I lied there, motionless in the dark staring at the ceiling, 8000 miles from home. God, what I would have gave for just a couple hours of sleep. I had been working 2 day shifts followed by 2 night shifts back to back and my insomnia was terrible. I had been awake for over 24 hours and my brain would just not shut off. It was my birthday and I had just turned 28 years old. I was deep in thought that night. A lot of things where racing through my mind about my own life, but I would have to put those thoughts on hold for later.
Silence was once again broken by the squelch of the radio, followed by shouts for the en famous Medic-12. Medic 12 was not only my work alias but now also served as my sleep deprived alter ego. I dawned my trusty steed (aka our Toyota camery) My blood shot eyes staired off into the night as I watched the red and blue reflections all around us from our light bar whilst we speed down the highway. Having had no sleep in over 24 hours, they where almost hypnotic. We get an update on the way to the scene that this is a large vehicle accident with multiple patients. The BLS(Basic Life Support) Ambulance on scene is calling for ALS(Advanced Life Support) back up and additional resources.
We finally reach our objective, but I see no vehicles, then I look down the 20 foot embankment to my right and see the body's and vehicles strung out all over the ground. I start making my way down the steep embankment. The first body I come up to is motionless, I quickly confirms he is dead and move on to the next person several feet away. They are also dead, I continuing moving along searching for every patient I can find in the dark, listening for screams of help. I come across 3 more body's a short distance away. 2 of them appear to be stable and are talking to me, but next to them I find someone motionless. Expecting another dead body I check and the person takes a spontaneous breathe. I open his airway and assign some of the BLS crew to start packaging him while I continue to search for more patients. I only find 1 other person and they to are dead. I return to the unconscious man who took the breath. We strap him to a backboard and load him into the ambulance quickly.
En route to the hospital I begin to suction all the blood from his airway and we assist his ventilations. The EMT's work on getting an IV while I continue to work on the airway. His Oxygen saturation levels are to low and he needs a secure airway. I attempt to intubate him (place a breathing tube into his trachea) But his jaw is clinched. unfortunately my station does not yet have paralytics which I desperately need to give him to unclench his jaw and facilitate passage of the breathing tube. I start to consider alternatives interventions to resolve the problem but we arrive at the hospital quickly. As we wheel him from the ambulance to the ER he go's into cardiac arrest . I say a vulgar word out of frustration and walk away. The ER team decides to work him sense it just happened, but I know you never really successfully resuscitate a traumatic arrests. After several minutes of interventions and 2 rounds of drugs, they discontinue all efforts and call time of death.
I wash up, grab all our gear, have the ED doctor sign our report and head back to the station. I managed to get a little bit of sleep but it did not last long. I would go on multiple calls like this the next 2 nights. Finally I got home and collapsed. I was mentally and physically exhausted and sleep for 15 hours strait.
Friday, October 15, 2010
Sunday, September 26, 2010
GhostBuster my first week as "Medic 12"
It was 3 am and as my eyes shut for what I hoped would be a blissful night of dreaming, the radio shattered the silence. "Medic 12 respond to fire" My eyes opened wide as I shot up and jumped into my boots. The call came across as a fire and thats the only information we received. My Basic partner and I hop into our fly car, hit the lights, and speed off into the night. I start going over the burn protocols in my head on the way to the fire. I know I will probably be the only Advanced Life Support unit at the scene, so I want to make sure I have a plan in my head when we arrive. I would soon find out the plan(s) I had where about to go out the window and there was no protocol for the situation I was about to encounter.
