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Are you a good Medic? How do you know???

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This is going to be a short one but I am hoping for many comments so that I can form a follow up post.

I have just received some really nice compliments from some A&E (ER) nurses about what a good paramedic I am.  I was of course flattered and its always nice to get positive feedback, but as is the norm for me, it got me thinking…..

Am I actually a good medic?

I think so, but how can I justify that opinion of myself?

So here is my request. Think about yourself and the way you practice then complete this sentance and leave a comment:

” I am a good medic because…… ”

Dont be shy, lets see if we can come up with some sort of universal definition of what makes some stand out from others. Oh, and in this case, medic means anyone in prehospital care, EMTs, First responders, paramedics etc etc.

Posted by Mark Glencorse on September 2, 2010 • Filed under: Ambulance, EMT, paramedic • Tagged: , ,

A Blogoversary for my Blogger BFF !

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I dont even know why I am writing this because I am sure that if you read my blog, you will also be reading Justins blog over at www.happymedic.com right?

Because you read his blog, as well as mine, you will already be aware that he has just celebrated the second anniversary of the start of his blog, right??

If by some strange reason you havent wished him many congratulations or if by some freak of interdimensional freakishness you have yet to read ‘The Happy Medic’, I would strongly encourage you to click here and go and say hi and send a lovely big cake over there!

I also know that this also marks the second anniversary of a particularly harrowing time for both Justin and his family after his close call in a building collapse, but sometimes good comes out of bad circumstances, right???

Well, it has been an amazing journey for Justin, and I feel so very privaledged to have been more than a tiny part of that journey, and to have spent time as part of his own family.

Congratualtions buddy!

Can you just imagine what the next two years is going to bring????

YOUR GOING TO CHANGE THE WORLD!!!! (Ted Setla, Nov, 2009)

Posted by Mark Glencorse on September 1, 2010 • Filed under: Ambulance, Happy Medic, San Francisco Fire Dept, bloggers, blogging, paramedic • Tagged: , , ,

Do we really need paramedics on Ambulances?

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Well, since I am back, I thought I might cause a little controversy discussion.

Or maybe not, who knows….

It appears that one of the constants in the EMS world wide is the question of what is the best skill set for responders to a 999/911 call? Along with this comes the whole ALS/BLS discussion, and as far as I can tell there has never been a definitive answer either way, although many of us have our own thoughts.

When I started in the Ambulance service in 2000, there had been a particularily long drought as far as paramedic training in my service area. It was far more common to have an advanced technician crew (EMT – I) than have a paramedic crew. In fact, it got to the point that the wording on the side of the Ambulances changed from ‘Paramedic Ambulance’ to ‘Emergency Ambulance’ as when a ‘Paramedic Ambulance’ turned up on scene, the patient and their family quite rightly expected a paramedic.

Times have moved on however, and skill sets and grades of staff have also changed. We no longer train ‘Advanced Technicians’. We still have some on front line duties, but that rank of staff has now been changed to our ‘Emergency Care Support Worker’ colleagues who are as far as I can tell are the equivalent of an EMT Basic.

When the role was first developed, there was alot of opposition to it. So much so that I would have hated to have been one of the poor souls that were in the first few cohorts of training. There were shouts of the role not being fit for purpose and there were objections from many paramedics that this new role would result in them having to be in the back with the patient for every job instead of doing ‘job and job about’ with their advanced technician or paramedic partner.

There were other, more legitimate concerns though, and these are the ones that I also agreed with, but over time (the last 2-3 years), the role has become imbedded in the service and the amount of experience our ECSWs have now had, makes them more than capable of providing great support to the paramedic that they are working with.

There are moves afoot, to increase their level of training to have them almost at the level of what the advanced technician used to be, and we are all waiting with baited breath to see what the outcome of all the consultations are on that one.

But all of this is just a pre-amble and a bit of history before I get to the main question that I want to ask….

Does every ambulance need a paramedic on it?

I would suggest no, and here is my rationale:

I don’t think that every patient needs a paramedic staffed ambulance. I do, however believe that every patient deserves an assessment from a paramedic.

That may sound a bit of a contradiction but there is a suggestion that the UK ambulance services could adopt a formula of response which could actually achieve this.

Think of this scenario:

If you are a paramedic, then you will be working on a car, by yourself. The ambulances will be staffed by a double ECSW crew, or an ECSW and a ‘new grade technician (if that rule becomes a reality). The paramedics on the car will be sent to all 999 calls, and depending on the severity of the patient’s condition at telephone triage, a crew will also be sent, or will be allocated once the paramedic has arrived on scene and has assessed the patient and determined the most appropriate response. That may be no response, travel by own car, travel in the Rapid Response Car, travel in Ambulance or refer onto an alternative pathway of care. If the patient then requires medical interventions or a level of care higher than that of the responding BLS ambulance crew, then the paramedic will travel with the patient to hospital whilst one of the other members of the team drives the RR car.

I do this already, and it works.

If I am sent to a patient who requires transport to A&E but does not require a paramedic level of care, then I will ask for an ‘urgent crew’ to transport the patient. If however, I am with a poorly patient and the only backup available to me is an urgent crew or a double ECSW crew, then I will just jump in the back. Im sure there are many others around the country and world who also already do this too.

Then there is the question of the amount of ‘emergencies’ that we actually attend which require the advanced skills of a paramedic. As we all know, these are by far the rarest of the incidents that we attend, and the most common are the ones which don’t require an emergency response and usually don’t even really need a trip to hospital.

If that’s the case, then why not keep the paramedics for the jobs that they are really needed for?

This is where the understanding and the change in focus for modern day paramedics comes in. I have written previously about if intervention or assessment is the most important skill set for a paramedic to work with. (here and here) Both are essential, but in the every decreasing percentage volume of genuine medical emergencies, our primary route for assisting the patient is rapidly becoming the appropriate assessment/advice and referral onwards.

It then follows, that this is the reason that paramedics need to attend ALL categories of emergencies. A service would be leaving its litigation doors wide open if it allowed its lesser trained members of the healthcare team to assess and advise the public about their minor illnesses or ailments. The only alternative would be the default position of all patients who are seen by a member of ambulance staff who isn’t a paramedic, get transported to hospital, which is precisely what we are trying to avoid.

I give you this picture, as I want to have a bit of a discussion. This is only one suggestion of many that seems to be doing the rounds of the rumour mill.

In this time of cost efficiency savings and having to really pull in the purse strings, could we not take it as an opportunity to become both more cost effective and provide a better service for our patients. That may sound like an oxymoron, but I can see the potential. What about you??

Posted by Mark Glencorse on August 31, 2010 • Filed under: Ambulance, EMS Topics, EMT, paramedic, patient assessment • Tagged: , ,

A twinkle of an eye tinged with sadness..

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I was working on the rapid response car a little while ago when I was dispatched to an elderly gentleman who had fallen whilst at a day care centre and had possibly injured his hip.

