Helping and Satisfaction

by Joe Moore

It seems that some are just a little into the addiction of helping others.  Consider this EMT as he begins his journey as a helper in another situation.

The morning is bright and sunny on this July morning as our EMT begins his day.  As a teacher and as a new EMT, he is lucky to be in a position to volunteer at his local doctor’s office.  This is his first day, and he is looking forward to meeting the new provider at the medical center.  He is excited to be in a position to help others in any way that the help is needed.

 
He doesn’t have far to walk since he lives less than a city block away from the doctor’s office.  Even though it is classified as a doctor’s office, the doctor isn’t going to be there.  The doctor lives across the thirty-two miles of water separating the most remote inhabited island in the Great Lakes from the mainland of Michigan.  The mainland doctor’s office of the supervising physician is located right across the street from the hospital where he sends most of his patients.  These thirty-two miles can sometimes create a serious issue for poor weather conditions, but let’s get back to the volunteering and helping.

The doctor’s office is staffed by a physician’s assistant and a family nurse practitioner.  Both of these providers function quite independently from the doctor, and, since the doctor is only present once every couple of weeks, they don’t have much choice.  Of course, the physician is just a phone call away, but independence is almost always preferred.  Of course, there is also a manager and a receptionist at the location for the volunteering.

I walk in the door to the medical office excited to be a helper.  Sally, the receptionist, greets me and welcomes me.  “Glad you are here, Jack.  We can always use some help.  Come with me, and I’ll get you started.”

A door is opened and I walk through.  Sally says, “You can’t put your stuff here in the doctor’s area.  It will be used today since he will be here later today.”

We walk around the building and I get the friendly tour of all the parts of the building.  The building has four exam rooms, but one is set up as an optometrist area.  The other three will be used differently.  The first one is used for kids usually and then the other two are used for teens and adults.  Right down the hall is the x-ray room.  At the end of the hall by the back door are two rooms used only for emergencies or suturing or casting.  Across the hall from the exam rooms are a nursing station and the room where items are sterilized and a restroom, handicap accessible.

Having been in the old office, I’m impressed with the whole setup.   Pretty amazing when you consider that the old building had only three exam rooms that were about the size of the bathroom is in this building.  There are places for five patients; three regular exam rooms and two emergency rooms.  I say, “Have these rooms ever been used all at the same time?”

Sally responds, “Not so far, but summer is just starting.”  Summer is the busy season in a tourist driven economy of the island.  The rest of the tour is delayed by the sound of a siren as an ambulance pulls up to the back of the building right where my tour came to an end.  Perhaps it was my karma or my silly comments, but this day was going to be a busy one.

Luckily, I have had some experience with the medical field and am familiar with the field.  The ambulance crew enters the building and brings the patient in.  Sally went back to her reception area and the day from Hades had begun.
Here we are in the middle of a very busy day, just about one hour after my tour.  Things have definitely changed.  The three normal exam rooms have patients in them.  Both emergency rooms are full, and this volunteer is running around helping in any way possible.  Two extra beds have been set up in the hallway and have patients on them.

Here is the day that I caused by asking my stupid question about the number of rooms and have they ever been all used at the same time.

My friend and fellow EMT Bill wheels the patient from the ambulance into the building through the back door.  Since I have been deserted by Sally, I just automatically gravitate to my buddy.  “What have you got here, Bill?”

“We have a sixty year old female victim of a fall.  This patient is complaining of pain in her right hip and also between her hip and her knee.  Vital signs are all currently within normal limits,” Bill reports to me.

Sally calls my name.  “Jack, I need your help.”  Sally and another patient are coming down the hall with the patient’s friend helping him limp down the hall.  The first thing that I notice is a rope wrapped around the patient’s leg.  This is the biggest rope that I have seen.  It looks like the size of the dock line for the ferry boat.  Below this rope is a gash with ragged edges that goes all the way down to the bone. 