We arrive to the scene, fire trucks are everywhere and the firemen are searching for patients inside. The Basic ambulance had the only patient waiting in the back of there ambulance. The patient was a male in his 30's appeared to be unconscious. I administered a sternal rub and he quickly "woke up" staring at me with confusion. Trying to find out whats wrong the patient in often a big challenge here because no one speaks English. My Basic partner is often the only one who can translate and his English is very limited. We get baseline vital signs, pulse ox-cemetery, a blood sugar, and check pupils. Everything is within normal limits. The patient appears to be very confused and is having trouble standing... Aparrently he is saying some very odd things in arabic. I start considering possible causes to his altered mental status and unstable gate. He wasn't near the smoke in the fire, and did not appear to have carbon monoxide poison, Hes pupils and vital signs where normal, his blood sugar was normal, he wasn't having a stroke, I did not smell alcohol, so why was he acting so strange? At this point I found someone who could speak pretty good English. He told me the patient had not slept in 2 days and saw a ghost.....
Apparently "the ghost" made him like this. I tried not to laugh but I could not hold it back, but as I looked around I was the only one laughing. I recommended we see if he had a past medical history, if he took any mind altering substances and he go to the hospital for a physiological evaluation by a physician but thats not what happened.
At this point as a Paramedic I was no longer in charge, but it wasn't a doctor that took over care from me it was a holy elderly man with a large beard. With a Quran in one hand he stood over the patient and began to pray. He started to perform some kind of procedure which I soon found out was like an exorcism This is when I left. I waited near by and talked with a local who spoke English. When I told him what was happening he said, oh yes... He saw a ghost and the holy man is healing him from the powers of the ghost. I said "a ghost, you believe that?" He said "yes, dont people call you in america for ghost?" I said "no... they call the ghost busters."
To make a long story short I wait for my first pre-hopspital exorcism to be completed and released the patient to the ambulance crew for transport to the hospital. I spoke with a local Medical Control doctor later that day and told him the story. He laughed and said yes a local EMT-B called him once for online medical control because of altered mental status. The conversation went something like this.
EMT: yes hello doctor I have a patient who is acting strangely and the patient says he was possesed by the spirit of a Genie. Please advise, over.
DR: Sounds like a Psychiatric patient, has the patient taken any drugs or does he have a past medical history?
EMT: Damnit doctor did you not hear me!? I said the patient is possessed by the spirit of a Genie!
DR: *Sigh*.... Yes, a Genie... Ok, monitor vital signs and treat any signs or symptoms as you usually would until you arrive the hospital so the Genie can be banished from the patient.
EMT: Copy that Doctor.
( for more on Genies check this link http://en.wikipedia.org/wiki/Genie )
I saw a lot things my first week including 3 Myocardial Infarctions (heart attacks), Assaults, Motor Vehicle Accidents, Diabetic emergency's, and Respiratory emergency's. I was so busy and had not slept in 24 hours. My body and mind where running on auto pilot. I just wanted a break or a real easy call but the last call of the week was an unstable unconscious person who was extremely hypoxic, tachycardia, had a very low blood sugar, tachypnea, an extremely low oxygenation saturation, with an uncontrolled airway. If left untreated this patient would die soon, from hypoxia if nothing else. The patient had a gag reflex but we needed control of the airway so I inserted a Nasal Airway Adjunct into her nose, then we attached oxygen to a bag valve device and started assisted ventilations. Her o2 saturations started improving immediately and all her vital signs started to improve except of course for her blood glucose level because she needed sugar. Her veins where very difficult to feel and extremely fragile. We attempted 3 IV's with no success to give dextrose, so I gave her a medication I have to mix called Glucogaun which is administered as an injection into the muscle. After I gave her the shot she started to regain consciousness as we arrived at the hospital. we re checked her blood glucose and it was now within normal range. I was soooo tired and worn out but I felt really good about the call. We took an unstable patient, fixed her airway control, fixed her ventilation problem, fixed her hypoxia and 02 saturation, which in return fixed all her other unstable vital signs except the glucose. Then we gave her the shot and fixed that, stabilized her and delivered her safely to the hospital who can continue managing her for the longer term.
