Community Paramedicine

After some thought and a bit of encouragement from some folks, I decided that I would try and document some of the things I have experienced and learned since becoming a part of a Community Paramedicine Program and whatever the future holds. I am by no means a master on this subject, I am still learning new things everyday as I explore this new side of EMS and all the things that come with it.

I thought I should give a little bit of my background. My adventures as an EMS provider started in 2003 as a First Responder. I have since worked my way through EMT-Basic in 2005 to an EMT-Paramedic in 2007 and most recently earned my certification as a Community Paramedic in 2015. I began working for the System I am in now in 2008 as a field provider and in June of 2015, I began this new adventure of Community Paramedic.

The two questions I am asked most often in this position are: 1) What is Community Paramedicine and 2) How is it different from a regular Paramedic? So for my inaugural post on this subject I thought I'd start with trying to answer those questions.

What is Community Paramedicine?

The best answer I have found for this comes from The North Central EMS Institute's Community Paramedic website:
"The Community Paramedic Program closes the gap by expanding the role of EMS personnel . Through a standardized curriculum, accredited colleges and universities will train first responders at the appropriate level to serve communities more broadly in the areas of: Primary care, Public health, Disease management, Prevention and wellness, Mental health, and Oral health. The Community Paramedic Program adapts to the specific needs and resources of each community. It will succeed through the combined efforts of those that have a stake in maintaining the health and well-being of its residents."

I recommend checking out the website above for those who are interested in learning a little bit about Community Paramedics.  There is access to FAQs, a Program Handbook, and talks about the standardized curriculum that has been developed for Community Paramedicine programs. It is a great starting point for information.

How is a Community Paramedic different from a regular Paramedic?

The term "Community Paramedic" has been used broadly to define EMS providers that have been trained to an expanded role (not necessarily an expanded scope of practice) to act outside of the traditional roles of emergency care and transport and include ways to promote a better use of emergency care resources and to further improve the quality of access to primary care.

No two Community Paramedicine Programs are going to be alike. These programs are designed to fit the community in which they are serving. Some may focus on specific disease processes (like CHF or asthma) while others may be focused on specific age groups (newborns or the elderly). Part of designing a Community Paramedicine Program is finding the gaps in the current systems and helping to fill those gaps.

failure

I’ve been in the best mood lately…well that’s a lie. I’ve been in a better mood is better worded. I have days where I feel like I am at the top of the world, other days I feel like I have everyone tricked into thinking I am ok while I feel like I am losing control or slowly slipping off the end of my rope with no knot to hang on to at the end. While I know my life is in a pretty good place right now I can’t help but feel like someone is about to pull the rug out from underneath me. I just keep waiting for it. I’ve had a few hiccups lately, but just waiting to fall flat on my face, show up naked in front of a thousand strangers, that kind raw humiliation. What kind of life is that?? Always waiting for failure? I’m talking about in my personal life, in my work life, in my social life, somewhere…I just feel like something is going to happen any day now…and if anyone knows me at all, they know I like to be prepared. I’m the girl who is usually 15-30 min early for any appointment or work, carries an umbrella in the car just in case, extra uniform in the trunk. I like being prepared, I like having a set schedule, I like itineraries. I hate being late, I hate being rushed, I HATE failure.  I hate disappointing people, especially people who rely on me.  

Sometimes you have to take the bad with the good

I know that times change, people change, and life is always changing. The thing is you don't always see the changes taking place and then one day you look back a few months, a year, a few years and are shocked to see the differences. Sometimes you barely recognize the old you, your old friends who aren't even in your life anymore. Hopefully the change is for the better, a better you, a better life, a happier you and life. 

I know that's where I am in life right now. While some changes have me stressed, like the changes at work, other changes have me grinning like a kid on Christmas morning. 