The patient says, “Hi, Jack.  I had a little chain saw accident this morning.  Luckily, Bob came along and helped me stop the bleeding by putting this rope around my leg, and I couldn’t stop the bleeding.”  This patient is my buddy’s father.  The seriousness of this injury hits me like a ton of bricks, but I have to block out the emotion and get to work.  I cut the rope to get it off the leg and use the trauma shears to cut the leg of his pants to get a view of the injury.  The majority of the bleeding has stopped.  The cut goes down to the bone and there are bone chips, dirt, sawdust, and blood all over the lower leg.

The provider comes in and says, “Get a set of vital signs and clean the wound.  I see the bleeding has almost stopped.  When you clean the wound using sterile water, it will start bleeding again, so be ready to bandage it.  I’m going next door.  We have a possible fractured femur in there.  We need to get her in and do an x-ray.  The doctor is here, and I have three exam rooms full of sick patients.  Two more injured in the hallway, and it’s crazy here today.”

I use the accepted cleaning technique to clean off the leg with the chainsaw cut, and it begins to weep, but not bleed profusely.  There is no need to put a tourniquet on.  The doc steps in and says, “Continue to bandage the wound and send him over to the emergency room.  He doesn’t need to go emergently, just on the next plane that is available.  I need you and Bill to put a traction splint on the lady next door.  She has a fractured femur.  She will need an IV and some morphine, and she will need to go by emergency flight.”

I finished the bandaging process and put on a rigid splint to prevent movement of the tissues of the leg.  This extra step was to keep movement to the minimum to prevent to wound from bleeding on the way over to the emergency room  Just as I finished, the provider came in to finish up with this patient and give final instructions.  I left to go help with the fractured femur.

Bill and I had gone through the paramedic course together.  He was the student, and I was one of the instructors.  “Did the doctor tell you to start the IV?” I asked.

Bill said, “Nobody told me to do anything.”

I said, “Well, they did tell me.  We need to get the traction splint on, start an IV, and give pain meds as needed, so let’s get to it.”

And another EMT went out to get the traction splint.  “I’ll pull traction and then you can put on the traction splint.  Let’s get it measured and ready to go,” I said to Bill.  “It’s only a two-person job, but your EMT can take a set of vitals before and then we can go right on to the other two things.”

I pulled traction on the leg warning the patient of the pain that would occur until I broke the muscle spasm of the leg muscles and got the leg into the position necessary to apply the splint as soon as the vital signs were taken.  “AHHHHHHahhhhhh, ohhhhhhhh,” came out of the patient’s mouth as I pulled the traction on the leg.  The pain subsided from a ten on the pain scale to about a three with the traction splint on.  Bill had done a very good job placing the splint and making certain that the splint would not move.  I helped logroll the patient onto a backboard with padding to make it more comfortable after the majority of the movement was completed and the patient readied for transport, Bill started the IV and I handed him the morphine to give to the patient for pain.  I had already diluted the morphine to one milligram in one milliliter and Bill asked me why.

“When you are in the plane, it can get kind of bumpy.  If you only want to give two milligrams and you hit a pocket of air and jump, you can end up pushing more than you really wanted to give.  I don’t think you want to kill the patient’s desire to breathe, do you?”
“Well, no,” Bill said.

“I’ve given her five milligrams in her IV and then mixed the other five in five cc’s of normal saline,”  Doc said you could give another two to three after loading into the plane, and the rest just before you take her off the plane.  That way she won’t probably need anything in the ER or on the way to x-ray,” I said.

The doc opened the door and said, “I’m not really needed here today, but the ER is going to be busy with Beaver Island patients in just a little while.   I’m getting on the same plane as the chainsaw guy, so I can continue his treatment.  I’ll be there to receive this nice lady in the ER.  By the way, you guys are doing a nice job here.  Glad you decided to help out here, Jack.”

Bill and I smiled, and Bill went looking for the provider for her final instructions.  She came in and said, “You will be heading over to the emergency room in just a few minutes.  The emergency evacuation plane is ready to go.”  To Bill, she said, “Okay, you can give her something for pain now.”

Bill said, “We already did out of our drug box, and we got the orders from the doctor, so we are all set to go whenever you give the word.”

The provider said, “You can go,” and she left the room to deal with the other patients’ needs.  I followed her out since I was not needed to load the patient into the ambulance. 
“What do you want me to do now,” I asked.

