LSA Medic 4 second half:
The night was busy. We ran calls all night. There was only one call, hypotension, that required interventions; MAP was 50, and it came out for dizziness at 2am. All the other calls were simple, and I don’t really remember what they were. That’s the nature of sleep deprivation; memory gets finicky. I did get maybe 20 mins of sleep on the stretcher between calls. That’s cool. It can be worse.
My partner stayed in the driver’s seat all night. I don’t know if she got any sleep. But she still kept being cheerful throughout the night. That’s admirable. Here, in the first photo, you see her, EMT S. Lopez, cleaning up the ambulance after we dropped a patient off at the hospital. I’m smoking a cigarette and taking a photo for the records. Overall, it was a good struggle.
This is what we do: to make a living and so others may live.
an attempt to nap
past midnight call
responding to a call
LSA Medic 7 first half:
It was a busy first half. One emergency after another. Simple calls, though, that didn’t require much intervention. My partner and I, working together for the first time, were posting at a hospital when the call came in close to us. We started to drive without knowing what it was for. A few seconds after passing some cars with lights and sirens. The call was updated, “cardiac arrest.” FD and our supervisor are responding as well.
We arrive at a nursing home, making our way to the room at the end of one of many halls. I enter the room to see a 3-person team from the facility working on the patient. The AED is analyzing, advising” no shockable rhythm” as my partner and I prepare the stretcher. I ask the nurse for a brief history of the patient; the downtime is 5 minutes. I'm now taking over the patient being the only paramedic on scene and confirming it is a pulseless patient. The patient is moved and now on the stretcher, I continue with compressions.
“I need one of you to continue compressing for me,” I say to the staff in the room when FD shows up. My partner is setting up the heart monitor, and I’m grabbing our bag when our supervisor, another paramedic, shows up. “Let’s start moving to the truck.” I tell the team.
In the unit, the monitor is showing asystole, meaning no pulse and no electrical activity. A few seconds go by, no more than a minute; IO is established, and the first epi is given. Intubation was successful, and I’m securing the tube when bloody tinge sputum comes up from the tube. My partner quickly sets up for suctioning to clear the tube. The monitor is showing PEA, pulseless electrical activity, meaning there’s hope now. CPR continues. Another epi is given. There isn’t much else we can do for the patient here. It’s time we go!
I'm in the back with two FD guys still working on the patient. We arrive at the nearby hospital, the monitor is still showing PEA; we get off the unit, still doing CPR. I give my report to the ER doctor; they take over; our job is done. Some time passes; patient is back with a pulse.
We arrive at a nursing home, making our way to the room at the end of one of many halls. I enter the room to see a 3-person team from the facility working on the patient. The AED is analyzing, advising” no shockable rhythm” as my partner and I prepare the stretcher. I ask the nurse for a brief history of the patient; the downtime is 5 minutes. I'm now taking over the patient being the only paramedic on scene and confirming it is a pulseless patient. The patient is moved and now on the stretcher, I continue with compressions.
“I need one of you to continue compressing for me,” I say to the staff in the room when FD shows up. My partner is setting up the heart monitor, and I’m grabbing our bag when our supervisor, another paramedic, shows up. “Let’s start moving to the truck.” I tell the team.
In the unit, the monitor is showing asystole, meaning no pulse and no electrical activity. A few seconds go by, no more than a minute; IO is established, and the first epi is given. Intubation was successful, and I’m securing the tube when bloody tinge sputum comes up from the tube. My partner quickly sets up for suctioning to clear the tube. The monitor is showing PEA, pulseless electrical activity, meaning there’s hope now. CPR continues. Another epi is given. There isn’t much else we can do for the patient here. It’s time we go!
I'm in the back with two FD guys still working on the patient. We arrive at the nearby hospital, the monitor is still showing PEA; we get off the unit, still doing CPR. I give my report to the ER doctor; they take over; our job is done. Some time passes; patient is back with a pulse.