Let's start with work. First off, I love my career, I love being a paramedic, that has not changed; what has changed is the environment in which I work that I used to love, that used to make you feel like part of a family. Now it feels like an ugly divorce with an even uglier custody battle. About 8 months ago we merged with the other medic unit within our hospital system, while it is the logical thing to do, it has been nothing but a heartache and a headache since. We (the medic group I was part of) went from about 8 full-time and 15 part-timers to now almost 150-175 staff total, we went from one supervisor who stood up for us, fought for us, and put us on a more then even keel with the nurses and docs in the ER, to 6 white shirts (which he was initially one of, until he felt it best to step down 3 months later leaving us with 5 white shirts). The supervisors that barely take the time to learn your name let alone recognize your face if they saw you in public. When issues came about in the ER, it felt like we just got blamed instead of them standing up for us, like our previous supervisor had. Sure, we got a pretty new truck with the merge, a truck we had been begging for for 6 years and the promise of like-new, refurbished monitors (which have yet to be seen still at this point). The management has left a lot to be desired at this point, not just by me but by several. This particular medic company has been around for 30 years and has always produced many prideful medics, who worked for this company for 10-15 years, some even longer. The morale of this place used to be amazing, they were considered to be elite medics in this area. And now? Now nobody gives a damn, people are looking for other jobs, people have taken other jobs. New management has been cleaning house, firing folks who aren't following the rules. They have decided to cut our staff form 4 medics 24/7 to 3. 3 paramedics to cover the entire county! There is so much more!! I just feel like this is going to impact the community in a negative way. But I'm just pee-on. I come in, do my job, go home and collect my paycheck and just be grateful that I have a job. 

Ok, enough negativity! Positive changes have been happening too. My little sister is expecting a baby boy in June! Its her first child and my 3rd niece/nephew. I am so excited! As if that news wasn't exciting enough my sister-in-law announced last week that she too is pregnant and due in August! (sex of the baby is yet to be known) I have been making amends with my biological mother, we have had a couple phone conversation on the last couple weeks and had some very heartfelt conversations. I had a lot of anger and frustrations that I simply just had to let go, otherwise I'd lose that relationship forever, and I honestly didn't want that. I've been in a relationship for close to 6 months now with the most amazing man. He is the kindest, funniest, gentlest, and most honest man I have ever known, besides my father. Did I mention he's rather handsome? (This is where he says "The generosity of women never ceases to amaze me") I would never say these things let alone blog them of I didn't believe them. 

So these days I try to focus more on the good, and less on the bad, because after all, what can I do about it?  Absolutely nothing!! 

Thank you Veterans!

What does Veterans Day mean to me?

That's the question I kept asking myself while writing this post. I know this day is to honor ALL veterans of all branches of the military.

I am currently dating a veteran, he served as an MP in the US Army in several places including Bosnia, Italy, and Fort Myer in Washington, DC. I have a close friend from high school currently serving in the Army. I have an ex-boyfriend who served in Iraq as an Army Reserve Medic. I have several friends who have served and are still serving in the Army, USAF, Navy, Air Guard, and Reserves. Both my father and my grandfather served in the military, my father resigned as a MSgt. in the United States Air Force. I have several childhood memories that take place on an Air Force base.

So again, what does Veterans Day mean to me? It means respect and honor and remembrance of people I love and care about and those who served with them, before them, and after them and those still serving today.

So please take the time and thank a veteran, thank them for the sacrifices they made for the freedoms you and I have today, cause THAT is what Veterans Day means to me.

the unexpected

Being in EMS we all know things don't always go as planned. You can try to prepare, but sometimes things take you by surprise. Hurricane Sandy was one of those surprises. I have always wanted to go to EMS World, well for a few years now anyhow. I've just never had the means. Well, this year was the same until I was donating money at a local fundraiser (ok I was playing bingo, I admit it!) and I won a nice little chunk of change, enough to allow me to purchase a plane ticket anyways. I talked to a few friends who were going and the stars aligned just right and I was offered a place to sleep so I could attend this year (felt like a once in a lifetime opportunity to me!) and it meant I could attend the wedding of a friend, MsParamedic!! Well, then Sandy hit. I was worried about my flight, I was watching it like a hawk...then I got the news...the friend who had offered me a place to sleep was stuck in NJ with no place to go until Saturday!! By then it would be too late. He tried to make alternate arrangements for me, I tried to make alternate arrangements for me, but I had no extra money to afford a hotel for myself, and everyone who was already there was so wrapped up in the conference and the events surrounding it no one was able to get back to us. I had a decision to make...as much as it pained me and disappointed me, I cancelled my flights 8 hours before I was to board my plane. I'm not going to lie...I cried...a lot for the first 12 hours...then I realized something...what the hell was my problem? I had a roof over my head, heat in my house, electricity, food, water. There were people a mere 4 hours from me who did not have these things, people that I know, people I call friends!! I had friends in New York and New Jersey who were suffering a hell of a lot more than me because of this horrific storm. People had lost their homes, their savings, their LIVES, and I was upset because I couldn't go on a trip! I was being so selfish and self-centered! So instead of feeling sorry for myself, I decided to pray for those in need. I couldn't do much else for them. I tried to reach out to those I could on Facebook and Twitter and let them know I was thinking about them and praying for them. And I just kept reminding myself just how damn lucky I was and how good I have it...

