Wednesday, April 28, 2010

My Father Was An Ambulance Chaser - Part 3 April 2010


Armed with a diploma from the Stanford University Hospital
Paramedic Program,
documentation from Highland Hospital in Oakland that I had passed
my hospital rotations, documentation from Southern Marin Fire that I had treated the required number of ALS (Advanced Life Support) patients appropriately,
as well as a folder full of certifications:
BLS (Basic Life Support), BTLS (Basic Trauma Life Support), 
PHTLS (Pre Hospital Trauma Life Support),
ACLS (Advanced Cardiac Life Support), and 
PALS (Pediatric Advanced Life Support) — I was still a very 
long way from being employed.  Visa was beginning to send 
thank you cards.

Now, California wanted to know about me.  
Did I have a record?  No.
Did I do drugs, no - please leave urine sample as proof.
California DMV (Department of Motor Vehicles) 
wanted to know if I had any driving infractions.  No.
How about drunk driving?   No.
Well then, you must come by the nearest DMV, pick up your
ambulance driving manual and study it for your exam.
But before you take the exam, we want a full physical
by OUR doctors. . .not yours.

I passed the physical exam, passed the ambulance drivers
exam, and was awarded a license to drive ambulances
in the state of California for 2 years - renewable.  

I was STILL not employable.

California required all paramedics to pass
the aptly named, 4 hour, BARE (Bay Area Regional Exam)
before you could work on any ambulance
in the state as a paramedic.
The nearest and closest exam was to be held in
Sacramento in 2 months.
More studying, more stress.
I passed
and was blessed by the state of 
California to start job hunting.

My first choice was San Mateo County, they had an international
airport and 2 little ones, a long coastline, mountains. urban centers, 
freeways, and a brand-new company
that had designed and purchased a fleet of new ambulances
and equipped them with all the latest high-tech
sophisticated  bells and whistles.
We even had TVs between the captain chairs in the cab!
Each ambulance was stuffed with all the latest medical equipment.
And they paid well too - woo hoo!

More hoops to jump through.
San Mateo County perused my paperwork,
Baystar (my potential employer) gave me
oral interviews, written testing, skills scenarios, orientations,
CHP (California Highway Patrol) ambulance
drivers ed and testing,
and assigned me to a crew for an ALS 
5-call evaluation.

There is nothing in all of this training and testing that can
prepare a new paramedic for their first day on the job!
With every crackle of the radio; my heart rate soared,
I perspired profusely, and turned a whiter shade of pale. 

There were 9 hospitals in San Mateo County,
I couldn't find any of them. 
I lived 2 counties away and was not familiar with SM.
My partners quizzed me between calls.
Ok, we're at the intersection of blah blah and blah blah,
what's the closest receiving hospital and
how will you get there?
Umm. . .
I memorized map routes, I asked fire to
direct me, I asked PD for an escort,
I found the hospitals on the first try — most of the time.

Meantime, I memorized the county protocols
until I could recite them in my sleep.

I started on the night car because I had no seniority
and worked 4 consecutive days of 12 hour shifts from 6pm to 6am.
Working twelve hour shifts required living in the ambulance the whole time
on street corners and in parking lots,
or wherever we felt safe.  Remember, we carry morphine.
I had an hour and a half commute on each end as well.
I was a mess.

My first call as a wet-behind-the-ears medic was for an
elderly woman, short of breath, in San Mateo, at 3:30 AM.
She scared the life out of me.

We found her in the foyer of her apartment building
breathing to beat the band, with a lengthy medical history,
and terrifyingly at the end of her rope.
  My partner and I assessed her,
her lungs were full of fluid and she was moving almost no air.
We put her on high-flow oxygen by mask, established an IV,
 sprayed Nitroglycerin under her tongue,  
gave her a IV diuretic, made her as comfortable as possible on our gurney,
and I climbed in back with her as my partner slid behind the wheel
for a Code 3 return to the nearest ER.
She made it — and so did I.

At the time, Baystar had 12 hour and 24 hour shifts for medics to work.
My favorite was the 24 hour shift because we worked only 10 days a month.
Part time job, full time pay.
My kind of career.