Once I had arrived on scene, I was shown through to the dining area where my patient, Jim, was sitting propped up against the wall. He appeared in good spirits and not in too much discomfort. I on the other hand could not help but wonder how we were going to get him off the floor.

Let’s just say that he was a very large gentleman.

After doing my initial assessment, I examined his hip. There didn’t seem to be any shortening or external rotation and there was no apparent deformity to the leg, although this was very difficult to assess due to the sheer size of his legs.

What was obvious however was that any movement resulted in considerable pain. One cannula and a substantial dose of Morphine later, Jim was feeling far more comfortable.

Luckily, the day care centre had access to various hoists and lifting devices and once the crew arrived, he was gently lifted onto our trolley.

The crew that had backed me up were not a paramedic crew which meant that I was going for a ride in the ambulance whilst one of the crew drove my car up.

It was a 25 minute transfer, so shortly after I had finished my paper work we started chatting about this and that.

Jim was a navy veteran from the Second World War. He started off with the Atlantic convoys, and then ended up in the pacific towards the end of the war.

” So did you end up in the water then Jim? ”
” No, not me. They never sunk me!!……….Mind you, my mates Jonesy and Tommy both got sunk 3 times”

He giggled like a child, obviously recounting numerous episodes of ripping into his friends for always ending up in the Ocean after their ships had been sunk.

“Maybe I was a lucky omen. We had a fair amount of trouble, we had people killed, but we never went down”

We proceeded to have a great chat about the war years. I could listen to these men and women for hours. I feel privileged to be in their presence. It saddens me that it won’t be long before their voices are lost forever, but until that time I will always have time to listen and appreciate what they did for the world.

It wasn’t long before we got on to other stories from his past.

“So did you have a war bride then Jim?”

“You’re joking aren’t you…Im not one for being tied down son. Never got married”

A wink followed with a sparkle in his eyes which went against the many years he has lived…

“But…… I was never short of a lady, if you know what I mean”

We both laughed loudly, and then giggled as he reeled off an impressive list of names of his ‘lady friends’ around the world.

“It was a different time back then. You never knew if you were going to be alive the next week, or even just the next day. I took every opportunity I could to enjoy myself”

“I don’t blame you Jim, not at all mate!”

By now, we were almost at the hospital, and I was trying to string out just a little more conversation, but before I knew it the door opened and we wheeled Jim into the department.

As I handed over to the nursing staff, I was hoping that he had just pulled a muscle rather than any breaks. He was an elderly man, and I wanted him up and mobile as soon as possible to stop him getting any complications.

I said my goodbyes, and did what I always do when I get the chance to look after any veteran. I took his hand and thanked him for all he did for me, my family and our country.

Later in the day, I managed to get back to the hospital and thought I would ask how he got on. The Consultant informed me that he had actually had a mid shaft femur fracture and was listed for surgery the following morning. What concerned me most though was the doctors leaving comment :

“It’s not a good injury for him to have. If he was fit and well, for his age, it has a mortality rate of 50-60%, add in his size and co-morbidities, he will be lucky to get out of hospital”

I hope he is in the minority, I really do. It seems more than a little unfair to survive a life like Jims, only to be taken by a relatively minor fall and all of the complications that go along with it.

Posted by Mark Glencorse on August 29, 2010 • Filed under: Ambulance, elderly care

Im Back!!

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It’s been a strange week.

Things have happened.

Some very important people in my work life appear to have had a change of heart and some others have absolutely astounded me with comments like

“There is a real opportunity to communicate like we never have been able to……we need to learn to let go of some of the control we have always maintained over what we say and do”

and

“This is just the way it is now, this is how people communicate. If we don’t adapt, we will be left behind”

These were a few of the comments that were made after I presented a review of the past 20 months of my life in social media, my blog and the Chronicles of EMS, to all of the most senior managers, and directors of my service. This was a meeting that I had been trying to get into for a number of months; maybe fate had a hand in it finally coming around when I needed it most, and so soon after events which caused me to question my ongoing blogging.

I went into the meeting hoping that maybe I could alleviate even a little bit of the fear that surrounds social media and blogging. What I  came away with though, was the impression that a door has opened ever so slightly into the possibility of my service taking very tentative baby steps into communicating with, and even engaging our staff, our associated professionals and most importantly the community that we serve using all of this new fangled technology that is available to us.

But what about those who I felt were ‘anti’ my blog and social media, or rather those that had reservations about the safety and use of social media and the potential for harm to the service?

Well, they still remain, but they remain silent….for now.

What I am left with however, is a feeling different than that a couple of months ago. I still don’t have a seal of approval from my employers but I now know that those who really and truly need to know and understand what I am trying to do both on this blog and with the Chronicles of EMS have heard from my own mouth how safe and professional I am with my on line activities. I have had the opportunity to stand in front of all of them and have my say about how I feel about utilising all means of communication to take my own service and all other Ambulance services into a new era of communication. That gives me the confidence to come back.

Then there are my personal reasons for leaving the blog, how it affected my family, and the amount of time I spent sitting in front of the computer rather than with my wife and children. This is where my self imposed ground rules come in:

1) I will only blog when at home when Mrs999 is at work
2) If Mrs999 and I are off together, I wont even log onto my blog
3) Mrs999 will soon tell me if I am getting carried away with blogging again and will beat me around the head with a metal spoon until I get the message.

Dont worry though, as since we almost always seem to be on opposite shifts, I will still have plenty of opportunities to write and share my thoughts and musings!

I have missed being part of the EMS Blogosphere; it’s not the same to be a reader as it is to be a blogger. Although I have continued to read everyone’s blogs, I just didn’t feel as engaged in the community as before. Im excited to rectify that and be part of my group of friends again.

An enormous and heart felt thank you is needed for all of you who took the time to post a message following my ‘closing down’ post. I know for a fact that your words also made a difference in changing some opinions about the effect that positive and real blogging can have on readers.

A big thank you to all of you who have been popping in to see what is going on and if I was back on line again, I hope you are happy to see me back!

And finally, a thank you to Fire & EMS blogs for keeping 999Medic.com live.

Anyway….let’s get this show back on the road shall we??

Normal blogging will resume in the next couple of days.

Posted by Mark Glencorse on August 28, 2010 • Filed under: Ambulance • Tagged:

There is a chance…..

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Bet you didnt think that you would hear from me again???

Well, maybe some of you knew that I wouldnt be able to keep away for ever….

This isnt a return….Not yet anyway.

I just wanted to say that there have been some developments along with a potential olive branch being offered. It may amount to nothing and I may well stay away from the blog, but I have a very very very very very important meeting next Thursday which may turn the tide for me and my ability to blog.

I just wanted you to know that I am still trying to make this thing work but one thing is for sure. IF it does work out and I come back, there wont be the usually 7-8 posts per week. During the last 6 weeks, I have realised just how much time was going into the blog, to the detriment of my family, and I wont be letting that happen again. Maybe 2-3 per week will be better??