This is what we do: to make a living and so others may live.
EMT D. Michalk
posting at mmc
post cardiac arrest
LSA Medic 4 first half w/ EMT Willie:
Lovely shift. What a lovely shift. The first call came out as hemorrhaging. Arriving at the scene, inside the home, the patient was sitting on the couch covered in their own blood coming out from a peg tube in their stomach. Blood was everywhere; the wound kept oozing blood. Bloody mess! We did our job as expected.
The next call came out for non-traumatic chest pain. The patient reports a pain level of 10 out of 10 on the left side of the chest, but it is not new. I discover on the heart monitor a not-so-common arrhythmia, a flutter. It's been 6 plus years since the first and last time I saw this arrhythmia. My medical director got a call from me asking them for approval for treatment since we don’t have a protocol for that arrhythmia. I got it. It's detrimental if left untreated. We did our job again. It feels so good being a badass.
The calls following those two initial ones weren't so action-packed, such as foley replacements, chronic pains, chronic illnesses, etc. No interventions were required besides just checking vital signs. Can't always be badass, huh?
That's just part of the job. There are highs and lows in the job. What’s also part of the job is the psychological and physiological changes from those highs and lows.This is EMS.
This is what we do: to make a living and so others may live.
At the station
checking off the truck
30 years in the field
helping a pt
LSA Medic 4 first half w/ EMT S. Lopez:
The supervisor asked me to step in and cover for a medic on shift. Im not sure of the reason, but I'm down to help. Once I get to the station, I find out I have a paramedic student on the truck. This is cool. I like to teach. The lesson began with emphasizing the importance of patient assessment. Paramedic student CJ, with great enthusiasm, was receptive to learning. Hours went on without emergencies. I utilized the downtime to teach him EKGs, medications, physiology, etc.
Finally, a call came in for a fall. Arriving at the scene, outside the home, the patient has a head injury, and one of their legs is short and rotated out, indicating a pelvis fracture. PMS was present before and after moving them; no intervention was required. In the process of assessment, the heart monitor shows the patient's pulse was in the 40s. The patient also had a right bundle branch block and left axis deviation, meaning an intensive cardiac history. Since the rate is less than 55, a non-perfusion rate, and unresponsive to a bolus of fluids, this calls for cardiac med, atropine. The patient's heart rate increased to normal limits of 80s. I did my job.
EMS students ride out for this type of exposure—to be exposed to real-life situations to relate to what they're reading in their books. And the point of the working paramedic is to enforce that teaching. I was able to further explain to CJ treatments, EKG readings, etc., using real-life scenario and objective information. I gave him the EKG for his studies. One more call came in, a total of 2 calls for a 9 hour shift, but it was simple; no interventions were required from an MVC, besides a c-collar and assessment.
This is what we do: to make a living and so others may live.
paramedic student CJ; 5th ride out.
EMT Lopez helping CJ with an assessment
sinus bradycardia
LSA Medic 7 first half w/ EMT D. Michalk:
At the station, there are several EMS students waiting. My partner and I start to check off our truck when the supervisor picks a student for us. We make our way to our first post once we finish checking the truck. A man standing outside his home salutes us as we drive through a neighborhood. That's so cool.
Hours went on without a call. In this downtime, I sit in the back with my student and get to know them. She tells me she aspires to be a doctor one day. Wish her well in her pursuits.
The first call was for non-traumatic chest pain with a medical history of Wolf Parkinson syndrome. Pain subsided before patient contact, but the feeling of fainting continues, denying any other symptoms. I find their heart tones are abnormal when assessing them, and their 12-lead comes back normal. I advised them to not ignore these symptoms and convinced them to go to the hospital for further medical evaluation.
The student leaves after the first call since the downtime continues. I don’t blame her for leaving. It seems like it's a slow day. I take a nap.