Eventually I accumulated enough seniority to bid for the 24 hour car
in East Palo Alto.
I arrived for shift change at 7 am
and got off at 7 am the following day.
The rotation went like this:  On, Off, On, Off, On, Off, On, 4 Off.
Those 4 days off were heaven.

We were free to do as we pleased between calls as long as we
were available and could be on scene of a call anywhere in our zone within 
the 8 minute county-mandated response time.
Life on a 24 hour paramedic shift:

 Again, this cartoon is the brilliant work of the funniest paramedic
in the business - Steve Berry
Ok, enough background, you get the picture.
Now for the fun stuff.  Stay tuned for:
  •  EMS stories - as the sirens wail
  • Real 911 calls
  • Defibrillating on the reef
  • The death of a partner
  • Novel ways to kill time between calls
  • 'Bending' the rules. . .shhhhhhh.
  • An accidental needle stick
  • Partners - the good, bad, and the scary Larrys
  • Ambulances crash too
  • System Status Management - get the gun
  • Getto medicine - get in and get out
  • Politics
  • Fire guys - gotta love 'em, even married one
  • Getting shot at
  • Stop eating and driving - we can't get the salsa out of the radios
  • Getting a clue


    1. I had no idea paramedics went through all of that. My hat is off to you! :)

      And I can't wait to read the other stories. :)

    2. Leslie - I know, most people don't. Thanks for the compliment, I share it with all the paramedics who put their dinners in the fridge and take off to help someone. Thank you for your kind words.

      惠IdellA_Fecteau1231蘋 wrote:
      Behavioral training habits, customs culture personality, personality affects the fate ....
      Thank you for your comment.

    3. 1. OMG, I definitely would not go horseback riding unless you were along!

      2. I never fully appreciated why we heard so little from you in those days! Love hearing the stories now.

      3. Clearly, I definitely never had a challenging job!

      4. More, please!

    4. The amount of testing & training are remarkable. I'm surprised. My daughter is a physicians assistant. She can diagnose, give shots, write prescriptions, everything but operate (but she can assist).

      To qualify for PA school she needed a bachlors degree. The school was essentialy a 2 yr Masters program but most of that was spent in the field & then passing the state test.

      When she started she was somewhat overwhelmed. When seeing patients she'd excuse herself & go find a book or to one of the doctors. It didn't take long for her to catch on though & I have no doubt she's totally competent now. But she said it was scary at first.

      It sounds like you were totally prepared from day one. It's going to be interesting to read your stories.

    5. Steve - coming up!

      G and C - you're right, nobody heard much from me in those days. I didn't have time for anything but driving to work, working, and driving home. I slept a lot on the days off.

      Joe - many of my medic friends went on to be PAs or NPs, some nurses, and rarely - a doc. If I had been younger when I started studying medicine I would definitely have gone on to PA. I'll bet your daughter loves her job, if she has good docs to work with. I noticed when I worked in the hospital that the docs and admin tended to dump the uninteresting or cranky patients on the NPs. Stay tuned for more.

    6. She has great doctors to work with. She only works 4 days a week (has kids), plus they pay for her trips to PA conventions across the US, Mexico & the Caribbean.

      She was one of those fortunate (or unfortunate) people that was good at math, sciences & the humanities so she had a terrible time deciding which way to go. She tried accounting but it was boring.

      She was hot on pharmacy but beginning hours are lousy at drug stores & taking pills from a big bottle & counting them into a small bottle also sounded boring.

      As with any job it's not all roses but PA was a great choice for her.

    7. She sounds like a very smart lady.

      I wonder what specialty she works in, GP, ER, Cardio etc.

    8. Geriatrics. The PA school required experience in, I believe, 5-6 disciplines. That was towards the top of her list. BTW, her least fav was pediatrics. The screaming got to her after a day or two & I guess she got as far away from that as possible. LOL

    9. Great post Trailrunner. You must have been run off your feet. We need people like you here at Lake Chapala!! Too bad they're not equipped in their ambulances here as you were.