Subaqua Sternal Rubs

I was weak. I had made it through 26-week Terms before, but during this, my 6th Term, (which is only 18 weeks long), I took a short sabbatical and went home for a week. It was right after passing (and getting a better than average score) on my second exams when everyone I know was either 1) going on vacation to another beach (not interested - gets kinda old after being in the Caribbean for 2 years), or 2) going on a scuba diving vacation to another island (which I can't as a result my little accident). So for about the same amount of money others were spending on a weekend away, I spent a whole week at home seeing family and friends (or at least the ones that were working either at the ambulance or hospital when I was.)

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This afternoon was the much anticipated first rotation (out of 5) in the Accident and Emergency Department. I was impressed with A&E starting with the waiting room, mostly because of the huge sign that said:

What I wouldn't have given to put up a sign like that in the ED where I work(ed), though I would make it 4AM instead.

Other than that, we didn't get to see much of the A&E (other than the fact that it had about 10 rooms, 2 resuscitation rooms, and an "asthma bay," where two kids were happily sucking on nebulizers), as we were whisked off to do guess what? Yup, another history and physical. Our patient was a 45yo male salesman who c/o lower abdominal pain which radiated to both flanks, accompanied with nausea and vomiting. Unfortunately, it was not anywhere near the critical care level the adrenaline junkie side of me hoped to see in A&E, but still a learning experience. Though the physical exam less so, as the pt had been drugged up with pain relievers, and the abdominal exam revealed absolutely nothing. As laboratory and imaging studies were not back yet, we didn't have a diagnosis more definitive than rule out kidney stones or rule out appendicitis.

After reviewing our history and the differential diagnoses with us, our precepting physician was signing our "green cards" (hospital rotation cards to prove we actually attended), the adrenaline junkie once again got the better of me, and I asked if it were possible to do an EMS rotation. His reply?

"Aren't you here to learn the history and physical? I don't think they do that on the ambulance."

Ok, so while some people who abuse the EMS system think it is a taxi service, it is in fact not. Seriously, does he think that EMS just throws the patient in the back of the rig and drives them to the hospital without saying a word in the 30 or so minutes it takes to get there? Most EMS providers do perform a history and physical to figure out what is wrong with the patient, so they can 1) give appropriate treatment and 2) give report to the hospital. Though to be fair, I don't know what level of training the EMS has in St. Vincent, and they may be just "ambulance drivers."

The precepting physician also added:

"Doctors do not go out on the ambulance, so you would have no supervision."

Of course he did not know that I have been a certified EMT/AEMT for the past 6 years, and haven't killed anyone yet. (Despite trying once or twice.) And to be honest with you, I really wouldn't trust some of the students here, or some of the students that rotated through the ED where I worked back home. Either 1) they know absolutely nothing, or 2) they'll rattle off every possible diagnosis out of Robbin's Pathology without ever mentioning the obvious one.

Oh well, maybe one of the other docs will let me play with the lights and sirens. (And save some lives, of course.)

Had two ambulances drive by with red lights in sirens in as many days. Either St. Vincent has a more developed EMS system than Grenada (i.e. take less than two hours), or they just like playing with the flashies and woo-woos.

I have my first ED rotation in a week (excuse me, Accident and Emergency), so we'll see if that priority driving has any point or not…

I never though I would see it: an actual post in the EMS category. Not one, but two EMS calls in the past week. Nothing spectacularly interesting, but it's something nonetheless.

Last week one of the campus Physician Extenders (campus EMS) calls me up to ask for some assistance back boarding a student that fell on slippery, wet, outdoor tile stairs. Believe it or not, the campus "ambulance" runs with only 1 crew. They have to improvise if it's anything more than a sore throat and the patient actually needs care on the way to the hospital. Crazy. And did I just spell improvise with an "s"? Wow, I've been in an English-English-speaking country too long. [Edit: It's even funnier now that after running spell-check, that even my spell check seems to think it is spelled with an "s," even though the server is located in Houston, TX. Well, I guess they did give us that brillant scholar we have for a president.) Anyways, up to the hospital for some x-rays and an overnight observational stay for "pain management." Or maybe the census was low at the privately run hospital, and the opportunity for income was seized?

Anyways, today someone knocked on my door to tell me that someone hurt themselves playing basketball (a seemingly-daily occurrence). A 23-yo male had an anterior-inferior dislocation of his right shoulder (for the 7th time.) Ice, immobilization and a trip up to the General Hospital. After films, and the orthopedic surgeon reducing the shoulder, the patient possibly has a second surgery to repair the labrum to look forward too. Which would kind of suck 3 weeks from the start of finals…

Oh well, that's all the excitement I get around here…

Remember when Domino's had the 30-minute delivery guarantee, and then when they retracted it ostensibly because their drivers were getting into too many accidents? EMS agencies are often required to arrive at the scene of a request for service within 8 minutes, at least 90% of the time, as part of their contract with the communities that they serve. And not surprisingly, ambulances are most frequently involved in crashes while in emergency (red lights and sirens) mode, trying to make the 8 minute standard. The ambulance crash log at EMSN has virtually daily reports of collisions involving ambulances.

However, a new study concluded that response times of 8 minutes or less were not associated with increased survival in most instances:

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