The second call comes in for nausea and vomiting; we find a fever of 100.1°F. Despite a family member being hostile and belligerent with us, we provide the appropriate treatments to help the patient. The patient felt much better; in fact, their clinical presentation improved, becoming more verbal.
The third call comes in for a medical alarm soon after clearing from the second call at the hospital. "Medic 7, disregard the call," says dispatch as we respond. We change direction to our new post.
The fourth call comes in some time later for vomiting, but the family reports the patient has been falling down since yesterday and called EMS today once the vomiting started. The assessment reveals a fever of 100.9°F and arrhythmia, Afib RVR, with a heart rate high in the 200s. I factored in tremors from the fever and artifacts from the leads. The 12-lead showed a clearer reading, still indicating the arrhythmia and the heart tones were rapid. No change occurs with medication. Arriving at the hospital, the ER doctor said it’s not an arrhythmia and their monitor is showing a normal rhythm. It's possible the medication took a late effect, maybe it was equipment error, or maybe it was just operator error?
The last call was simple, and not much intervention was required besides showing the patient how to pinch their nose to stop the bleeding. I end the shift reflecting on the calls.
This is what we do: to make a living and so others may live.
At the station
EMT student
first call
partner helping student with the stretcher
nose bleed call
end of shift
LSA M4 first half w/ EMT A. Ybarra:
This is the first time working together. In fact, we've never met before. He tells me he has 10 years in the field. I'm feeling optimistic about the shift.
The first call interrupts our resupply routine that comes after checking off the truck. We get on scene as the second truck for a major MVC. Medic 1, McAllen PD, and FD are on the scene with the patient still in the truck with a C collar and IV established, waiting for us. The patient complains of right flank pain and nausea. I give Zofran to prevent vomiting from the driving. Surprisingly, they didn't have any major injuries.
The second call comes in soon after clearing the hospital and getting our supplies from the station. The call is for another MVC, but this time it's a minor one that didn't require any interventions besides collar and trauma assessment.
After the call, we make our way to our post at a hospital. While there, I help an elderly woman using a walker struggling to find her car. I did a good deed. I am probably still going to hell, though.
The third call comes in sometime after the good deed for breathing problems. We did a quick checkup despite the patient refusing EMS. We can't force people to go. The law calls it kidnapping.
We got back to the hospital to post when the fourth call comes in. It’s for “heat/cold exposure,” and upon patient contact, the patient reports weakness, dizziness, and vomiting. It’s looking like dehydration. The plan of action is cool air, fluids, and Reglan med. I ran out of Zofran. The patient improved.
We catch a break from back-to-back calls. I was able to eat peacefully and play solitaire on my phone. We change posts again and again and then again. Through casual conversation with my partner, he tells me he plays in a local Tejano band called Valley Boyz 956. This is cool. Tejano is cool.
The fifth call is for sickness. The patient complains of abdominal pain, vomiting, and has a fever. The plan is to give them fluids to hydrate them and cool them down. But the patient refused the second IV attempt; the vein exploded with the first IV. It happens.
The last call was a returning patient from the last shift. This time, the family member calls for help to get the patient from the car to their house. The patient is looking extremely sick despite just leaving the hospital. We were able to convince them to seek help from a different hospital since the patient and family weren’t pleased with the previous hospital care. We advocated for the patient and family member. We did our job. The patient thanked me for caring for them and thought I was very handsome. I’ll take it. Life is too dark to not take the compliment. It was a good and steady shift. I made it out alive.
This is what we do: to make a living and so others may live.
EMT A. Ybarra
First call
second call
fourth call
Medic 7 first half w/ EMT L. Gaytan:
Arrive at the station on time as usual. I find out who I’m working with there. It’s not the first time working with EMT Gaytan, but it has been a while. He is a solid partner, and the shift looks promising. I sense a disturbance in the force; there's going to be cardiac arrests today. An hour later, our truck gets to the station. We check our truck and eventually head to our first post.