Anyway, its good to say hi again, please keep your fingers crossed for me next Thursday. Its going to be a pivotal presentation I am giving and I sincerely hope it provides me a way back.

After all, I really miss you all.

Posted by Mark Glencorse on August 18, 2010 • Filed under: Ambulance

My farewell to blogging……..

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I can’t believe I am actually at the point where I have to write this but this is my note to all of you that Medic999 is closing down and this will be the last post. 

I have had a truly amazing experience over the past 18months. I have made friends, travelled, shared experiences and have learned more from my peers than I could have ever imagined. 

I hope you have gotten something out of reading my posts too! 

A lot has happened in the past few weeks but the clincher has been the knowledge that there are some out to prove just how ‘dangerous’ blogging can be for those who write blogs. 

More and more has been happening recently that has made me more nervous than I have been in the past about what I write. I know, 100%, that I have not broken any patient’s confidence, I have not brought my service into disrepute and that I have acted as a professional throughout the whole time I have been blogging. 

I have written and published 483 posts. There have been over 3000 comments and I have had over 250,000 hits. I created ‘The Handover’ EMS Blog carnival which is still going strong as the only EMS related carnival That’s no mean feat! 

As you know, I am a family man, and that is my prime responsibility. I cannot risk my livelihood and my ability to financially support my wife and children. That has been the final nail in the coffin of my blog. 

I find it a shame that the reason for this blog ending is the general lack of understanding of blogging and social media. I feel that I have promoted best practice, shared my passion for the job that I do, and hopefully have shown all readers what it is that makes EMS and those that devote their lives to it so special. However, there still remains this general unease about social media and blogging in the Health Service. Some of the bloggers out here may want to continue the fight, and maybe I am being a coward, but I dont want to risk getting into a position where I cannot provide for my family and can no longer do the job that I love so much. 

Maybe this is a bit of over reacting on my side, but I have never been wrong about my gut feelings in the past, so I am going with this one too. 

I hope you have enjoyed my writing. As a final request, I would love it if you could leave a quick comment if this blog has touched you, made you think about your practice or how you do your job. I plan on sending all comments from this post to those who need to be persuaded that blogging can be a positive thing, in the hope that one day I can come back again, with more support and confidence in what I do. 

If you have never commented, then this is your last chance. Let everyone know why blogging should be here to stay! 

So with the blog gone, what about The Chronicles of EMS? 

CoEMS continues to go from strength to strength. Ted and Justin are hatching bigger and better ideas all the time. I have decided to take an intentional back seat for a while. I have spent so much time away from my family that I have had to make the decision to put family first and step back from all the transatlantic travel for a while. 

I am not leaving CoEMS; I will still be part of it, like all of you who follow it. I remain passionate about our goals and visions for the future of worldwide EMS and I am sure that you will see me again in some of the future episodes (they don’t get rid of me that easily) 

I will remain active on Twitter as @UKMedic999, so hopefully we can still keep in touch there, and you know you can all drop me an email whenever you want at mglencorse@yahoo.co.uk. 

I will also obviously still be reading everyone else’s blogs and commenting when the urge takes me and I will be downloading all of my posts and all of your comments from the past 18months  so that when the time is right I can bring them all back. 

One thing hasn’t changed though…….. 

I still work in the best profession in the world and I still feel lucky and privileged every time I step on my ambulance. 

I hope that I have shared some of that passion with you and I really hope that you all realise how much you have helped me at times also. 

Before I go, I want to commit once last thing to the interwebs. 

There have been two men, with two families that have come to be so close in the last year that I truly feel as though they are an extension of my family. 

Justin, you have become another brother to me over these last 10 months. Who would have thought that we would have clicked so well? You, Kim and the girls have opened your home to me and made me feel so welcome that it was that little bit easier being away from Sandra and my boys. We have shared some amazing times together and I will not forget them for as long as I live. From the ride on the ladder engine in San Francisco, to seeing your face as you stood on Hadrian’s Wall remembering your Grandma. The time that we stood together watching the pilot episode of The Chronicles in the Hotel Frank realising what we had achieved to bluffing our way into showing the Chronicles in the Ballroom of the Denver Downtown Sheraton. There are so many moments that I will cherish, but this isn’t the end my friend. There will be more memories to make and more goals to work towards. Plus, the families still need to meet. You have been Awesome, my partner in Bromance!!!!! 

Ted, you took Justin’s and my little project and turned it into something that still continues to make people reassess what EMS can achieve. Your passion and commitment to your art of film making is truly awe inspiring. Many times, all Justin and I had to do was to just be ourselves whilst you made our everyday actions look far more. I don’t know how I will be able to cope without listening to you tell me how we are going to ‘change the world!!!’ Two of the many things I will never forget….. One – sitting outside of the Irish Bar on my first trip out, Justin doing his pitch to the camera “You can buy the whole seat….But your only gonna need the edge”, and you nearly falling of your chair as you were crying with laughter so much; and two, Coyote Ugly in Denver and your Kid rock dancing!! Dude, you ROCK!!!! 

I have been blessed to work with Justin, Ted and so many more people than I could ever list. You know who you all are, and I hope you know how much you mean to me. 

TEAM CoEMS!!!! 

So that’s it guys. 

See ya! 

So long and thanks for all the fish! 

(hitchhikers guide to the galaxy reference for those that don’t know)”

Posted by Mark Glencorse on June 23, 2010 • Filed under: Ambulance

A Message

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I know I have people in my own service who read my blog and learn from and appreciate my writing.

I know I have people in my own service who read my blog and wait for me to trip up.

I know I have people in my own service who actively look for things to get me into trouble.

I now know I have people in my own service who have tried to cause trouble for me and this blog.

So, here again is the disclaimer that has sat in the side bar, since day one:

“I respect my patients and colleagues confidentiality. What you read here is essentially a work of fiction based on real life events. The stories will be changed in many ways to ensure anonymity of all involved, except me!

But rest assured, the essence of the tale will remain. I will be honest with my feelings my thoughts and my emotions, that much I can promise you!”

As it states, these stories are a work of fiction. Yes they are based on real patients, but you will not know who they are, Okay.

This means that I dont gain consent, because I am not sharing any of their personal details, ok?????

As I said in my last post, I need time to think.

I cant decide if this blog should continue or not, I dont know if it is worth the risk.

I have already made other decisions, and those I will share with you soon, but thatpost will be the only post for a while.

I will still be around. I will still be tweeting and twittering with you all, and rest assured that I will also be reading all of your blogs and chucking in the odd comment or two.

Until then my friends……


Posted by Mark Glencorse on June 18, 2010 • Filed under: Ambulance

Im not here..

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I need some time to think a few things through chaps……

I may be a little while, but Ill let you know how I get on.

Posted by Mark Glencorse on June 17, 2010 • Filed under: Ambulance

A fascinating day in the Studio

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I am sitting in the San Francisco airport waiting for my flight home and reflecting on this last trip to the US (But there is a whole other story which I will share in the next post!!)

