The Reason Why We Sing
December 2024
regarding 2 HVAC awards
These awards are printed on a color laserjet printer with a complete lack of consistency in branding or organization on almost see through stock paper - all signs of a small volunteer org stretched to the limit on some days. I have no doubt these were printed with care and affection and I see the faults in the spirit of wabi-sabi rather than mistakes…
This place has changed me over the past 7 years in fundamental ways. People ask me if it is the ‘adrenaline’ that is a reason to get drawn to EMS and Emergency Medicine in general. I really don’t think so. It is not what lasts or gets under your skin.
For me - and this is especially after the rise of ‘WFH’ in Covid and its aftermath - it has to do with the way in which we work. A crew working together to figure out a situation - sometimes also working with police, fire or other EMS crews - shares a focus combined with closeness and trust. And the center of it, a patient who is having a particularly bad day. A unique set of skills.
I have really enjoyed my career as a sysadmin to devops engineer. And there have been projects that have had intensity and sense of common purpose. But not like a shift on an urban ambulance.
These awards have nice associations for me - the Covid award reminds me of a time of a lot of unknowns and a fair amout of fear.Working together helped to chop those up into manageable chunks. Amazing ingenuity at the time dealing with real supply issues and new PPE (Tyvek suits, etc) and new decomm systems. And the organization was in service 24/7 with 100% volunteer EMTs.
Many of our members are in the beginning of their careers - some premed/pre-nursing, some EMS and a few in the military. Thinking back on that CPR call - our paramedics were delayed, our second crew heard that over the radio and preemptively brought us supplemental oxygen in case we ran out. The call was in a building which had small elevators so we had to coordinate a move down a few flights with all the attached equipment while ventilating the intubated patient. Multiple people doing their part - I remember a particularly tall police officer holding the IV bag at one point…
And then after the call as we clean up, restock and debrief. I looked around and noted 2 premed students, a member just past boot camp for his military service and a young electrical engineer. None of them older than 25. One of them asking the paramedics for critique. Humbleness, desire to improve, shared experience.
This is what makes you come back after the initial excitement of ‘lights and sirens’ and trauma activations. Not some idea of individual heroics. It is genuinely a privilege to work in such a way to build competence in an often messy and unpredictable craft while at the same time building trust with teammates and patients.
I was part of another resuscitation attempt a week ago - for a child and afterwards I realized that the only way to handle such a call is a part of a group.
The “shared purpose” is patient care. There are a number of perishable technical skills to keep up on but after 7 years I feel the thing I need to improve most is patient care. On the ambulance you have 15 or less minutes from when you meet a person on perhaps the worst day of their life to when you hand off in a hospital. (These are urban EMS timings - my trauma center is 2.7 miles away from the city and 3 other options within a 5 mile radius). There is a lot to get done in that compressed time frame. I have forgotten to introduce myself, forgotten how uncomfortable it is to be strapped in on a stretcher and taken down impossibly narrow streets backwards on the way to ERs that on certain days resemble Breughel paintings more than the apex of modern medical science…
I have finished the didactic part of a Paramedic program. In NJ they require you to get an Associate’s degree worth of classes and about 800 hours of hospital clinicals and another 450 hours of field (ambulance) clinicals. I say about as with each phase there are quantifiable metrics - I had to do an extra 3 “labor and Delivery” shifts to get my full number of births…
The hospital clinicals were amazing - the best parts of the paramedic program for me - they were at RWJ Barnabas hospitals a med school affiliated system - so teaching in the DNA. Nurses have spent time showing me skills like venipuncture, ECGs as well as many other bedside procedures (texas catheter, anyone?). A nurse taking a few minutes to show you something is roughly equivalent to 4 hours in the lab woking on plastic mannikins… The RWJBH nurses are excellent teachers.
And in the hospital that quality of teamwork with shared purpose and trust has been the addictive substance - not the ‘adrenaline’. It also has been an opportunity to really work on the patient care aspect of the work. RWJBH nurses have a good way of balancing heavy load with understanding how important that blanket or cup of ice water is.
I enjoy the Jack Carr series of books - his main character has a nice mantra: “Take a breath; Look around; Make a call”. For me it is “Look at/Listen to your patient” but same general idea.