We arrive to the scene, fire trucks are everywhere and the firemen are searching for patients inside. The Basic ambulance had the only patient waiting in the back of there ambulance. The patient was a male in his 30's appeared to be unconscious. I administered a sternal rub and he quickly "woke up" staring at me with confusion. Trying to find out whats wrong the patient in often a big challenge here because no one speaks English. My Basic partner is often the only one who can translate and his English is very limited. We get baseline vital signs, pulse ox-cemetery, a blood sugar, and check pupils. Everything is within normal limits. The patient appears to be very confused and is having trouble standing... Aparrently he is saying some very odd things in arabic. I start considering possible causes to his altered mental status and unstable gate. He wasn't near the smoke in the fire, and did not appear to have carbon monoxide poison, Hes pupils and vital signs where normal, his blood sugar was normal, he wasn't having a stroke, I did not smell alcohol, so why was he acting so strange? At this point I found someone who could speak pretty good English. He told me the patient had not slept in 2 days and saw a ghost.....
Apparently "the ghost" made him like this. I tried not to laugh but I could not hold it back, but as I looked around I was the only one laughing. I recommended we see if he had a past medical history, if he took any mind altering substances and he go to the hospital for a physiological evaluation by a physician but thats not what happened.
At this point as a Paramedic I was no longer in charge, but it wasn't a doctor that took over care from me it was a holy elderly man with a large beard. With a Quran in one hand he stood over the patient and began to pray. He started to perform some kind of procedure which I soon found out was like an exorcism This is when I left. I waited near by and talked with a local who spoke English. When I told him what was happening he said, oh yes... He saw a ghost and the holy man is healing him from the powers of the ghost. I said "a ghost, you believe that?" He said "yes, dont people call you in america for ghost?" I said "no... they call the ghost busters."
To make a long story short I wait for my first pre-hopspital exorcism to be completed and released the patient to the ambulance crew for transport to the hospital. I spoke with a local Medical Control doctor later that day and told him the story. He laughed and said yes a local EMT-B called him once for online medical control because of altered mental status. The conversation went something like this.
EMT: yes hello doctor I have a patient who is acting strangely and the patient says he was possesed by the spirit of a Genie. Please advise, over.
DR: Sounds like a Psychiatric patient, has the patient taken any drugs or does he have a past medical history?
EMT: Damnit doctor did you not hear me!? I said the patient is possessed by the spirit of a Genie!
DR: *Sigh*.... Yes, a Genie... Ok, monitor vital signs and treat any signs or symptoms as you usually would until you arrive the hospital so the Genie can be banished from the patient.
EMT: Copy that Doctor.
( for more on Genies check this link http://en.wikipedia.org/wiki/Genie )
I saw a lot things my first week including 3 Myocardial Infarctions (heart attacks), Assaults, Motor Vehicle Accidents, Diabetic emergency's, and Respiratory emergency's. I was so busy and had not slept in 24 hours. My body and mind where running on auto pilot. I just wanted a break or a real easy call but the last call of the week was an unstable unconscious person who was extremely hypoxic, tachycardia, had a very low blood sugar, tachypnea, an extremely low oxygenation saturation, with an uncontrolled airway. If left untreated this patient would die soon, from hypoxia if nothing else. The patient had a gag reflex but we needed control of the airway so I inserted a Nasal Airway Adjunct into her nose, then we attached oxygen to a bag valve device and started assisted ventilations. Her o2 saturations started improving immediately and all her vital signs started to improve except of course for her blood glucose level because she needed sugar. Her veins where very difficult to feel and extremely fragile. We attempted 3 IV's with no success to give dextrose, so I gave her a medication I have to mix called Glucogaun which is administered as an injection into the muscle. After I gave her the shot she started to regain consciousness as we arrived at the hospital. we re checked her blood glucose and it was now within normal range. I was soooo tired and worn out but I felt really good about the call. We took an unstable patient, fixed her airway control, fixed her ventilation problem, fixed her hypoxia and 02 saturation, which in return fixed all her other unstable vital signs except the glucose. Then we gave her the shot and fixed that, stabilized her and delivered her safely to the hospital who can continue managing her for the longer term.