The whole purpose was to come and film a few more episodes of the Seat at the table show, but this time it was going to be a little different. We werent going to be in Ted Setla’s Garage (and yes, as hard as it is to believe, those first 7 episodes of SATT where filmed in Ted Setlas garage), but instead in a proper TV studio in San Jose.

The other difference was that it was the first time that Justin and I had to film with guests who were not already our friends and colleagues.

But before they all arrived, we had to get set up :

Mr Ted Setla, in his element!

Once we were ready our first guest arrived, Jon Clotier from Zoll Medical.

As you know, Zoll has been our main sponsor and strongest industry supporter since we started this crazy journey, so it was great to have Jon on to share his views on where the industry and profession is heading as far as technology and equipment go. What pleased me most of all about this session was that it wasn’t an advert for Zoll products, more like a discussion between three paramedics, with the added benefit that one knows ALOT about the technology side of things.

Next up we have the President elect of the International Association of EMS Chiefs, and Chief of EMS for Oakland Fire Department, Bill Sugiama; and Mike Taigman, the General Manager for AMR, Alameda County. This discussion was fascinating for me. Mike shared with us the experiences that he is having leading the way in setting up a community health program utilising his Medics and the support services in his area. He seems to be making significant strides forward for US EMS, however, looking in from a UK perspective brought about some interesting points to further delve into.

Chief Sugiama, helped us to understand how his fledgling organisation (IAEMSC) is working hard on a national level, to try and raise the level of awareness of EMS within the political spectrum and give EMS its own unique standing in the US political spectrum. (Oh and I did ask why it is called the ‘International’ association when it appears to be just America!

The final program saw Justin and I talking with Carl Kustin, Fire Captain, City of San Mateo (President of Lee & Associates), Gerry Kohlmann, Fire Chief (Retired), Conference Chairman for TAK – Response ; and last but not least Jason Hoschouer, Motor Police Officer and Contributing Author to American Cop Magazine. The discussion was intended to look into the reason that the inaugural TAK Response conference is actually needed. Why is it that agencies still seem to have a difficulty working together in times of extreme stress and how can this be made better?. Gerry has some amazing ideas about it all, and he really was a fascinating man to listen to and to question. The same goes for Carl Kustin, who brought in some real life examples of when things go right and when things go wrong. Jason brought the operational police viewpoint to the table which balanced the conversation between senior managers and operational staff. Personally, I would like to see an episode dedicated to law enforcement and EMS working together and would love to have Jason back on at a later date.

And a HUGE thank you goes out to those that were in the chatroom at various times throughout the afternoon. We tried to get as many points in as possible, but it wasnt so easy this time. Rest assured though, either Justin or I were always looking and reading what you guys were up to and that helped us mold the conversation into something that we hope speaks to you guys too.

The one thing that blew my mind though, was after all of the filming, Justin, Ted and I are standing around the table just chatting to Carl and Gerry, and they start telling us about how they handled the task of co-ordinating the recovery and search of part of the pile after the 9/11 attacks.

I just stood back and listened in awe at these two men.

It really is amazing the people I have met thanks to this little ol blog and the things I write.

I hope you enjoy the episodes as much as we enjoyed making them. The first one should be due out next week, and will also be broadcast to resident of San Jose on the Public Access Channel.

I will post the link whenever Mr Setla puts out an episode.

Posted by Mark Glencorse on June 16, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, Seat at the Table • Tagged: , , , , ,

Flying the flag in the USA

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Well, its a tough life!

I am hiding in the Happy Medics kitchen whilst he and Kim work on the tea (read dinner) for tonight.

obviously not a staged photo! - What is Kim chopping??

Its nearly 100 degrees outside and I dont do heat very well.

Yet again, the curse of my transatlantic travel hit again and saw me delayed at Chicago O’Hare in the terminal for 2 hours, then sitting in the plane on the tarmac for the following 3.5 hours. All in all, it took 28 hours to get from door to door, which leaves me feeling more than a little tired, but very happy to be back with my U.S extended family.

So why am I here?

Look at the top of this page and it is likely that there is a advert for the (Hi, Justin pushing Mark aside to say hello…Hello!) upcoming filming of the next three episodes of ‘A Seat at The Table’ These epiosdes are being brought to you with the assistance of Zoll and Penwell and the contents of the shows can be found here. You can click the advert or click here for the chat room which will be open from 1pm Pacific time which is actually a great time of 9pm UK time.

I am very excited about having the opportunity to discuss some interesting topics with some influential folks in the EMS industry and the Police force.

Remember though, you can be part of it also by logging in to the chatroom where you will be able to hear the audio and pose your questions and thoughts in real time at your own ‘seat at our table’.

We would love it if you could be part of it and have your say.

Oh, and the flying the Flag in the USA title……That will be this then:

Justin saying 1 - 1, or is it something else??

Posted by Mark Glencorse on June 14, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS • Tagged: ,

A comment to make me think….

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If you have been reading my blog for a while now, you will have read on multiple occasions, my thoughts on religion and my own personal beliefs, or lack of them.

Today, a comment popped up from my old blog site, from a post from about a year ago, which detailed my thoughts and troubles following a particularly difficult suicide I had to deal with.

If you haven’t read the original post, then click here to read it to put the following comment into context.

The comment that came in is from a gentleman calling himself ‘FirePastor’

As his name suggests he is a pastor for his Fire Service and EMT`s and he has put forward his own views for me to mull over and consider. I dont see his comments as preaching to me, but I do very much appreciate the sentiments in his comments.

So much, that I felt it was a waste for it to sit hidden in an old post on an old inactive blog site. With that in mind, here it is :

“I just read this today, a little over a year after you wrote it I do believe.

I have to tell you that I am a man of devout faith. I am actually a pastor and chaplain to my firefighters/rescue emt’s. In regards to one of your last paragraphs. You stated something to the sorts of you didn’t believe in Heaven or Hell but an afterlife. You commented earlier than that about you hope the young lady found peace. Heaven equals peace. That is just the deep down in our spirit realization of who our creator is whether we acknowledge him or not.

I don’t want you to think I’m coming down on you for this because that is not my intentions. I wanted to put another opinion out their for you to consider. I know you say you sometimes would love to have faith but that would mean this young one would go to hell because suicide is sin. Lets look at this carefully. I think that suicide is very selfish because its not just yourself that has to deal with your actions but everyone…..including you and other first responders. You aren’t by yourself. That said, I am of the conclusion (through scripture of course) that:
#1- We have no idea how God works in situations like this.
#2-There is no telling what feelings or thoughts of remorse went through that young ladies mind while in the act…..the scriptures tell us that he knows our thoughts as well, not just our actions.
#3- We will ultimately never know the eternal destiny of this young woman until we ourselves get their.