making a difference

Most of us can remember why we started this career. And most of the time it was help people, to make a difference in someone's life. We have all learned that making a difference doesn't happen everyday. Occasionally we run that call that we know we have all trained for and that training pays off. I once had the pleasure of meeting a wonderful lady. Our meeting was unfortunate for her. This woman was a nurse of 50 years, still practicing 2-3 nights a week in the local prison. The night of our meeting she was attempting to go to bed when she began having a pressure in her chest. She thought it was just gas from a soda she had earlier in the evening. In just over an hour the pain and pressure increased dramatically, radiating to her neck, shoulder, arm, and back and then she got nauseated and sick. She decided she was just going to try and tough it out until her son-in-law heard her vomiting and checked on her and immediately called 911.

Upon my arrival BLS had just gotten an initially set of vitals. All it took was one look and my gut shouted "not good". Placed a 4 lead on this woman and immediately did not like what I saw and proceeded with a 12 lead. Within 5 min of being on scene I knew this woman, who had very little past medical history, was having a heart attack. My BLS crew helped her onto a stair chair and out of the house and down the stairs to stretcher while I called Medical Command at the local hospital and spoke to a Dr. who had received the 12 lead I sent and agreed this pt needed a cath lab and to proceed to the heart hospital, a mere 30 miles away, but that takes the better part of an hour, even with lights and sirens.

I fell back on my education and got my thoughts in gear.  Zofran given IM before we moved pt to prevent any more vomiting, ASA given orally as pt was being moved into stairchair, IV placed on first try as soon as pt was in the ambulance, and then I began the NTG SL sprays and morphine administration. While my pt remained in a lot of discomfort throughout the transport, I did my best to make her as comfortable as possible. The receiving facility knew we were coming and had received 2 EKGs prior to my arrival, one directly form me and another faxed from the local hospital I bypassed. They also received a phone update from me while enroute. I was greeted by 3 doctors, 2 nurses, and an ER Tech all prepared to help my patient. 

During the ride I got to know my patient a little better. She told me of her nursing career of 50+ years, and how she enjoys keeping herself busy by working at the prison infirmary 2-3 nights a week. She was concerned about not making it to her next scheduled shift the next night. She also  told me she was expecting her first great grandchild, a girl, very soon, that the baby shower was next weekend, and she didn't want to miss it. It wasn't until we were about 3/4 of the way there that she looked me straight in the eye and asked "Is it possible I am having a heart attack?" It was at that moment that I realized 1) I hadn't made it clear to her that she was and 2) I had kept my cool so well that she was unaware of just how serious her condition was. I looked right back in the eye and said "Yes ma'am. You are having a heart attack, but I guarantee I am doing everything I can to help decrease your pain and that I am taking you to the most appropriate place for you to be to fix it."

Normally a patient in this condition would go immediately to the cath lab, but due to another patient already on the table there, the ER team did their best to make my patient as comfortable as possible until they were able to get her in. The patient had to have thanked myself and the ambulance crew a dozen times during the handoff process. 

I have the capability to follow up on patients that I take to this particular facility, so the next day I followed up and found she had a 100% blockage in her RCA.  

It's patients and calls like this that remind me why I continue to do this job even when we run the frequent flyers, the drug seekers, and all the other calls we consider "BS". This woman will most likely walk out of the hospital and return to her busy life, her nursing job, and that great grandbaby that is coming so soon...

EMSToday 2012 overview

Just got back from JEMS EMS Today 2012 this morning. It was a blast as always! It was so great to see old friends, make new ones and have fun while learning new things, seeing new products, and just having some great conversations with some amazing folks. I have so much going through my mind right now. The biggest thing that hit home for me this year was EMS 2.0. I have known about EMS 2.0 for a while now, but something clicked this weekend for me. While I had known about it, I didn't fully understand what it was until I tried to explain it to my best friend, an aspiring paramedic student. When she had questions I couldn't answer I went back and did more reading and research and a whole lot of listening this weekend. I finally get it! AND...I want to help! I want to do more than share a post here and there on Facebook and Twitter. I want to be an advocate, I want to learn more and understand what is going on with my profession, I want to make my way to the front lines! I would never have even heard of this if it hadn't been for the First Responders Network folks, Scott Kier, Sam Bradley, Justin Schorr, Ted Setla, Paul Bahnik, Cayce Justus, Maddog Medic, Patrick Lickiss, Random Ward, James Brasiel and all the others closely involved!