Friday, September 17, 2010
Getting paid to sit around
I have been here over 6 weeks now and have only worked the 1 observation shift I wrote about in my last entry. The good news is I am salary and have been getting paid regardless. For some reason it takes people a long time to process in here, in addition to that I got here during Ramadan and Eid holidays. As cool as the concept is of getting paid to sit around, its pretty boring and I hope to hit the streets again soon. I hope to have more exciting news to update everyone on soon. until then......
Sunday, September 5, 2010
Life is fragile
Yesterday was my first shift, it was an orientation shift with another U.S. Paramedic. Our first call was for some one who "fainted." We jumped in the fly car(which is a souped up Toyota Camry modified like a police car) and sped towards our destination. A BLS ambulance was behind us when we left the station but it wasn't long before it was unable to keep up with our fly car and I soon lost sight of it. Our EMT-B driver was one of the more "experienced" ones and I still almost craped my pants as we reached speeds of 118MPH. I looked out the window and everyday objects where just a blur at these speeds. Cars did not pull over for us and sometimes it felt as if we where traveling faster than the sound of our siren before it could warn drivers ahead of us. If it is possible to travel forward in time or through a wormhole I might discover it soon.
A lot raced through my mind on the way to the call, and it wasn't so much about the patient. I was a little scared for my own safety. I knew if a car pulled out in front of us, opened a door, changed lanes, or anything happened in our path we where screwed. I thought about statistics, statistics like how Saudi Arabia is #1 in the world for motor vehicle accidents. I thought about how 16 people die everyday in the very city we are now driving 118 MPH hour in. I thought about how ironic it would be if the people sent to save the those people could just as easily become part of the daily statistic here and it wouldn't even make the news.
I thought about how our driver wasn't wearing a seat belt and how to him and most of the other locals, everything that happens is "gods will." I am sure that comforted him, but let me assure you it did not comfort his atheist human cargo.
Upon arriving to our destination we where lead into a small room with 2 beds. Our patient was laying on one of the beds and as we went to assess him we noticed something important, he was cold. After checking his skin tone/color, pupils, pulse, and respiratory rate we slapped the EKG patches on him to confirm the obvious... HE WAS DEAD. DOA, Dead on Arrival. In fact he had been dead for so long there was no reason to even attempt resuscitation efforts and we pronounced him dead for the police and gave them a copy of our report.
How funny that we came so close to death ourselves just to reach a corpse. I soon learned that we drove this way to every call, sometimes on the freeway going against traffic in the emergency lane. I saw a lot as the day went on. A man that was scalped with an exposed skull wondering around confused after an accident with a semi truck. We quickly shoved what was left of his scalp back over his skull and wrapped a large trauma dressing around it. As the day stretched on we had several other car accidents resulting in broken arms, shoulders, missing teeth, closed head injury's, open head injury's, burns, and almost anything else you could imagine. We even had a couple shortness of breathe and cardiac calls. This was all on 1 shift.
I am going to be busy and get a lot of amazing experience but things are a lot different here and a lot more dangerous. Life is fragile here, and not just for the patients.
Saturday, August 21, 2010
First Impressions
I have been in country nearly 3 weeks now and let me tell you, its been quite the experience so far. I am still processing into the system here and am waiting for some paper work to clear before I can start work so I have a lot of down time.
Trash: There is no recycling and you simply throw your garbage on the street in many areas. The city has a team of East Indians who patrol around in green jump suites with garbage cans.
Class System: Is very much alive and as a white American male I am almost on top. I have been ushered to the front of several waiting lines.
Women: Have to be pretty much completely covered up and there is no interacting with them in public really. They also are not allowed to drive here.
Co-workers: The guys I have met so far have all been cool. I am meeting people from all over the world including, Australia, South Africa, England, Saudi, Egypt, and more.