There IS a God and we will give an account for our lives one day when we stand judgement before his holiness. There is salvation in Jesus Christ for those who accept him. It doesn’t take all of the brains in the world to accept faith but to accept willingly that there is forgiveness. If you want to reference that you will find it in 2 Corintians chapter 3.

I didn’t write this to preach at you but to shed awareness. I hope I wasn’t too forward with all of this as well. I am sure that the Lord’s heart broke when your patient made that decision, BUT He is the one who decides…..I trust in his judgement because it’s a lot better than my finite mind will ever comprehend. I will be in prayer for you and everyone else associated in this tragedy.

I dont really have a great deal to say about it, but I felt it deserved sharing.

I keep saying that I dont believe, but yet even I now acknowledge that all of my questioning seems to point to the fact that I am searching for some sort of meaning in what we see and deal with through our profession. Whether that is a religious quest, or just trying to get a handle on the whole ‘bad things happen to good people’ that I keep seeming to see, is the question.

Thank you for taking the time to comment and share your beliefs ‘FirePastor’. I really do appreciate it.

Your words havent convinced me of anything other than what I already ‘feel’, but they have made me think again, and for that I thank you.

Posted by Mark Glencorse on June 11, 2010 • Filed under: Ambulance, EMT, Random Musings, paramedic, random thoughts, religion, suicide • Tagged: , , , , , , ,

ECG Geek 10 – The Discussion

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So, here is the ECG again :

click to enlarge

If you need to see the patient presentation, then click here to read part one of this post.

I said that as well as the ECG itself, I wanted to have a bit of a discussion about something that cropped up and made me think a little after the job. But first, the ECG.

Some of you got this as the same interpretation as me. Some of you went into more depth than I know (especially Tom Bouthillet who sent an email to me) and some of you were a little off, but I can only share with you my thoughts about the ECG.

Bearing in mind that the patient was asymptomatic, young and a fit gentleman, I got a bit of a shock when I saw this come out of the Lifepak 12 with an interpretation of “Extensive Myocardial Infarction” on it. I glanced at the patient again, then took a few seconds to really look at the ECG, then come to my interpretation.

I thought this was an STEMI Mimic/imposter and not ‘real’ ST Elevation. The patient has huge QRS complexes especially notable in V1, V2, V3 and V4. The ST Elevation that can clearly be seen in V1, V2 and V3 is what I interpreted as what is commonly referred to as ‘high takeoff’ or Benign Early repolarisation, but he also displayed some characteristics of LVH (left ventricular hypertrophy). All QRS complexes are within normal widths but the depth of the S waves in V1, V2, and V3 make it very difficult to discern between the S waves and the R waves of the lead below. If you take the time and really look, you can figure out where the S wave ends in V1 and V2 and it can be seen that the corresponding height of the ST Elevation increases with the increasing depth of the S wave. This is a finding which is not seen in Acute AMI and helps to make a determination that this is not a STEMI. Take all of these findings along with the fact that there are no reciprocal changes anywhere else on the ECG, and things start to slip into place.

My fellow blogger, Tom Bouthillet has also wrote about the shape/morphology of the ST Segment and what characteristics the ST Segment has for Acute AMI compared to the STEMI Mimics. This tracing shows an upwardly concave ST segment as opposed to an upwardly convex segment.

Take these two diagrams reproduced from Tom’s blog, Prehospital 12 Lead ECG.

and :

Tom goes on to write:

“This finding is not particularly sensitive. It is, however, fairly specific……….The STE-mimics almost always present with upwardly concave ST segments and an absence of reciprocal changes”

But, taking all of this into account, what gave me the biggest sense of security is that it ‘just didn’t look like an MI’ on the 12 Lead ECG.

Maybe this comes with practice and extended self learning, but after a time, you just get a ‘feel’ for ECGs, even if you can’t definitely diagnose everything that you think you can see on the ECG.

This brings me to the main point of this post.

I had a patient in the back of my ambulance who I was sure, after a full assessment, was not having an MI, yet his ECG stated that he was. Everything that I had learned in my own time about STEMI mimics and imposters is not taught in my service and is seen well above the level that is required for an operational paramedic. I was confident to just take this patient to the local Accident and Emergency department rather than transmitting the ECG to the regional PPCI (Primary Percutaneous Coronary Intervention or Angioplasty) centre, however, I was stepping WAY outside of my current guidelines by doing this.

What if I didn’t take him to a PPCI centre and this did turn out to be an MI? I would be hung out to dry!!

If I ended up in a ‘clinical variance committee’ meeting and I was judged by my peers, It would be highly likely that those who were giving their opinions would not know what I do about 12 Lead ECG interpretation, and all they would see was that there was ST Elevation and the LifePak 12`s Interpretation said Extensive Myocardial Infarction.

So, I did what I had to do, and transmitted the ECG to the PPCI Centre. When I spoke to them on the vehicle mobile phone I gave them my assessment and my interpretation of the ECG. The Nurse in charge went off to speak to the consultant then came back to the phone and stated that the consultant agreed with my interpretation and that I had to take the patient to the local A&E Department.

Which begs the question, why do I need to know so much more about 12 Lead ECG than what I teach others in the Paramedic training course our service runs?

I can definitely see the benefit in more education on detecting the more subtle findings of ‘borderline’ MI recognition and I have, on more than a few occasions, referred patients to PPCI who did not initially meet criteria for referral, but whose angiograms had gone on to show a blockage of a coronary artery. I guess you will never get fired for referring someone who wasn’t actually having an MI?

However, deciding that someone isn’t having an MI, even though their ECG makes it look like they are (to the untrained eye), and not referring them or transporting them, is a whole other ball game.

I am confident with my interpretation abilities, and I have yet to be caught out (even though I know it is only a matter of time), but I will still continue to transmit the ECGs to the PPCI centres for someone more senior and on a whole lot more pay than I get, to make the final decision on transport and treatment of ?STEMI Mimics.

Does that mean that I don’t need the level of knowledge that I have?

Maybe…..But I am an ECG Geek and I just always want to know more and more?

What are your thoughts?

Would you ever decide to not transport or refer someone who ‘by the book’ meets criteria even though you know it is a STEMI Mimic?

Posted by Mark Glencorse on June 8, 2010 • Filed under: Ambulance, ECG, ECG Geek, EKG, EMT, paramedic • Tagged: , , , ,

ECG Geek 10

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This time I want to discuss a little more than the ECG itself, as this case got my mind going a little bit and I thought I would share.

I am going to give you a brief history of the incident,  then show you the 12 lead ECG. I want to know your interpretation of the ECG then in the next post I will give you my interpretation and then have the discussion that I really want to have.

But first, the ECG…..

This gentleman was a 32 yr old male who had called for an ambulance after feeling a ‘little unwell’ and having a fall (? Collapse) and injuring his right knee.

