A nugget of EMS organizational wisdom every day. #41 If you’re going to lie, go high.
I never bought into carrying all that extraneous paramedic crapola around my waist. I was a big clumsy guy when I worked on the streets. Anything worn on my hip was subject to maximum abuse via stucco walls, wrought iron staircases, and narrow hallways.
I figured if I couldn’t pull it out of a crumpled pocket it wasn’t worth shlepping around with me all day.
My mom used to give me beautiful watches every couple of years as birthday gifts. Each one of them was destroyed in turn on the road. Smashed against the wreckage of a car, scraped along the pavement while trying to slide a patient onto a spinal board, or unmercilessly dunked in skanky icewater while pulling a drunk up out of the gutter.
I learned how to tell time in my head.
Some of my colleagues bought very fancy Littman Cardiac stethoscopes. They said you could hear every wondrous detail on auscultation. They compared notes about their stethoscopes. They talked about which earpieces were best. Wearing a steth around one’s neck was an EMS rite of passage from classroom to street. Entire relationships were based on stethoscopes.
I carried a beat-up old steth from the ICU at the late great Reddy Memorial Hospital. It was a clunker that had seen far more than its share of life, death and all twelve steps in-between. I’d curl up the tubes, tuck in the ear pieces and jam that sucker into my shirt pocket so deep there was only a hint of aural wizardry sticking out.
That steth gave great ear. I could hear a lung sucking air or a heart kentucky while my partner was navigating through rush hour traffic in a motion-sickness-inducing siren-soundtracked slalom down Avenue du Parc.
I wasn’t going to win any points for style with that steth but given the fact that my prescription eyeglasses were nicknamed BCG [birth-control-glasses], stethoscope style points were the least of my concerns.
And then were were the bunny ears and the silver boots, but you already know about all that.
When I transitioned from a full-time streetmedic to the Head Coach over at CSL EMS, part of my job was turning-in new medics. We’d go through all the equipment and vehicle checklists and then we’d climb into a rig and head out into the ‘hood for a morning tour. I had a routine back then that usually included a stop at Solly’s Bakery for bagels and then we’d nosh and talk our way through the community.
In Baltimore County, we might have been accused of trolling for trauma but in Cote Saint-Luc it was more like drifting in cardiac canyon. At some point after breakfast the dispatcher’s voice would interrupt life-as-we-knew-it to announce ’10-200 Cavendish’ [or pick the street name] and seconds later the rest of the address and the initial info would stream out of the radio speaker as we switched into EMS responders once more.
On one such morning, a newbie medic was nearing turn-in time and was assigned to be my partner. Her waist holster was packed with goodies including seatbelt cutters and a window punch lest I plunge the rig into a swimming pool en route to the call and she needed to escape by blowing out the window while we foundered in the deep end. There were purple Nitril gloves, and not one but two penlights and a pen and a cool little writing pad. She had the new Littman steth around her neck with a cute little teddy bear riding shotgun on the tubes.
We rolled on a call for an 87-year-old woman in respiratory distress. My partner was working vitals. She called them out “Pulse 80, BP 120/80, resps…”
“Say what?” I heard myself say in my head. “Say again,” I managed in real life.
Our patient was maxxed out CHF closing in on pre-code status.
“BP 120/80…”
“Here, use my steth and stop using your watch to count 15-second intervals. Focus on what you feel and what you really hear. Remember look, listen and feel.”
A minute or two later. “Pulse 100, BP 160/100, resps 32.”
“Thanks.”
Later, on our way back to the station, I told my partner, “It’s far better to just tell the truth and say you need help with the vitals, but on a call like that if you’re going to lie, go high.”
When I saw her next the fancy steth was replaced with one that she had tested at home, in station and in her boyfriend’s car with the music blasting. She continued to wear the holster although eventually the seatbelt cutter /center-punch gave way to extra barf bags and a bigger collection of gloves. She never had problems with vitals again.
Be well. Practice big medicine.
Hal
