Paramedics in the Spotlight

Join us in celebrating the awesome work Paramedics do on the job and in their free time!

November 1, 2019: Leah Lavers
Written by: Ronda Ryder


Ryder: “What area of paramedicine do you currently practice?  What does a typical day look like for you?”

Lavers: “I currently practice in an urban emerge setting in and around the core of Calgary. A typical day consists of arriving at my hall, going to one of the changing dorms and changing from my street clothes to my uniform. I then go out and wipe down the truck and check the bags for it’s contents and the back of the truck and take note of anything that needs to be restocked.  I sign into the CAD and make sure the radios have adequate battery and grab extras as needed.

Generally at this point we are being dispatched on a call, especially if it’s an evening shift. I’m on a peak car which means I work 0700-1900 hrs and 1500-0300hrs . So in the mornings we might get some down time to eat breakfast or maybe catch a quick nap or work on continuing education. On the evening shift we are generally on a call right away or maybe sent for hallway relief for the day crews. That’s one of the unfortunate things about being on a peak car.  If we aren’t doing hallway relief we are generally service the vulnerable populations of the downtown core. Overdose of fentanyl or alcohol or simply just picking them up and moving them to a less conspicuous area such as a shelter or their subsidized housing site. Shifts are generally 12 hrs. Most meals are eaten in the ambulance on the way to calls or while doing paperwork in a small dirty office in the ambulance bay.”

Ryder: “Did you enjoy your education experience for paramedicine?  Can you give one suggestion to schools?”

Lavers: “I did enjoy the education experience . Though I wish we could have paid practicums as most of us are established adults with mortgages and families.  Suggestions I would give the schools are instead of hospital practicums that we start integrating clinical time with the community care paramedics. Something I believe is more applicable than a hospital.  I would also recommend that they start teaching self care and resilience in their programs to better prepare yourself for later on in your career when everything isn’t new and cool and now becomes that heavy burden as burnout and PTSD start to set in.  Something employers can do is offer programs other than R2MR ; such as counselling services with psychologist, scheduled breaks that allow us to process and digest what we’ve just been through.  I would also recommend that schools don’t allow students to go straight from EMR to advanced care paramedic without a few years in between to gain experience. All too often young kids coming through with no life experience and no being exposed to unimaginable things are freezing in the heat of the moment. Most people cannot process trauma until the brain development and plasticity has reached at least 26 years of age . I think that the minimum age to enter into paramedicine should be 25. That way social skills and brain development have had a chance to develop.”

Ryder: “Do you have a favourite call?  Maybe one that made you grow as a practitioner?”

Lavers: “One of my favourite calls is probably on of my first cricothyroidotomy calls. She was a 30 something year old Phillopino lady with throat cancer. She was getting weekly endoscopic procedures to monitor the tumor growth. This particular day the family called because she was vomiting and coughing up blood. When we arrived she was in an apartment building on the 3rd floor with an additional walk up loft. As we walked up we could see the blood all over the wall and at least a litre in a garbage can and she was laying on a mattress on the floor in the upstairs room.  It looked like a murder scene.  At the time she had a faint pulse and was unresponsive and barely breathing. There was no place to work so we picked her up and carried her down the stairs to the main living area floor to work.  As we carried her down the stairs blood just flowed freely out of her mouth soaking our uniforms.  We tried to suction but our machine couldn’t keep up so we called for an additional unit for support.  We tried to bag her but couldn’t get air in.  I tried intubation but couldn’t pass the tube because of the tumor. I went in with the magill forceps to pull out clots the size of over cooked scallops.  They were so hard yet viscous at the same time. And I kept pulling sooo many out. I had the suction in at the same time as the blade to tried to follow bubbles to find her trachea with no luck.  This women had lost so much blood. We knew we needed to cric.  Unfortunately we had just switched to a new system and it was awful.  There were no scalpels provided in the kits and the trocar itself was not sharp enough to puncture the skin without the safety popping off releasing the tube down. It requires two of us to pierce the skin and finally get the cricothyrodemy in place . Finally we were able to get air in. At this point we knew that this lady had to be brain dead but now in cardiac arrest we would give her the proper 20 minutes of ACLS and give this women as chance or at least her family a chance to come from the Philippines to say goodbye. I was talking to some of her family when I could hear my partner and our backup unit charging the life pack.

