The #FOAMed Airway

I’ll be the first to admit it, I take my airway skills for granted! I assume they’ll always just be there when my patient needs them, that they’ll never fail me at a critical juncture.

Like, when my patient is crashing and can’t maintain their own airway – You know, important moments like that.

This feeling of comfortable airway competency has been a mainstay for me for quite some time, it allowed me to sleep at night and fumble my way through many a call. Don’t get me wrong, I’ve sunk my fair share of endotracheal tubes, enough to convince me of my competence with the skill at least.

Then I moved to a “slower” station, opportunities for intubation became fewer and further apart – Doubt about my ability creeped in as each shift without a tube marched on. During this period two new pieces of airway kit were introduced into our arsenal, the bougie and King LT SGA respectively. This was nice, but did little to mitigate my airway apprehension. In fact I think it made it a little bit worse – Suddenly there was more to know, another practical skill set to master and very little instruction provided to help me along!

Into my fog of confusion came a strange light in the form of a twitter hashtag, #FOAMed. At first I was confused by this hashtag as it appeared on tweets that appeared to be from doctors and other health care types. I briefly wondered what foam parties had to do with medicine…

Then I came across this site which explained everything in a clear, concise manner and with a great deal of enthusiasm. From it I also learned that #FOAMed is an acronym for Free Open Access Meducation – Very clever!

I became very excited as I realized what this find meant for me in my little paramedic station in Ontario, Canada – There was an entire cadre of health care professionals pumping out relevant, well written and insightful posts about the very topics that were causing me so much worry!

Win!

What could make this any better? The opportunity to interact with the authors of this material directly, and a strong likelihood they would respond! All that I needed to do was follow along on twitter using the #FOAMed hashtag and read the many blogs referenced within the tweets.

As for my airway jitters and bougie blues? I tamed them by learning about the Kiwi Grip here and watching the excellent airway cam videos here!

I eagerly followed the conversations Dr. Minh Le Cong, of the Royal Flying Doctor Service, had with his many colleagues via his twitter account (@rfdsdoc)). The amount of information from these sources alone was staggering!

There are many paramedics contributing to the #FOAMed phenomenon, and they’re welcomed as valuable contributors with a unique perspective to share. I’ve recently come across this #FOAMed themed blog, written by a paramedic from a paramedic’s perspective.

I can’t begin to do justice to this movement in this one blog post, but I encourage my colleagues of all levels (especially students) to explore this new horizon on their own as it will enhance your practice and increase your comfort by leaps and bounds. The best parts? It’s fun, it’s convenient (you can access this on almost any device), it’s interactive and seemingly endless in scope!

I’d like to think that by introducing this phenomenon to as many paramedics as I can, that I’ll be giving back a little of what I’ve gained from it so far. My intention is to post as regularlyly as I can on the subject, highlighting interesting things I’ve come across, opinions I’ve formed as a result and any other topics I come up with.

Anyway, it’s late and I’ve prattled on enough – I hope that I have inspired you to hop on the #FOAMed train and journey with me wherever it may take us!

Stay Safe!

Style

Everybody has their own style. It’s what makes us unique as human beings and distinguishes our efforts when performing similar tasks as professionals, students, hobbyists etc.

It’s taken a long time and a lot of reflection for me to arrive at my style as a Paramedic, and it’s a continually evolving process. My style adapts and changes to new responsibilities, changing roles and situations as well as the people I interact with on a daily basis. It’s not perfect, nor is it infallible but it has worked for me for most of my adult life.

Until now.

I’ve recently decided to take a stab at writing as a way to challenge myself, express myself and generally open up to the world. Up until this point my writing has been confined to patient care reports and Twitter.

Which brings us to writing and style… I have no clue what my writing style is, in fact until a friend read the sparse pickings on this blog so far, I hadn’t even really thought about what my writing style could be. My previous writing experience dictated a technical style where brevity and clarity is paramount. It’s kind of exciting to break free from those restrictions and let loose (metaphorically speaking).

So will I write in a relaxed, conversational style? A darkly humorous style? A stiff, pedantic style? Will I disturb, or agitate with my writing? I just don’t know, yet….

I think I’ll just write and let my subject matter dictate the style I write in for now, I’ve got enough hangups about writing as it is… Such as a perceived lack of knowledge around the “rules” of writing.

However, according to Thomas Basbøll and his blog Research as a Second Language, a writer should be less concerned with the “rules” than with simply relaxing and allowing the “rules” to develop as you write. I think this advice is marvelous and if you’d like to read the article you can find it here.

Phew, I feel more relaxed about this writing thing already…

Till next time, do stay frosty!

Esprit de Corps

From Merriam-Webster Dictionary:

The common spirit existing in the members of a group and inspiring enthusiasm, devotion, and strong regard for the honour of the group.

www.merriam-webster.com

It’s a rare thing to see a display of esprit de corps outside of an individual paramedic service, even rarer still is to see it applied to paramedics across the province. This sad state of affairs has taken years to develop and will likely take years to correct.

We can no longer be separate little islands in the same big lake, content with the idea that “someone” will step up when the need arises. As a profession we need to develop the idea of solidarity amongst all paramedics province wide regardless of service/labour organisation affiliation.

At a fundamental level what this means is that when the honour or integrity of one paramedic is questioned, the honour and integrity of ALL paramedics are being questioned and as a result all paramedics undertake the responsibility to stand and speak in support of their colleague and profession.

We can scale this feeling to encompass a service, a region, or the entire cadre of paramedics across the province. However, to effectively engage all paramedics provincially this feeling of esprit de corp must be non-partisan and without undue influence from outside sources.