Ok, I have more stuff to talk about from EMSToday 2012 but am hoping to make another post about it.

As always, thanks for stopping by!

Count your blessings...often

Wow, Blogger changed its look...don't know if I like it yet or not. I'm not very technologically inclined, so once I get used to something I like it and find change hard sometimes, like the new facebook...HATE it, but that's life I suppose. Life changes...a lot. I was slapped in the face with a reality today, that I should be a LOT more grateful than I tend to be. An old friend of mine messaged me today to tell me he had been involved in a very bad car wreck, he is fine, but there was a fatality in the other vehicle, a young high school student, she was the passenger in the vehicle her mother was driving when her mother swerved to miss a rear-end collision in her lane on a small highway and crossed the center line resulting in a head on collision with my friend. Talk about a miracle that my dear friend is ok, I cant even begin to imagine what that mother must feel like, to know her actions to save herself and her child resulted in her daughters death. Immediately after hearing about this you know what I did? I called Daddy and Mom, that's right, I turned to my parents, the 2 people in the world that I know will always be there for me, no matter what. I had a wonderful conversation with them. Talked about how Mom isn't feeling the greatest, has a stomach bug. Talked about my siblings, how my sisters have decided to move in with each other for a little while, and about 2 of the greatest kids I know- my niece and nephew and how they got to spend a few days with Pap and Doh (my folks) and went to the marble festival, and rode the ferry across the Ohio river and how unimpressed a 6 year old can be while a 3 year old is simply fascinated.  Family has always meant a lot to me, which makes me wonder how I can forget to be so thankful.

Life in general has been pretty good for me lately. I quit a part time job that wasn't making me happy and in turn started a new one that I am still deciding about. I met an amazing guy when I had decided that I had more important things in life to worry about than dating. I might be 27 ( for a whole 12 days now...lol) but I have not had a lot of experience in the dating world.  I didn't date in high school, and my Junior year in college met a guy that I thought was IT, we dated for 3 years and turns out I was wrong. It never ceases to amaze me how people are put into our lives, some longer or shorter than others, for so many different reasons, for encouragement, support, advice, and sometimes for heartache or for us to make a bad decision so that when the right folks show up we can make the right decisions, to make those friends that last a lifetime.

Its realizations like these things that make you check in with yourself. Are you happy? Are you living life to the fullest? Are you taking life for granted? There have been several reasons lately to remind me to be thankful. Multiple friends diagnosed with cancer, a family member who had a cyst on his brain that had to be drained, a friend who can pick right up where things left off last time she saw you, 4 months ago, and another friend who can probably use a shoulder because she got her heartbroken on top of struggling through  a difficult school program so she can reach a goal in her life.

I definitely need to remember to count my blessings, and should probably do it more often, not just when a friend has a close call or a bad day....

slacker, I know!

I was called out today about slacking on my blog...truth is I have been. I dont really have an excuse...life has just been going...a lot happened at the end of March in personal life which made me have to change some things. I lost what I considered to be a good friend, and not to death but to lies and deceit.  She was evicted from our house, leaving me to pick up the pieces, the bills, and the trash. I have to say life has gotten better since she has been gone. The last few months she was around were not good ones for me. It also made me take a closer look into my life...I have re-evaluated the relationships I have with people, my goals in life, both personal and professional.
I have been asked by several people why I chose to be a paramedic, why not be a nurse? Even my own folks have asked me this. Truth is, I am not sure, but I do know I love what I do. I know a lot of people who are burned out or well on their way there, but I still feel like I am still learning the ropes even though I have been a paramedic for 4 years and in EMS for 8. While I'm not a "dinosaur" I am not quite the newbie I once was. I try to keep up with EMS news and all my Twitter folk and fellow bloggers are helpful with that. I was hoping to make it to Vegas for the EMS World Expo this year, even applied for a scholarship but wasn't a luck winner. I will post my essay in blog for reading later...I promise.

EMSToday re-cap

So I realized that I still had not posted my re-cap of EMSToday and it has been well overdue! I got to be part of a surprise visit of SSGJBroyles. I got to hangout with several of the CoEMS folks for food, drinks, and even some karaoke. These folks included, but may not have been limited to, the following: SSGJBroyles, Gingermedic, Ambulance Driver, Hybridmedic, TraumaSheares, SES4EMS, CKEMTP, The Happy Medic, Setla, NJDivemedic, and many more!

I started this post about month after EMSToday and am just now getting it published....I know, I'm such a slacker!