I poked my head out of the private room the family was sequestered in and had a puzzled look and they said that they had a rhythm they could shock.  So, we did and the most awful thing happened.  She was so bloody and we could not keep her dry no matter what we did that when we shocked it arced and had burnt her chest where the pads lay.  As we hopped back on the chest for CPR we carefully removed the pads and applied new ones this time anterior posterior.  We shocked a few more times and to our surprise got ROSC.  At this point we had been on scene for quite some time with all the calamity of errors and challenges we had faced. We decided that since there was no elevator we would disconnect everything and carry her down the stairs and hook everything back up at the bottom.  Our fire crew was amazing and was done with precision.  We strapped her down and to our surprise still had a pulse.  We wheeled her outside (which was -30) and into our unit only to find that in that short amount of time that the cric tube had frozen, cracked and broke.  We quickly replaced ALL of our equipment including the bvm and we were able to again ventilate our pt.  We did a quick radio patch to the hospital who were not impressed at this time in the morning that they did not have time to prepare as we were sitting on their doorstep.  But we made it!  They saw what we were working with and how exhausted and soaked in blood we were. She ended up living a week in the ICU so family could come and discontinue care and let her pass.

Now this call happened 5 minutes to shift change on one of the coldest days of the year. I was a newer medic and it taught me to adapt and overcome and not be driven by protocol because not everyone fits into an algorithm. We needed to think quickly on our feet when everything was thrown at as to try and make this call unsuccessful but we macgivered and came out on top.  We considered this a success because her family was able to give her the proper goodbye.”

October 4, 2019: Logan Straub
Written by: Ronda Ryder


Ryder: “What area of paramedicine do you currently practice?  What does a typical day look like for
you?”

Straub: “I am currently practicing as a community paramedic in Medicine Hat and have been since October 2018.  Generally, my day is scheduled ahead of time and varies greatly day-to-day.  I do anything and everything, utilizing my full scope of practice; I am usually called to provide initial patient assessments where I’m required to consult with a physician – whether it’s the family doctor or my MCN – and initiate treatments.  These treatments consist of blood draws, foley catheter insertions, IV hydrations, IV medications and prescribing medications in conjunction with the physician.  I’m also utilized in providing wound care, which can be anything from wound cleaning/dressing all the way to providing sutures.  Lastly, as a community paramedic, we can act as a bridge for patients who do not currently have a family physician; we can provide the resources and a baseline trust for these patients to seek further care for themselves.”

Ryder: “Did you enjoy your education experience for paramedicine?  Can you give one suggestion to schools?”

Straub: “I thoroughly enjoyed my time at the Medicine Hat College studying paramedicine; the instructors were excellent and provided me with the appropriate tools to strive as a paramedic.  The focus on true emergencies was superb and provided me with confidence on how to manage these cases.  One suggestion I would make is to provide students with a more realistic approach to patient assessment and care instead of focusing on the ACP-scenario format.  Secondly, I suggest that there is a more candid discussion on the 95% of EMS calls we truly go to as well as the out-of-town transfers.”

Ryder: “Do you have a favourite call?  Maybe one that made you grow as a practitioner?”

Straub: “I met a patient during my time on senior practicum who I have not been able to forget to this day.  I first met this patient while he was attempting to commit “suicide by police.”  The patient stood 6’6 and weighed around 120kg and was previously known to police.  We were able to talk this gentleman down and transport him to the nearest hospital without incident – during the transport, the patient was very candid about his current mental state and how he had previously attempted suicide in a variety of violent ways.  The next day, after transporting another patient to the hospital, I saw this gentleman again in the ER in handcuffs as he had been placed under arrest for another attempt. I saw the patient once more in ER that same tour for the same complaint but did not come across him again.  I think about this patient often, of course wondering if he found the help he needed or was “successful” in his attempt; I think at that time, I was too young to realize the impact he had on me but since then, I use him as a reminder that no matter what walk of life you are from, we all deserve the same respect and dignity. I’ve found myself in situations where patients are aggressive and violent towards my partner and I and it’s difficult to remain level headed; keeping that patient in the back of my mind reminds me that all most people need is someone to listen to them. All that the patient needed was someone to just listen and he was agreeable and cooperative.”