulance.

The last thing that was in the plan was potentially the most controversial. The addition of officers to the operational structure. The idea being that an officer would respond to calls that needed additional management skills that the average member might not have. Multiple casualty incidents, haz mat, structure fires, violent crimes, and the like would all get an officer responding to provide additional support to the crew, watch their back, liaison with other organizations, and in general be able to run interference to allow the to do their job. The corps of officers would be small, just 8 or 10 members with proven leadership and scene management skills and they would have free reign to respond whenever they thought they might be needed.

For all of the resistance that was verbalized the debate was short, the objections few and the vote unanimous except for one abstention. Progress.