The provider answered, “Check in with Sally.  Maybe she has something for you to do.”  So I headed back down the hall to the reception area.

I wasn’t there more than ten minutes, with Sally explaining about filing the charts that had been approved by the doctor, when the provider came and asked for my help.  “We need to put a splint on the ten-year-old patient in the hallway.  You need to have gloves on, and I need you to hold the splint material in place while I wrap it.  It will work just like a cast, but will allow for the swelling to go down.”  The other patient from the hallway was gone with just this one still here.

So there I was holding the wet splinting materials with yucky goo on my gloves and a thankful parent standing there.  The parent had been one of my previous students, so I knew her and her child.  It’s kind of funny when you think about it.  “Thank you, Mr. Moore!” said the parent who graduated ten years ago from the school where I taught her and her husband.

The splint had dried enough for me to let go, and Sally came in to tell me to go to room one to help out there.  I stopped and went to the bathroom and then washed my hands and arms to get the goop off, and then I went and knocked on the door to room one.  In there was another of my former students with a baby.  I said, “Hello there, little one,” with a big smile for the mom and baby.

“We’re here for shots, “my former student said.  My smile faded, not knowing what I was going to be asked to do.  I got the baby to smile, and I played with her for a few moments while we waited for the provider. 
The provider came in holding two small syringes and said, “You know how to give shots?” 

I looked at her and said, “Yes.” but my smile faded.

“Here’s what we are going to do,” the provider said.  “We are going to give the baby two shots.  You will give yours on the top of the left leg after pinching up the skin like this.  I am going to give mine in the right leg, and we are going to give them at the same time.  Are you up for this?”

“Yes,” I said.  The baby was still smiling and obviously happy, but wouldn’t be that way for long.

“One, two, three!” said the provider quietly, and both needles went into the respective legs.  The expression on the baby’s face, I will never forget.  If the baby could talk, she would have said some really nasty words, but, since she was too young for that, she just squealed loudly and then began to cry.  We did this all at once so that the baby would only be hurt once, but I think it hurt me more than it hurt her.  Parts of this job really are not that fun.  The mom thanked me, and all I could say was, “Sorry,” and then I left the room with tears in my eyes.

“We have another emergency patient coming in by ambulance,” Sally said.  “This is a man with chest pain, and that’s all they said.”  This is what greeted me when I returned to the reception area.  The filing would just have to wait.  I head back down toward the back door and got there just as the ambulance began backing up.

 
The Basic EMT and a First Responder took the patient out of the ambulance, and my first question was, “Where is the paramedic?”

The EMT responded, “He’s on the airplane on his way over to the mainland.  We were there when the pager went off again.  So guess what?  You are now the paramedic on duty.”  This was said as the patient was wheeled into the room.

I noticed that the patient was my golf partner only after he said, “Hi, Jack.  I’m not feeling so well.”

The words came out of my mouth without thinking, “You look like crap, Charlie!”

To the EMT, “Can you give me a report?”

He said, “Patient was out cleaning up the yard, raking leaves left over from last fall, and picking up junk when the chest pain began.  He went back into the house and sat down, but the pain did not go away.  We arrived and took vital signs, which seemed within normal limits, but we did note a lot of edema in his legs.  We gave him the aspirin in the protocol, but we didn’t have a monitor, so we couldn’t do a 12-lead.  We remember from class that we needed to do the EKG, but didn’t have a monitor to do one.  It went with the other patient, and we did not have time to get back to the garage and pick up a replacement.”

I said, “Okay, thanks.  Now get the bluebag and set me up for an IV with a saline lock, and I’ll put this 12-lead on him.”

We did a regular 12-lead, a right-sided 12-lead, and a posterior 12-lead quite quickly.  The pulse oximeter reading was 92, so we put on oxygen by nasal canula at 2 liters per minute, which brought the oximeter reading up to 95.  The EKG did not show any problems on the right, but the patient was obviously having right sided heart failure symptoms.  The lung sounds were wet and that’s the reason for the saline lock instead of giving fluid.  The saline lock IV went in smoothly and was finished when the provider entered the room and said, “Nobody told me about this patient.  What’s going on?”

