The Answer is Always Airway... and Administer Insulin

     As encouraging as it is that I have a interviews at a couple PA programs, I know that many, if not most, people do not get admitted their first try.So, ever since September I've been taking an accelerated EMT program. So long as I finish the class and pass all my exams (a practical skills exam for Oregon and a written national exam), I will be a licensed Emergency Medical Technician by January. This will help me not only continue my medical education and get a job in a medical profession, but my hours as an EMT will count as medical experience hours. Such hours are required by almost every PA school, but are difficult to get because most schools want these hours to involve "hands on, direct patient care." Simply put, you have to somehow be responsible for a patient's care. This is why most volunteer positions in the U.S. will not count, and is one of the main reasons I spent a month at St. Joseph's hospital in Kenya last summer. 

If we did our lab skills with dolls...

     Before you begin to think though that I'm only taking the EMT classes to help fulfill a requirement and it's something I have to force myself to do, I should say one thing: EMT class is a blast. While I'll admit that the 8-hour days, which begin with a 5:15 am wake-up call, are sometimes long and tiring and I probably won't miss them after class ends next week, I have still really enjoyed the course. This is due in large part to my excellent instructor (who includes a Star Wars themed question on almost every quiz and tells us great stories from some of his paramedic calls) and great classmates (who always make me laugh). Of course, I also find the subject matter quite interesting, and it feels so good to finally be able to actually do something to help a person who needs medical attention, rather than simply learn about the molecular basis of their condition. 

A tasty way to combat hypoglycemia

     The class has affected my daily life as well. For one thing, my family is probably sick and tired of all the medical facts and stories I bring home. For another, I study for class and exams using daily occurrences, like the time I cut myself on one of those blasted thick plastic electronics cases (which I think are a bit excessive) and I found myself staring at my injury thinking, "well, it's deep, but the blood seems to just be coming out slowly and sort of oozing, so it's probably just a capillary bleed." This spills over to other people and I've begun to understand better the conditions of friends and family. This happens with strangers too. A few weeks ago a teenage boy came into the coffee shop where I work with his mentor. The man offered to buy the boy, who seemed a bit confused, anything he wanted, but the boy initially refused. Eventually he admitted that he probably should get something to eat since his "blood sugar was low." He ordered a drink and some food... and promptly forgot what he had ordered. The whole time I was watching his behavior and thinking "likely Type 1 diabetes mellitus, probably suffering from at least mild hypoglycemia." I was ready to fill up a spoon with caramel drizzle and just have him suck on it if he seemed to get any more disoriented (and before he became unconscious which would mean such actions would be contraindicated), but a sweet coffee beverage and sugary donut seemed to resolve any blood sugar blues quite nicely.

    I could do into far greater detail about all the things I've learned and the things I've taken away from the class, but I realize that not everyone will find it as fascinating as I do so instead I'll include a list of tidbits that I think people might find interesting/helpful as well as some quotes and phrases from the class that might give you all a better idea of what EMT class is like. One thing to note is that, even though our instructor is continually telling us to use our "big boy/girl words" (i.e. correct medical terminology), many of his phrases for the class sound like they fit in a kindergarten classroom.

Things You Should Know 

• If you're pregnant and your water just broke, you probably have time to get to the hospital without needing EMS (Emergency Medical Services). This is especially true if this is your first pregnancy because the first stage of labor (the contractions) lasts an average of 16 hours for the first pregnancy (labor for subsequent pregnancies is typically much shorter). Apparently a lot of people call 9-1-1 for "imminent delivery" and contractions have just started. Sometimes the patient isn't even pregnant. Sometimes they're not even female (don't ask me how this works). 
• Women who are having a heart attack often do not present with the stereotypical symptoms of crushing chest pain that often radiates to the left arm or leg. Sometimes women just feel like they're having stomachache or back pain. 
• When EMTs respond to diabetic emergencies, they often encounter bystanders or family members who plead with them to give the patient some insulin. In light of this fact, I think I should state that insulin is not a diabetic "cure-all." All insulin does is act as the key that unlocks the cells and allows them to absorb glucose (sugar) from the blood. If someone is suffering from low blood sugar (hypoglycemia), insulin will not help them. It will actually make the situation worse, and might even kill them. This is why EMTs and paramedics are never allowed to give anyone insulin, and even nurses typically are not allowed to administer insulin to a patient without another nurse there to verify that they are giving the correct dose. Our instructor really stressed this fact, so now it has become a standing joke to reply with "administer insulin!" whenever he asks how to treat different patients. 
•  If someone is suffering from hypothermia, DO NOT rub their cold limbs. If they're that cold, it means that parts of them, including the plasma (which is mostly water) in their blood is actually frozen. If you rub them, the ice crystals in their blood can potentially slice their blood vessels to pieces. Yeah... not good. Call 9-1-1 and follow the dispatcher's instructions until EMS arrives.
• People are more likely to get overheated on days that are hot and dry than days that are hot and humid. This is because the moist heat tires you out quickly and people realize that they should cool off, whereas on dry and hot days, people can feel fine and then suddenly experience heat exhaustion or even heat stroke. 