The first call comes in for a sick call. Upon patient contact, I discover weakness, abdominal pain with distention, nausea, and dizziness. Stroke assessment is negative, and the 12-lead only shows left axis deviation. I wasn't able to further help the patient with fluids for what looks like dehydration and a bowel obstruction. Patients veins kept exploding.
The second call is for a fall. A sweet elderly patient is sitting on the edge of the bed with a head and arm injury. I apply a collar and an arm sling to help. Her vital signs are within normal limits, except her sugar level is at 568. I start an IV on the second attempt to administer fluids for her high sugar level. She was sweet and polite. It was an honor to be able to help her out.
At the hospital, I find out the other trucks brought 3 cardiac arrests. My partner reacts to this by saying, "You called it in the morning."
The third call comes in as soon as we get to our post. It's for a minor accident. The patient is complaining of neck and shoulder pain. I apply a collar, and the assessment reveals no other injuries. Simple call. We transport.
At the hospital, I get the chance to eat my dinner. I'm feeling good despite having back pain. It's not new; it comes and goes. It's a gift from working EMS. Fuck it. We clear the hospital and get to another post.
The last call is for a sexual assault. Police are on the scene. We are posting nearby, waiting to go or clear. There are 30 minutes left till the shift ends. "No EMS required as per PD," dispatch says. We clear the area and head back to our station. We get to go home today after surviving a 12-hour shift.
This is what we do: to make a living and so others may live.
waiting at the station
our truck gets here
first call
12 lead
posting
end of shift
LSA Alpha 3 w/ EMT M. Chapa:
I got to the station an hour early and checked off the truck alone. It's peaceful checking off the truck prior to clocking in. There's no pressure or stress or a call interrupting the process. Chapa shows up at the time of shift and helps with the rest. I've worked with him a couple of times; he is a good partner. We make our way to our first post. It’s gloomy and raining.
On the way to another post, we get the first call. It’s for a medical alarm. We arrive at the scene and discover that the alarm button was accidentally touched. The patient was asleep with the device. I still check on the possible patient but still obtain a refusal. We clear the scene and head back to a post. I did my job.
Lunch, a nap, and a podcast later, we get a second call. It’s for a chest pain patient. Arrive on scene, McAllen FD providing aid to the patient. Patient complains of chest pain, weakness, and SOB. Yesterday they went to the ER, and the new symptom today is the chest pain. The 12-lead and vital signs are normal except for the temperature, 101.6°F. The focal assessment reveals congestion. An IV, fluids, O2, and albuterol treatment. Chest pain subsided, and the patient felt much better. We transport with difficulty due to the flooded roads. We made it to the hospital.
Once cleared from the hospital, we got another call. We travel through flooded roads when the engine begins to smoke. Chapa says the steering wheel is difficult to turn. We let dispatch know about our situation. After our unit is grounded, we make stop at a nearby hotel and wait for help or the rain to stop.
We move to a nearby hospital to use the canopy to check the engine. It's just smoke, no fire. The steering wheel is working again. I call the supervisor, letting them know we can go back in service.
The third call comes in nearby for a sick patient at a clinic. Alpha 2 attempted to respond but couldn't due to the ongoing conditions. Rescue is there with the patient, needing a unit to transport to the hospital. We make it. The patient reports fatigue since this morning. The call is simple, and vital signs are normal. We just transport slowly due to flooding and the number of cars stranded on the street. It took an hour to get to the hospital when it normally takes 15 minutes or less.
The rain stops, and the fourth call comes in for abdominal pain. There is an hour and a half to go till the end of the shift. The patient complains of chronic abdominal pain that got worse today after taking a new antibiotic. The patient refuses a 12-lead. The vital signs are normal. We transport. “Are you going to be able to do an IV moving?” the patient asks. “ Of course,” I reply. I got it on the first attempt, and the patient was impressed. There is a long wait at the hospitals. We eventually transfer care, and it's the end of our shift. We survive the rain and the flooding.
This is what we do: to making a living and so other may live.
transporting