“I’ll give you a report as soon as I finish this lock,” I said.  “I’m the paramedic on this run.  This is my golf partner, Charlie, and he has signs and symptoms of a heart attack.  His regular twelve lead says, ‘Acute Myocardial Infarction expected’ so we did a right sided 12-lead and a posterior 12-lead.  We’ve been using your monitor and your oxygen.  His breath sounds are wet, his legs have a lot of edema, and his pain is 5 out of 10 before nitroglycerin.  I just noticed his oximeter ready has dropped to 90.”

“What’s the pain at now, Charlie?” I ask him.

“It’s still a 5 to 6 and creeping up.  The nitro I took didn’t do any good,” Charlie said.

“It was your nitro, wasn’t it?”  I said.

“Yes, I always carry it around with me since my first heart attack,” he said.

“We’re going to try our nitro now instead, just see if it helps, and we’re going to turn up the oxygen to help your breathing,” I said.  “Tom, turn it up to 4 liters per minute, and have the BVM ready to assist his ventilations if the oximeter reading doesn’t come up.”
The provider said, “Give him a nitro and get another set of vital signs, and then we’ll see where we are.”

I put a nitroglycerin tablet under my partner’s tongue, waited about five minutes and had the EMT take a blood pressure.  While the blood pressure was being taken, I asked Charlie, “Can you give me a number on the pain now?”
He said, “Well that nitro actually worked.  I’d say that the pain now is down to a 1 or a 2 now.”

The vital signs came back from Tom as he said, “I’ve got a pressure of 130 over 92, and a pulse rate of 92 with respirations of 18.  Jack, do you want him hooked up to the auto BP cuff, oximeter, and the monitor from the echo unit?”

“That’s sounds like a really good idea, Tom,” I said.  “Tom, after you bring those inside, will you please call and see if we can get another plane ready for this flight.  Charlie here needs to get over to his cardiologist.  He’s up in Petoskey, isn’t he, Charlie?”

Charlie said, “Yes, it’s doctor Roffle up at Northern.  So, I’m gonna have to fly off the island, right?”

“I’m not gonna lie to you, Charlie.  You need to get to the hospital.  You need some evaluation by your cardiologist and possibly some changes in your medication,” I said.  “We’ll probably have you back in time for golf on Wednesday night.”

The provider came back into the room.  “So, how are we doing here?  Things have slowed down now and I can dedicate some time here.”

My reply was, “We’re doing okay.   The nitro from our drug box actually worked.  It lowered Charlie’s pain from 5 down to a 1 or 2, so I’m thinking that we should do a nitro drip, keep some morphine handy, and transport him to Northern where his cardiologist is.  They are seeing about another airplane and we should know about that shortly.  What do you think about that plan?”

“That sounds good to me.  I’ll get the nitro, put it in the bottle, and get the pump,” the provider said as she walked away.

While the provider was gone, Charlie said, “My pain is headed back up to 4 or 5 now.  Can I have another nitro?”

“You betcha,” I said as I got another nitro tablet and put it under his tongue.  I said, “Tom, we’ll need another set of vitals and then switch over to our monitor, okay?”

“Yup,” Tom said.  He turned to the First Responder and said, “Will you get copies of his medications and his face sheet from Sally for me, please?  Charlie, can you sign this form that signifies your willingness to have us provide information to your insurance company, please?”

The provider came in with the spiked bottle connected with the special tubing for the IV pump.  She said, “I can’t seem to get this line to clear of air.  Do you want to give it a try?”

“Sure “I said.  I was quite familiar with this since I teach it in my classes. The tubing has to be held upside near the controller to allow the air to get through the entire tubing.  Once it’s clear, you have to turn it right side up and turn it off.  Then you have to insert the controller portion of the tubing into the IV pump and close the door.  All of that was done, and then we hooked up the IV drip pump tubing to the patient’s IV tubing and opened the saline lock to allow the drug to flow into his vein.