...but for some reason this is just fine.



This is too "invasive" for most states...

• Oregon is one of the most progressive states when it comes to what EMTs can do. For one thing, EMTs in other states can only give someone epinephrine if they have their own Epi-pen. Oregon realizes that not everyone carries their Epi-pen with them everywhere, so EMTs are allowed to give patients in anaphylactic shock epinephrine via an injection just under the skin. We're also allowed to check a patient's blood sugar. In other states, if a patient has a history of diabetes and an altered mental status, the protocol is to just give them glucose, even though the cause could be that the patient already has high blood sugar (hyperglycemia). The thinking is that a finger prick to check blood sugar is an "invasive procedure" and since most diabetic emergencies are due to low blood sugar (hypoglycemia), administering oral glucose should help, and giving glucose to someone who is hyperglycemic won't really hurt them (at least not in the short-term). While this is all true, Oregon still disagrees and says that EMTs should be able to just check the blood sugar so they know what the best course of action is and are also able to give accurate, detailed information to the hospital. Considering that we're allowed to deliver babies and insert supraglottic airways, pricking someone's finger or giving a small injection into the shoulder doesn't really seem like that big of a deal.

Quotes/Phrases from Class 

• Treat with diesel -getting someone to the hospital asap because there's nothing more you can do for them on scene
• Drive by Braille -I'm guessing most people can figure out what this means. It's really not how you want to be driving.
• Let's go get the stair chair -a code used to communicate that the scene is no longer safe (usually because you've just discovered that the patient or a bystander is crazy and/or dangerous). It works because you really only need one person to carry a stair chair, not everyone, but most people wouldn't know that so they don't become suspicious when all of the EMTs return to the ambulance.
• Blinkies and whoo-whoos -lights and sirens 
• No pumpy-pumpy, no livey-livey -our instructor's explanation for why the heart is important
• Talky, talky then touchy, touchy -how to assess a responsive medical patient
• Rappin' and cappin' vs. limpin' and pimpin' -our instructor's phrases to describe the responses produced by activation of, respectively, the parasympathetic vs. the autonomic nervous systems. Most people probably know these responses better as "fight or flight" vs. "rest and digest" 
• "Trauma is a naked sport." 
• "If you don't have an airway, you don' have a patient." -This is why you make sure everyone has a "patent" (clear) airway before treating anything else (even life-threatening bleeding) and why the answer to almost every test question is "airway."
• "I open the patient's mouth. What do I see?" "The mouth is full of secretions and vomitus." "Yes!" -Real soundbite from skills lab 
• "Screaming barfies" -also known as "hot aches," these result from warming extremities after you've gotten them so cold that you've reached the point of frost nip (precursor to frostbite). Basically, reheating them hurts so bad that you want to scream and barf at the same time.
• "Ding, ding, whoop, whoop. Here comes the hero wagon." -how firefighters arrive on scene 

Here's one final soundbite from class. This sort of thing where someone just threw out a random answer happened a lot. It was always good comic relief.

Instructor: "Fresh water or salt water drowning, which is worse?

Everyone: "Salt."

Instructor: "Right, everybody knew that. And why is salt water worse?"

That one guy: "Sharks!" 

Should you be interested in how cops sometimes view EMTs and firefighters, here's a cartoon we watched when we discussed "mechanism of injury:" Freeway Patrol: Episode 5