On arrival, he was fully conscious, alert and orientated. His colour was good, skin was normal, and he did not complain of any other pain or concerning symptoms other than pain to the medial part of his right knee. There was no chest pain, no dizzyness or headache, and no palpitiations or other possible cardiac symptoms. He had slight swelling and tenderness to the medial side of his right knee but was able to weight bare and hobble about his house.

His observations were all within normal acceptable limits

Pulse 93, regular and strong

BP 138/75

SaO2 98% on room air

Due to the fact that he had fallen and cant really remember why, he got a ECG for a rhythm strip and a 12 lead. His rhythm was sinus and his 12 lead is as shown :

click to enlarge

So, what is going on with this chaps ECG and what is your next course of action?

Posted by Mark Glencorse on June 6, 2010 • Filed under: Ambulance, ECG, ECG Geek, EKG, EMT, paramedic • Tagged: , , , , , ,

A Chance of a lifetime!!

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So here is the big news!

We need your help.

Over the past few months our esteemed creator/director/producer and all round good guy, Mr Thaddeous Setla, has been meeting and pitching to TV Executives across many of the networks in America,  and whilst they all really like what we are doing, they want to see a change to the name ‘Chronicles of EMS – The Reality Series’

What we need from you is your creative thoughts on a new name for the show. It will continue to be ‘The Chronicles of EMS’ but we need a new tag line instead of ‘The Reality Series’

It has to showcase what we are doing.

We are not just a fly on the wall TV Show – We want to challenge the status Quo and drive forward change in EMS

We are not an American only show – We are truly international and plan on travelling the world seeking out best practices and sharing them worldwide.

Just as important, we are an entertainment show that embraces it supporters and followers like never before.

We need something catchy and powerful, and for the one who comes up with the winning formula, there is an amazing prize on offer.

The person who provides the new name for the show will have round trip flights and 3 nights accommodation to a location of their choice where the Chronicles of EMS will be filming. This could be New York, San Francisco, Germany, Austria etc etc. If we are going there, the winner can come with us. They will also receive show credits and some ‘on screen time’ in a future episode too.

If thats not enough, they also get a 16GB Wi-Fi, 3G iPad.

If the winner is under the age of 18, they will win a top of the range 64GB ipad Wi-Fi & 3G.

The only requirement that we have to enter,  is that you are a member of our Chronicles of EMS community. This is free to join and can be done by clicking here.

Full terms and conditions can be found here.

Submissions end on the 9th July 2010, when we will provide a short list of the top 5 entries which will then go on to the public vote from the 12th July up until the 6th August. The Grand Prize winner will be announced on or around 10th August during a live Tweet Up in San Francisco.

So what are you waiting for?? Get your entry in by using the form found here, and Good Luck!

Posted by Mark Glencorse on June 3, 2010 • Filed under: Ambulance, COMPETITION, Chronicles of EMS, CoEMS • Tagged: , ,

Medic999 and the Podmedic

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The big Chronicles of EMS news is coming in about 10 hours time, but until then, here is a video that Jamie Davis, ‘The Podmedic’ did whilst interviewing me via skype video about the current drive trying to get the Chronicles of EMS on the new Oprah TV Network out in the States.

If you havent voted for the show yet, click here. And remember you can click away till your hearts content!!

Heres the video :

Posted by Mark Glencorse on June 3, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, Podmedic • Tagged: , , , , , ,

When ‘caring’ becomes a challenge.

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I started to write this blog post and realised as I was halfway through it that no matter how much I changed the details, I could not make it anonymous as what happened was fairly unique and so would become identifiable if I spoke about patient details and circumstances surrounding the job.

But there are still some things I want to reflect on, so I am going to handle this a different way and make this all about me and my thoughts instead of anything to do with the patient. Got that? …. Ok….

Recently my good lady wife (@Mrs999 on twitter – if you don’t follow her yet, make sure you do. She is far more entertaining than I am!!) found herself in a situation where she was most definitely placed in harm’s way whilst trying to care for a patient.

Thankfully, both her and her partner managed to escape the situation unharmed, but it really could have been a different story altogether.

Coincidentally, I was sent to this patient a couple of weeks afterwards, not knowing it was him until the police on scene mentioned details about a previous incident a couple of weeks ago which made me realise he was the one that was involved in my wives case.

For the first time in my career I was faced with a situation where I found it difficult to really ‘care’ for a patient, and this has made me think long and hard about my feelings that I had and the way that I conducted myself.

I’m not just saying this for the sake of my employers who may read this, but I can honestly say that I provided him with all of the assessment, interventions and transport decisions that I would have done with any other patient. The treatment he received was thorough, considered and everything was done that should and could have been done.

Was I my normal and usual charming self?………..

I don’t think I was.

There was never anything that he could complain about, because after all, my job is my vocation. It puts food on my families table and provides us a lifestyle which we enjoy (along with Mrs 999`s wage obviously). I love what I do and would never risk that.

But I couldn’t bring myself to go the ‘extra mile’

That left me wondering if I was wrong, or was I just being human?

Or in fact, was I doing better than many others would have done.

I am pleased with how I handled it, but I need to be honest with myself and hope that I am not put in that situation again. It would be waaaaayy to easy for things to get out of hand if he became aggressive and threatening to me or my mate.

Have any of you been in a situation like this?

How did you handle it?

Posted by Mark Glencorse on June 2, 2010 • Filed under: Ambulance, EMT, paramedic, violence • Tagged: , , ,

Guest Post – They All Live On….

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One of the best things about being part of the Fire&EMS Blog network, is that at least once a week, one of my blogs posts lands on the Facebook page of JEMS (which if you are not yet a fan of – you should be!). This has a two fold affect. Firstly, the hits on my blog go through the roof for a couple of days, and secondly, and most importantly for me, people who wouldnt normally comment on my blog leave comments on the JEMS facebook page instead.

It was whilst I was reading some of the comments left by the JEMS readers on my post ‘Getting too attached?’, I decided to chip in myself and ask if anyone wanted to share their stories, I would be happy to do that for them.

Since then, I have read some truly heart wrenching stories from some amazing professionals around the world. Most of them didn’t want their tales posting, they just wanted the opportunity to tell a stranger,who understands,  what they went through and how it affected them.

I feel privileged to have shared so many experiences..

One person who contacted me was ‘North Dakota EMT’, who said she would like to share her story with all of you. I hope that she finds the experience of sharing her story with all of you as therapeutic as I do. Thank you for sharing, I feel honoured to have heard your story.

So……I will now turn my blog over to her :

(obviously, names and identifying information have been changed)

They all live on…In one way or another…

As the ambulance pulls up on scene my gut drops to the bottom of my stomach. It’s not going to be a “good” call and it’s already started out wrong. People are standing around the front door, some are crying hysterically, others are just standing there with glazed looks on their faces. Picnic tables are covered in an assortment of food and children are playing quietly but watchfully around the eges of the campsite.

