Ambulance Today – Spring Edition 2019

The Spring Edition for 2019, has hit the shelves, its live now on Ambulance Today. Click on the link below to download and read the magazine and my article on page 42.

From the Africa Desk of Ambulance Today:
Case Presentation – Electrical Alternans in the field

Ambulance Today Spring Ed 2019 .pdf

For this Africa quarterly, I am discussing a cardiac patient encountered on a remote site in Africa and the unique challenges faced by the paramedic and his support team.

Initial 12 Lead ECG Electrical Alternans.jpg

 

There is also a special feature in this edition, on interviews with  and I was both honoured and flattered to be included in this article as one – Joe interviewed persons he considers to be key in the regions/Continents of the Globe. You can read about my thoughts on EMS in Africa, the challenges, the way forward and some of my dreams. The Africa interview is on page 30.

GLOBAL CLINICAL EMS SPECIAL:

Around the World in 80 Questions – on pages 11 to 41

To all the followers of this page, if you want to see an article written about any specific aspect of Emergency Care on the African continent, or get me to interview a key role player, drop me a mail. Equally, if you have any news items you would like us to run either in our magazine or on our daily-updated global ambulance news website please make contact.

To my fellow passionate EMS friends across the world, I trust you are enjoying this journey, as we continue to explore this fascinating continent. Till then be safe out there and stay passionate – Enjoy!

At What Cost

Been thinking a lot of late about the cost of service, the sacrifice, be it medical, fire, police and military. Read a few clinical articles in the week in JEMS, on PTSD and how services don’t deal with it, and reread an article I wrote awhile back and the article I quoted.


the price you pay

come so far

waited so long

worked so hard

only to be in a dream

heaven or hell

it always changes



dark holds the light at bay

the more you give

the more they take

the more they live

the more you die

stand firm

fight for the price you've paid



pay in blood

sometimes your own

some cease feeling

for themselves or others

teases and the doubts

solved by being

uncomfortably numb

made it back home

but how?



checking out is possible

but you can never leave

you can't walk away

from the price you pay

nothing more wretched

than what must be endured

been through hell

is it all worth it?

© 2017 michael d emmerich

Image © 2011-2017 DanSun PhotoArt – www.dansunphotos.com

A Matter of Life

air goes in and out

blood goes round and round

that says the medic

keeps you alive



in sickness and death

illness and injury

not all goes as it should

this is well noted



blood and guts

sickness and death

that last …..

potential breath

affirms our quest



intimacy with death

fuels our passion

in life in its abundance

ours

and yours …

the next patient

© 2017 michael d emmerich

 

god is in session

wailing, screaming sirens

tear the night apart

screeching burnt rubber

scar the asphalt

as you deeply inhale and sigh

carbon, rubber and sweat

attack your senses

hands on the spinning steering wheel

thinking, planning, expecting

the unexpected

no plan survives initial contact

grabbing rushing pushing jostling

questions, answers

sobbing screaming crying

 ……. silence



gloved hands palpate poke prod

ears listen, eyes roam

instructions issued

 god is creating

and it will be good

skin exposed

clothes cut

working in blood and flesh

are gods tools

needles puncture

flashbacks appear

and reappear



machines beep

fast then faster

fluids chase in

smells assail your senses

burnt metal, blood, vomit

you drive them down

sweat drips off god

mixing with blood

god is in session

angels hover



pressure

applied and present

vials crack, needles puncture

….. skin

beep … beep …….. Beep

slower and slower

vocal chords visualised

the bag of life

is squeezed

continuously

rhythm of life is kept in balance

a refractory pause ensues

gloves changed, sweaty brows mopped

spectacles wiped clean of sweat

decisions discussions decisions



beeping changes

angels move closer

god intervenes

shoves them rudely aside

not today god says

not on my watch

© 2016 michael d emmerich

image courtesy of – Image © 2011-2017 DanSun PhotoArt

EMS – You Can Never Leave

Last thing I remember I was running for the door

I had to find the passage back to the place I was before

“Relax,” said the night man, “We are programmed to receive

You can check out any time you like but you can never leave”

EAGLES – Hotel California

EMS is like the Hotel California: “You can check out anytime you like… but you can never leave” the memories, faces, successes and failures will always be with us. They dim at times over the years, but they are always there. I read a thought provoking and honest analysis on being a paramedic a few months back and have been mulling over her post, digging through ramblings from my field journals and the skeleton of a story I have been working on for about 2 years… these all prompted me to ramble further…

The blog post that triggered this article is: Unless you’ve been there, you wouldn’t understand: A Paramedics farewell to the job. Posted on February 10, 2015 by Di McMath

https://dimcmath.wordpress.com/2015/02/10/unless-youve-been-there-you-wouldnt-understand-a-paramedics-farewell-to-the-job/

One of the key issues for me is the ability/or lack thereof to detach from what we are doing and seeing; this drags one into the massively dehumanising temptation of EMS. I do feel that this dehumanisation is both inexorable and dangerous – as practitioners we need to know how to halt or slow it down. After 30 years of emergency medicine practise; I am still not entirely sure if we can entirely halt the process, which is why we can never fully check-out.

Being a fan of the poetry of Wilfred Owen, and as I reread his poems on a regular basis, I was drawn back to his poems during this thought process and found some further insight on reading “Insensibility”:

And some cease feeling

Even themselves or for themselves

Dullness best solves

The tease and doubt

The poem plays along the interesting juxtaposed lines of detached versus involved, and the varied degrees of these mindsets. Those of us in the profession have over the years dabbled with both approaches, the trick is for each individual to find his/her own balance. That is all part of the process of slowing down the dehumanising process. Finding this balance is key, if we do not, then we are doomed to keep repeating the mistakes of our past (mistakes as regards emotions and those of a clinical nature).

Emergency Medicine has the ability to dehumanise and diminish or renew and expand our powers of feeling. It is our choice to decide which path to follow. We realise soon on in our profession that this is one of the many choices that we have to make. How we deal with this choice determines how we deal with another key critical decision we as practitioners in the field are confronted with at numerous times in our career. Who lives or dies, or why do some people die despite our best efforts; and the pain of admitting defeat and saying okay, we need to stop now, the patient is deceased.

It is on these crucial scenarios, that I have to agree with the title of Di’s blogpost:

Unless you have been there you wouldn’t understand – Its sounds trite, but it is so true.

Trying to explain this process of immediate Triage, that at times needs to be done in very short time frames, less than a minute, is very difficult. Those are some of the choices we can never walk away from, and even when we do make them we cannot stop thinking about “What If?” the curse and bane of every paramedic. The cursed ability to second guess yourself long after the fact on an ongoing basis. It is here where we as emergency medicine practitioners are faced with the dehumanising and diminishing or the renewing and expanding of mental and medical health.

The goal of our profession should be a living force in the quest for and prevention of human suffering, but that sometimes comes at the cost of our own mental health. As we enter, continue in and exit this amazing profession, lets consider the cost to those we have served and continue to serve. All we can do as practitioners is warn, and that is why the practitioner needs to be truthful.

Updated:

Read these 2 poems I wrote on the cost of service:

https://mikesnexus.com/2017/04/23/at-what-cost/

https://mikesnexus.com/2016/10/30/god-is-in-session/