Flophouses, Foyers and Lobster Trap Hearts; Plus, Does Your Doc Throw Stuff?

I worked a shift today at one of my part-time jobs, a non-transporting gig based in one of Massachusetts's most economically depressed cities.
This job is usually a good jolt to the system because in addition to this city, the service provides ALS to a couple of the state's nicest -- that is, wealthiest -- towns.
The juxtaposition can be jarring.
One call you're intubating a cardiac arrest in the fetid bathroom of a flop house and trying not to think about what the gooey stuff is that you're lying in, and the next you're evaluating the chest pain of an elderly matriarch -- whose relatives skippered the Mayflower -- in the foyer of a brick mansion that itself is bigger than your own home.
I make no judgments here about either of these patients. They both get the best I have to offer.
That's the great thing about being a Paramedic.
We don't have to worry about who these people are -- the sick and injured who call 911 or have it dialed for them.
No matter whether you're the alcoholic homeless guy at the local wet shelter who had his nose broken in a fight with another alcoholic homeless guy from the local wet shelter, or the CFO of a Fortune 500 company in flash pulmonary edema, all we have to do is treat you.
Throw in a little humanity and you're on to something...

Doctors take the hit in this article, but none of us in the field are blameless.
For me, the dangerous hour is 3 a.m.
Certain decisions that seem completely justified or rational in the middle of the night -- like throwing discarded pizza and Chinese food containers against an EMS charting room wall instead of actually asking the ED nursing staff to stop using the only table in the room as a trash bin -- will almost always be revealed during the daylight to be really, really stupid.
I've noticed that some people in healthcare seem to equate personal competency with a license to treat the rest of the field like fools or little children.
I don't know where this comes from.
Mostly I think it's a form of amnesia.
When you forget where you came from it becomes even easier to forget where you are -- a small part of a big team trying to alleviate suffering and cure illness.

For those of you who might have missed it, there's a bit of a Rennaissance happening at Spencer Rescue over the last year or so. This article in the Telegram makes reference to Spencer Rescue's pact with Paxton, and is a great example of how a little cooperation and innovative thinking can bring good things to all sides.

I don't know much about how EMS operates in Upton, but it seems changes are afoot. Although maybe unrelated to anything going on in nearby Upton, EMS in the Milford area has undergone a sea change lately, what with the sad demise of the 2181 non-transport service out of Milford Regional Medical Center. I'm not sure who's stepped in to make up for the loss of ALS coverage, other than AMR now owning the entire operation in Milford itself. Uxbridge Fire Department has been making strides to get its ALS program running, while Events and Alert Ambulance are still in the area. I'd love to hear from people who can explain where everything stands down there.

Does it seem like we respond A LOT in the course of a week for patients complaining of possible reactions to antibiotics?
It seems we're not imagining things.
A recent study found that nearly 20 percent of all hospital evaluations for adverse drug reactions involved antibiotics, affecting nearly 150,000 people.

Here's something for the Medical Oddity of the Month Club, courtesy of George, a partner of mine at the part-time job I wrote about earlier who works full-time as an RN in a cath lab.
George is one of my favorite partners of all-time, mostly because despite having over two decades on the streets as a Paramedic, George still approaches the job with a sense of wonder and a desire to learn.
I hope I have half his intellectual curiosity when I've been a medic that long.
So anyway, George had to give a little mini-lecture at a meeting of the cath lab staff on the subject of takotsubo.
Also known as Transient Left Ventricular Apical Ballooning, it's basically a deformation of the left ventricle resulting from extreme psychological or physical stress.
The name is derived from the shape of traditional Japanese lobster traps, which the stricken heart resembles.
It's kind of rare, but not unheard of. George has himself seen two of these cases in the cath lab, where he's been for less than a year.
I don't know how knowledge of this will help you directly in the field, since it's not something we'd be able to discover and even if we could, there's nothing to be done about it prehospitally.
But I'm not adverse to knowing stuff just for the sake of knowing it, and takotsubo is pretty interesting, so if you feel the same way, then bon appetit.

For those of you willing to send it along, one of my main goals for this blog is to be a resource for EMS and related news for central Massachusetts.
I'm not looking for gossip and I have no agenda other than spreading the word about goings-on in our part of the prehospital world.
If you have anything of a newsworthy nature -- and my list of things that might be considered newsworthy is pretty broad, everything from new vehicle purchases, contracts, hirings, open positions and whatnot to attaboys and award announcements -- please feel free to email it to me and I'll be sure to get it in the blog.
Also be sure to spread the word about Central Mass Medics.