We see the concept of esprit de corp used most effectively in the fire and police services across North America. Be it an individual, or an entire service in trouble the support offered by every other member is swift, consistent and powerful. As a profession we would do well to take a closer look at this phenomenon and learn how to apply it to our own unique circumstances.

To be clear, I am not proposing that we throw away the labour organizations who represent us at this time, merely that we start to think of ourselves as paramedics in Ontario rather than Ottawa paramedics, Niagara paramedics, Flight paramedics, etc. Narrowly defining ourselves by the region we serve, or the service we work for, allows us the luxury of ignoring the plight of our fellow paramedics who may desperately need our support in times of trouble.

There are more than 7000 paramedics in Ontario and countless more the world over. We all share a powerful bond in our common purpose, goals, trials and troubles.

With these numbers and taking into consideration our similarities and common strengths, I cannot see a reason why the paramedics of Ontario continue to operate in their own little bubbles when it comes to matters of solidarity.

How do we encourage a province wide esprit de corps amongst an admittedly jaded and cynical group of professionals? I don’t have that answer yet, I’m not sure if anyone does…

This however I do know; a paramedic should never stand alone during difficult times and that it is the responsibility of each paramedic to step up to support their colleague in need.

Psychic Armour

Death usually doesn’t affect me that much. I’ve been at this profession long enough now that my psychic armor is fairly thick.

Not so thick or strong though, that it can’t be penetrated from time to time. This is what reminds me that I’m still human after all.

A child’s death, or the unexpected death of someone by traumatic means are two scenarios where my armor isn’t strong enough.

In this post I’m going to relate a story of death by trauma. I’ll leave pediatric deaths for another post I think.

A death as a result of trauma tends to upset me more than a natural death due to age or illness. In this case I find myself reflecting about how mere moments ago this was a living, vital person with plans and a future. Usually they are in the midst of some boring, mundane daily task when their life ends. Commuting to work, a trip to the corner store, waiting to cross the street and so on.

No one seems to die while heroically saving the damsel (or dude) in distress from a teeming horde of villains. At least not in my, admittedly limited, experience.

The catalyst for this blog was a call I responded to as a solo responder (my partner had left early that shift) for a motorcyclist down on a narrow, two lane rural road.

I know this section of road well as it’s my route to and from work, it’s very pretty but treacherous if you take it at speed. I arrived moments before the transport ambulance did and was faced with a group of people all pointing down an embankment at a tree.

This did not bode well.

I took what equipment I could carry and began my descent, thankfully I was joined at this point by a medic from the other ambulance. We found the patient wedged at the base of the tree exhibiting all the signs of a severe head injury (unconscious, with decerebrate posturing for you medical types).

The patient wasn’t dead, but it was going to be difficult attempting to keep them that way. The heat and humidity of the day along with a dearth of helping hands exacerbated the challenge we faced. We were able to immobilize the patient and I initiated what treatment I could on the slope. Eventually the fire department arrived and we finally had enough trained hands to secure the patient fully and extricate them to the vehicle.

Once there, further assessment revealed several more life threatening injuries that I managed to treat just prior to transport to the helicopter landing site.

I transferred care to the chopper medics and we watched them fly off, into a sunset no less, to a trauma hospital.

I felt pretty good about the execution of this call, all challenges had been met and I had excellent help on scene, including some phenomenal bystanders.

The next day I learned that the patient had died shortly after arriving at the trauma hospital.

That sucked. I had allowed myself to think that maybe, just maybe, they would survive. Nope.

Armor pierced, dammit.

I don’t consider this a failure on my part, the patient was mortally wounded and they would’ve died regardless of what treatment was available on scene, including an operating room full of trauma surgeons.

One second they were alive, hopefully enjoying themselves, the next they were as good as dead.

In a heartbeat.

Be careful out there people.

Beginnings

All things have a beginning, a middle and inevitably an end. I have been priviliged over the years to be a witness to all three at various points in peoples lives, most of them strangers, some friends and others family members. In this blog I hope to allow myself the luxury of exploring the many thoughts, ideas and emotions that these experiences have sparked within me. As I grow older and mature (theoretically) it becomes harder for me to sort them all out in my mind. So I have decided to try my hand at writing as a means to exorcise demons, restore order from chaos and ultimately learn more about myself.

This isn’t the first time that I have felt this way over the years, but it is the first time where I have felt compelled to actually commit myself to the process. I have no illusions about this blog becoming more than a mental playground for myself, but if it does my hope is that the readers enjoy themselves and possibly learn something.

I decided to name the blog after my favourite standby location, those of you who are my colleagues will recognize the name and location immediately. For those who don’t, it is an area bounded by a lake with many quiet and picturesque parks to sit and contemplate life and all that stuff. I recall fondly spending hours just sitting in my truck thinking, listening to music or just talking with my partner.

I’m stationed elsewhere now and don’t get there nearly as often now. I’d like to recreate that vibe with this blog as much as is possible in a digital, 2D framework.

I reference the fictional Pensieve because it symbolises what I want from this blog nicely , that being a receptacle for my thoughts that I can return to at a later date to make sense of them. If anyone can suggest a real world concept that is similar please let me know in the comments.

I plan on writing as often as I can and I have a few posts lined up in my head. The difficulty will be in finding the time to sit down with a very active 2 year child demanding attention. Posts will be on any subject that piques my interest or evokes a strong reaction in me. For the most part there will be quite a few topics related to EMS and paramedicine as it is a large portion of my life. There will also be posts about my experiences as a father and how that relates to my job, the two can become intertwined unfortunately.