Women: Have to be pretty much completely covered up and there is no interacting with them in public really. They also are not allowed to drive here.
Co-workers: The guys I have met so far have all been cool. I am meeting people from all over the world including, Australia, South Africa, England, Saudi, Egypt, and more.
Driving: Everyday we leave the hotel we place our lives in the hands of drivers who make demolition derby look like a safe driving course. Here are a few examples of what I have witnessed so far off duty around town. Cars stopping in the middle of a 4 lane 1 way street then reversing against traffic over 40 MPH for several city blocks because they missed a turn or exit. Motorcycles driving on sidewalks, cars doing doughnuts in the middle of busy 4 way intersections, cars drifting in and out of traffic at speeds over 100MPH, several car accidents outside our hotel and down the street. Today our emergency support vehicle was rear ended in front of me by a driver at night with no head lights. Everyday 18 people die in this city from car accidents. I asked my taxi driver the other day if he had ever hit a pedestrian and he said yes, 4 over the years which included 1 death. Saudi Arabia is #1 in the world for car crashes and vehicle related deaths, and I can see why. When I do start working it will be a very dangerous job responding to emergency's.
People: Everyone has been nothing but nice so far. What little exposure I have had in country has been positive. All the locals are have been very friendly to me so far, many are happy and excited to see an american. Most speak only a little English, some speak none. I have already picked up several words in Arabic and plan on buying a book so I can communicate a little better with everyone. When you get a crowd together usually someone can speak English, but certainly not everyone. Many of the Saudi Locals wear the traditional thobe and checkered headgear, others dress more western. However there are still strict dress codes enforced in public. I cant wear any of my sleeveless shirts or really tight stretch jeans. I guess Ill invest in some Fred Perry's and braces....
Food: Still getting use to this part. We have been eating a lot at american restaurants like Apple Bee's, Tony Romas, The outback, TGIF, ect. There is no kitchen in our hotel and its difficult to eat healthy but I am doing my best. The breakfast buffet the hotel gives us is pretty good. We get outside food delivered for lunch and dinner, but often its very bad for you and poor quality. They are working on fixing this for us. The local food is not so bad and consist of humus, kabobs, lamb, strange paste like things, and Shawarma. We have Safeway here so I invested in some weaties and fruit the other day which should help. I also have access to a personal trainer and gym which I plan on utilizing soon. The personal trainer is from the Serbian military and is a professional body builder. He does not speak a word of English, but he is very good at showing you what to do and helping you with fitness goals, so long as your good at charades or have a translator handy.
Well thats all for now I hope all my paper work clears soon so I can start working. I miss all of you back in Portland!
Wednesday, August 11, 2010
Ramadan and my first week
It has been 1 week sense I have arrived in Riyadh. Ramadan started today which is a Muslim holiday. During Ramadan(which is 1 month long) Muslims can not eat or drink during daylight hours. All restaurants and many shops are closed until dark. Non Muslims may not eat or drink in public, sooo... this is going to be an interesting month.
So far this week I have got to know the other Paramedics, went out to dinner with most of the guys, exploring around the city, visited a couple of our ambulance stations and a helicopter station. Everyone has been very friendly, including the locals. I am meeting people from all over the world. I am still processing in for the next 2-3 weeks before I start work.
I have been ushered to the front of several waiting lines at hospitals, embassy's, and admin lines simply because I am American. Hopefully this does not go to my head :)
The hotel I am staying in is nice, but its boring and does not have a kitchen in my room. Its also not within walking distance to much. I am looking into compounds to live on but they are all full with waiting list. Bordem can set in easily when there are no movie theaters, clubs, pubs, dancing, censored Internet, 2 English channels on tv, no interacting with females, and everything closes 5 times a day for prayer.Nothing opens until 4pm because its so hot during the day.. We will see how next week go's.
Once I get my living situation figured out I can pick up some hobby's to keep myself busy, find some good coffee shops, build a group of friends to do things with, and start going to a gym. I might even get a a big SUV because people drive insane here and gas like 30 cents a gallon.