The frantic mother runs out from the crowd of people carrying her baby in her arms with tears streaming down her face and big black gobs of eye makeup smudging under her eyes. (It’s funny the things we notice in a moment of stress isn’t it?) She hysterically tells me that the baby was fine this morning when she laid him down for his nap and she’s babbling a bunch of stuff I don’t really hear.

I look down into the blanket she has wrapped around the baby, it’s one of those soft fuzzy blankets that everyone loves to run their hands across and feel the smoothness of, and I see the beautiful face of an infant. Such a beautiful little baby I think to myself. Then I focus on his eyes and see the blank, gazed stare and the blue around his lips and my heart does a flip in my chest. She hands me the baby and turns around and collapses into the arms of someone who looks like they might be her mother. She’s turned her back on the pain, trying to find some kind of escape from all that she knows will come next and my heart aches for her.

We run to the rig with the baby, get out the pediatric kit and do all the right things. The next couple of hours go by in a blur as we get to the hospital and assist in the attempts to resuscitate the beautiful little boy who will never hear his mommy say I love you again, never go to school on that first day and feel the fear in his heart of beginning a new stage in life.

And then we stand there and talk quietly with the doctor and nurses who just minutes ago we were standing side by side with, desperately trying to bring back a little heart that had quit beating. We console each other with talk of other things. Each of us mourn the life of the little boy that was lost in our own private way, trying hard not to let on how deeply it affects us. The nurses and doctor go back to their patients and my partner and I restock the ambulance and head back to the bay.

The rest of the day has a quietness to it. There is no silly banter and no goofy jokes. We deal with what has happened in our own little ways. My partner calls his wife and asks to speak to his children. I call my babysitter and ask how my sons day at daycare went and ask her to give him a hug for me but I don’t talk to him because I know I’ll break down and cry. We take the rest of the calls that come in and maybe get a little angry sometimes when we attend to someone who really doesn’t need us, and work a little harder on the ones who do, but we try not to show it.

The next morning when we get off our shift, my partner and I say the usual good-bye to each other and we each walk away with a little piece of Tobias James in our heart…………

Ten years later, and lil Tobias is still a piece of my heart and although others have joined him there, I think he still holds the biggest piece and always will…….

Posted by Mark Glencorse on June 1, 2010 • Filed under: Guest Blogger, Guest Post • Tagged: ,

You know you’re a patient when…..

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Justin took over the EMS Garage again this week for another edition of ‘The Happy Hour’. The chaps had a discussion about what actually is a patient, which proved to be a very enlightening discussion. Click here to listen to the show, or subscribe to the EMS Garage on iTunes.

Following on from this, one of the guests, Jamie Davis posted a video on his Medicast web site which has a little bit of fun with the statement ‘you know you`re a patient when…..`

I hope you enjoy this as much as I did.

Jamie is starting to do weekly video blogs as well as his many podcasts (I dont know where he gets the time!!), so make sure you pop over to http://www.mediccast.com and see what he comes up with next!

Posted by Mark Glencorse on May 31, 2010 • Filed under: Ambulance, Funny moments, fun stuff • Tagged: ,

One quick glance

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I feel that this should have been my submission to Steve Whiteheads edition of ‘The Handover’ under the topic of ‘in that one moment’, but alas, tis too late!

Its still worth sharing though (I think)

Now, this isnt one of those” arent I great posts”, I hope that you will all read it and be able to recognise the very same abilities that you have when assessing a patient. I think, that this sort of thing shows experience more than anything else, so if you cant say this has happened to you yet, then dont worry because one day it will!

I was called to a patient who was choking. I am working on the rapid response car and head off at speed to the address that is showing on my computer terminal. Its only a 5 minute drive but that is enough for me to run through things in my mind to prepare for what I am going to do if it is in fact a “Worst case scenario” that I am about to find myself in.

As I pull into the street and start looking for the address I see the flapping hands of a adult female standing by a back gate. Once I pull up alongside the house, I quickly glance over to her to see the look of wild panic in her eyes and think that maybe this is a ‘proper job’

I quickly gather my kit from the boot (trunk for my US readers!) and head into the house. As I pass through the hard I see a boy (approximately 7yr old) crying hysterically and shouting that his “Grandad is dead!”. There are another 3 children in the yard in varying states of distress with one other adult looking shocked and shaken.

Straight into the house and through the kitchen, noticing copious amounts of empty lager cans and cheap wine bottles in the kitchen. The house is in a general state of disarray and has even more people inside, all of which appear intoxicated to a greater or lesser degree.

Getting closer to the front of the house and I hear shouting and groaning….

“Come on!!”

“Uuurggghhh!!”

“Come on you Bas&%rd!!”

“Uuuurrghhh!”

I walk into the front room and take in the scene in one quick glance.

An adult male is standing upright infront of the couch. He is conscious, looks red in the face, and seems to be alert to what is going on around him. There is no evidence of central cyanosis, no apparent respiratory compromise and although he is not talking, he is making a loud “Uuuurrgghhh” noise every time the lady standing behind him on top of the couch is performing a very strong and forcefull abdominal thrust on him.

“Stop that now!” I say loudly.

“But the woman on the phone told me I had to do it”

“I know, but that was for a choking patient. He is isn’t choking”

And there is my point. In total from leaving the car to getting to the patient, took about 7 – 10 seconds. From seeing the patient to the moment when I told the woman to stop doing the Heimlich manoeuvre – about 0.25 seconds.

Isnt it amazing how, over time, you just become accustomed to seeing what needs to be noticed to make a rapid clinical decision. Most of the things that we see, hear or smell are recognised and filed away without us even being aware of it, but if you actually stop and think about it, it is really quite something to see.

Posted by Mark Glencorse on May 30, 2010 • Filed under: Ambulance, Assessment, paramedic, patient assessment • Tagged: , , , ,

Medic 999 now on Facebook

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If you havent already noticed, there is a funky new widget over on the right there which shows a feed from the Medic999 face book page.

It has taken quite some time to get round to starting one off as I always thought that it would just be more of a fuss and I would just end up repeating everything that I have been putting on to the blog.

However, now that I have started it, I realise that there is so much more that I can be doing over there which compliments, rather than repeats what can be found here.

I intend to post all of the links that I find interesting from reading everyone else blogs over there as well as many of the videos that I stumble across whilst looking around the EMS Web.

I started it just 3 days ago, and I am amazed that I already have 293 followers on it!!

For those who have already been over and clicked the ‘like’ button, thank you very much!

What I am hoping is that you will all post stuff onto the wall too, so that we can start our own little community going to (which has already started to happen)

Im excited about this, I wish I had started earlier!

So, what are you waiting for…..Click HERE and go and have a look. Let me know what you think.

Posted by Mark Glencorse on May 29, 2010 • Filed under: Ambulance

The Handover – Edition 15

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The current edition of the Handover Blog carnival is up at Steve Whiteheads EMT Spot.

This month he asked us bloggers to write something about a moment when things just seemed to click into place. Whether it be as a new starter in the profession or a seasoned medic who just has ‘one of those moments’, these are times to be cherished and reflected on.