So far this week I have got to know the other Paramedics, went out to dinner with most of the guys, exploring around the city, visited a couple of our ambulance stations and a helicopter station. Everyone has been very friendly, including the locals. I am meeting people from all over the world. I am still processing in for the next 2-3 weeks before I start work.
I have been ushered to the front of several waiting lines at hospitals, embassy's, and admin lines simply because I am American. Hopefully this does not go to my head :)
The hotel I am staying in is nice, but its boring and does not have a kitchen in my room. Its also not within walking distance to much. I am looking into compounds to live on but they are all full with waiting list. Bordem can set in easily when there are no movie theaters, clubs, pubs, dancing, censored Internet, 2 English channels on tv, no interacting with females, and everything closes 5 times a day for prayer.Nothing opens until 4pm because its so hot during the day.. We will see how next week go's.
Once I get my living situation figured out I can pick up some hobby's to keep myself busy, find some good coffee shops, build a group of friends to do things with, and start going to a gym. I might even get a a big SUV because people drive insane here and gas like 30 cents a gallon.
Thursday, August 5, 2010
I have arrived in Saudi Arabia
Today is my 3rd day in Riyadh. When I first arrived, after being picked up from the airport I was driven to my hotel at speeds of about 90MPH. As we weaved in and out of traffic I looked out the window at a large hurd of camels. Once we reached the hotel I was shown to my room. Its pretty nice and has all marble floors, a 42 inch plasma screen tv, Persian rugs, an oversized California king bed, a huge wardrobe and a really nice living room area with a big couch some nice oversized chairs and large coffee table.
At this point I met with a couple guys from the SRCA, one of which was wearing the traditional robe and head gear here called a "thobe" I believe. He pointed to the large fruit basket, platter of pastries, bottles of juice, and water that was prepared for me. "Is this to your liking?" "Is everything satisfactory?" he asked. They both explained to me I was welcome here in Saudi Arabia and they where very excited to see me. One of them kept calling me "Mr. Mike Paramedic" which I thought was pretty cool.
After being properly welcomed they left my room so I could rest after my 24 hour plane ride. A couple hours later my door bell rang, I opened to the door to find room service guys with bow-ties delivering my lunch and also a 2 pound box of dates to snack on. I met with my friend Aaron and the other U.S. Paramedics and 1 UK Paramedic yesterday. So far they all seem like nice guys. There are only about 10 of us right now, and half of them are being transfered to the Helicopter for flight, so that only leaves me and a few other guys as the only ground Paramedic service for a city the size of LA. Hopefully some more guys arrive soon. It is currently the weekend here and I will start processing in within the next couple days.
Ill keep you all up to date often. Please feel free to contact me with any questions or concerns.
At this point I met with a couple guys from the SRCA, one of which was wearing the traditional robe and head gear here called a "thobe" I believe. He pointed to the large fruit basket, platter of pastries, bottles of juice, and water that was prepared for me. "Is this to your liking?" "Is everything satisfactory?" he asked. They both explained to me I was welcome here in Saudi Arabia and they where very excited to see me. One of them kept calling me "Mr. Mike Paramedic" which I thought was pretty cool.
After being properly welcomed they left my room so I could rest after my 24 hour plane ride. A couple hours later my door bell rang, I opened to the door to find room service guys with bow-ties delivering my lunch and also a 2 pound box of dates to snack on. I met with my friend Aaron and the other U.S. Paramedics and 1 UK Paramedic yesterday. So far they all seem like nice guys. There are only about 10 of us right now, and half of them are being transfered to the Helicopter for flight, so that only leaves me and a few other guys as the only ground Paramedic service for a city the size of LA. Hopefully some more guys arrive soon. It is currently the weekend here and I will start processing in within the next couple days.
Ill keep you all up to date often. Please feel free to contact me with any questions or concerns.
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