Click HERE to go over and read this edition and hopefully be inspired a little.

Posted by Mark Glencorse on May 28, 2010 • Filed under: Ambulance, blog carnival, the Handover • Tagged: , , , ,

Some light hearted relief!

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After all the heavy subjects recently, a quick little film posted on the Chronicles of EMS web site by one of our friends from Germany Sascha Fehr, will be sure to bring a smile to your face!

When we travel to Germany, we will be working alongside Sasch, and I cant wait!

Anyway, enjoy!!

Posted by Mark Glencorse on May 28, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, Videos • Tagged: , , , , ,

Getting too attached?

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Have you ever had one of those patients who really had an impact on you?

Not a big job, not a traumatic job, just someone struggling with their personal demons and not particularly winning?

A little while ago, I had the privilege of looking after a 19 year old lady who had collapsed at work and had a possible seizure. I go there along with my crew mate John, and immediately realised that in this case, it was not a seizure.

Kirsty was sitting in a chair, staring into space, looking a little pale and trembling in her arms and legs. She was not responding to her work mates, and they were propping her up on the chair to stop her slouching and sliding of the front of it.

No response to verbal stimuli, but a groan and a focusing of the eyes after a short bit of painful stimuli courtesy of the anesthetist’s handshake.

She came around and started talking to me in a mumbling fashion. She appeared to be really anxious and a little scared. I wanted to move her to the ambulance so that there was some privacy for her whilst I tried to get to the bottom of what was going on, and do some further tests (a quick feel of her radial pulse told me that she was tachy at approx 140 beats per minute, so I wanted to do an ECG anyway)

On the back of the ambulance, she was reluctant to tell me much about what was happening and what she remembered about what happened. She wasn’t being obstructive, just obviously had some things that she wasn’t happy in sharing with us.

As John brought her bags on to the back of the ambulance, he dropped one and a couple of bottles of tablets rolled on to the floor. Kirsty immediately jumped up and lunged for the tablets with a look of panic in her eyes.

“What are they Kirsty?”

“Nothing, nothing, ok? It’s just some tablets, nothing special, ok??”

Her eyes began darting to and from John and I, and for a second, I think that the tears are about to start, but she regains her composure and smiles sweetly.

“They are just a couple of diet pills, that’s all. Nothing bad, you can buy them over the counter. That’s ok isn’t it?”

Things start to click in to place, but as I look at Kirsty, all I see before me is a beautiful young lady who doesn’t look too thin and is certainly not over weight.

“How many of these have you taken today?”

“Quite a few, but its ok you know. I’ve done it before. It’s okay, just been a little bit of a tough day….Can I go know, I’m fine”

I inform her that we need to do some more tests before I can consider letting her leave and get on with her day, even though I have already decided on these tests being as much of a stalling factor as well as a diagnostic tool. I wasn’t happy, my spider sense was tingling.

As John took her blood pressure, BM and pulse, I started to delve a little more. When I got to her medical history I decided to ask her if she had any trouble with dieting and eating disorders.

“Oh God no, I’m just the same as any girl. We all want to lose a little bit of weight you know”

This went on and on, but gradually over the period of the next five minutes the truth started to come out.

She had struggled with anorexia and body dysmorphia from a very young age and had been sectioned under the Mental Health Act a few years before when her weight dropped to 4 stone.

John then made an innocent comment which resulted in a response from Kirsty that neither of us expected

“Don’t be daft, you look great!”

After hearing that Kirsty physically started shaking, became twitchy then started punching herself in her chest.

“Please don’t say that! Just don’t say that!!”

I was shocked by the way that comment affected her, but I also understood that it must have been like the biggest insult in the world to her. I don’t understand her thought processes that brought her to that response, but I now knew that that wasn’t the way to approach this.

Kirsty settled a little, and switched back to her smiley demeanor from before. She was complaining of palpitations, which along with her tachycardia meant that I needed to do an ECG. I explained all of this to her knowing that it was going to be tough for her to let me actually place the leads and do the tracing. I assured her that I would cover her up and would expose her as little as possible, but that it was important for us to do.

She accepted and seemed to be mentally preparing herself for the ordeal that lay ahead. She was okay with the limb leads, and even joked on about not shaving her legs, but as I asked permission to place her chest leads, she started to hyperventilate.

“Kirsty, if this is too much, I can leave it ok?”

“No, just do it. Do it now!”

As I started to raise her shirt she cried out

“No, No, No, No!!”

I actually flinched, I got such a shock.

“Its okay, I’m not going to do it okay. I’m not willing to put you through this, it’s ok….”

I sat back down in my seat and looked across at her.

“Right John, let’s just head off, I’m not going to do anything more here”

Kirsty forced a little smile and seemed to sink even further into the trolley, pulling the blanket up around her chin.

What was going on in her mind? What sort of hell must she be in? I wouldn’t dream of saying it to her, but all I could see was a physically beautiful woman, who seemed very sweet, and who most guys would be proud to have on their arm on a night out.

I know that wouldn’t matter to Kirsty. I know that that isn’t what she sees when she looks in the mirror.

I felt a connection to her, I wanted to help. I wanted to make things better, but again, all I could do was try to be kind, not make anything worse for her and take her to A&E, where I know they will do nothing for her eating disorder as it is a chronic mental health problem (unless she is showing any physical abnormalities from it in her blood work)

We spent the rest of the journey chatting, with Kirsty continuing to try and persuade me that all girls feel like her and me trying to persuade her that I understand that she is going through more than just a little momentary concern about her weight.

I handed her over to the nurse at the hospital, who was great with her and put her into a quiet room where she wouldn’t be disturbed. I said my goodbyes and went back to the vehicle but just couldn’t stop thinking about her.

Why had she affected me so much?

Is it because I saw a woman who had absolutely no outward weight problems that I could see, but still sees herself as overweight?

Is it because I know that after a 7 year history she seems no further forward in any sort of treatment or recovery than she ever has been?

Or is it because, yet again, like most patients that I care for with serious psychiatric problems, as pre-hospital health care professionals, we can do nothing other than transport them to a facility that is inappropriate for their needs?

Posted by Mark Glencorse on May 27, 2010 • Filed under: Ambulance, Annorexia, EMT, Eating disorders, paramedic • Tagged: , , , ,

My Friend from Germany

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CoEMSI would like to introduce you to Sascha Fehr, a Medic from Braunschweig  in Germany.

He is one of the medics that Justin and I will working with when we go over to film some of the European episodes of The Chronicles of EMS.

Sascha just wanted to say `Hi` and let us know that he is going to start to do video journals togive us an insight into German EMS.

You will be able to watch his updates on the Chronicles of EMS web site, and also on the Medic999 Facebook page.


Find more videos like this on Chronicles of EMS

Posted by Mark Glencorse on May 27, 2010 • Filed under: Chronicles of EMS, CoEMS, Videos • Tagged: , , , ,