We were almost ready to load the patient back into the ambulance, but the provider wanted to be certain that the pump was set correctly.  She looked it up in some reference, and then set the pump to the rate she wanted.  She said, “You can set this at a higher rate if needed.”

We loaded the patient up into the ambulance and took him to the airport.  Since I was the paramedic on duty at this moment, the responsibility for the patient was on my shoulders now.  We transported the patient out to the airport.  The other aircraft was on the way back to the island, but would take almost fifteen more minutes before it would arrive.  We had already used up almost an hour of the time with every minutes meaning loss of cardiac muscle.

I voiced my concerns to Tom, and he went off in search of the aircraft’s pilot.

In less than five minutes, the pilot came out and said, “Load your patient using the ambulance cot into the aircraft.  Since this a life threatening emergency, we are going to be creative in our method of getting Charlie to the mainland.  If you remember the way we used to load the cot into the plane, then that’s the way we will do this.  It seems that the plane with the air transport cot had to divert to Charlevoix to drop off the last patient’s son to get a car.  It may be another half hour or forty-five minutes before that plane gets back here.  We’re going to get this patient to the hospital quickly, but safely.  Load him into the plane, and we’ll use straps to hold down the cot.  You can sit facing the back and have access to your patient that way.  Let’s get moving!”

This actually worked out pretty nice.  The IV bag with the IV pump was on the IV pole attached to the ground ambulance cot.  The monitor was on its monitor stand made for this ambulance cot.  Everything was on the cot that we might need for monitoring and caring for the patient.

We loaded the jump kit and all the other equipment and the drug boxes into the plane.  The patient cot was secured to the floor of the plane.  The patient was secure on the cot.  And even more importantly, this patient was going to get to definitive care within the 90 minute window.  The 12-lead had already been faxed to the hospital, and we had already called the hospital with a STEMI Alert. (This alerts the ER doctor and recommends the cardiologist be called and waiting for the patient at the hospital.)

We are all in the plane and ready to fly off the island.  We taxi out and begin the emergency air transport of our friend and golf partner.  We are now in the air headed to Harbor Springs Airport.  I call the hospital using my portable radio and headset, and give them an update on the patient’s condition.  It sounded something like this:
“McLaren Northern, Fifty-Seven Air One, Beaver Island…”

“Unit calling, re-identify and give your report,” they respond.

“This if 57 Air 1……We are enroute to Harbor Springs Airport with patient with initials CJM.  This patient’s current vitals are BP 130 over 90, pulse of 88, respirations of 18 and SPO2 of 96.  Patient continues to complain of chest pain, now at 4 out of 10.  He is being treated with O2 at 4 liters per minute, has an IV in the LAC with a nitro drip.  The patient’s condition remains stable.  We believe this is a STEMI alert patient.  We have faxed the EKGs and previous patient history as well as the medication list.  The patient’s cardiologist is R—O—F—F—L—E, Roffle.  We will be at the Harbor Springs Airport in fifteen minutes.  Do you request any further information or have any orders for us?”

“57 Air 1, standby… per Doctor James…Administer a sublingual nitro and note the pain level after.  You can continue as needed, and you can also consider four milligrams of morphine sulfate to decrease the patient’s pain.  Continue to monitor the patient.  Contact us if you need anything else.  McLaren clear.”

I repeated the order and followed them throughout the fifteen minute flight.  It never ceases to amaze me that those involved in my friend’s care are only concerned with his care and his comfort.

We landed in Harbor Springs, unloaded the cot, moved the patient over to the Allied EMS cot, gave our report, and turned the patient over to the Allied EMS agency’s ground ambulance at the Harbor Springs Airport.  We had successfully and efficiently transported my golf partner to definitive care within the window necessary for treatment.  We had saved a lot of heart muscle by doing it this way.  There is no way to predict the outcome if he had not had this efficient emergency transport available.
Charlie was taken in this ambulance to McLaren, was quickly evaluated in the ER and was taken to the cath lab where they reopened two vessels in his heart that were almost completely blocked.  Charlie did well, but missed the next golf outing due to his hospitalization.  Two weeks later he was on the golf course, outplaying me as usual.

I am frequently asked, “Why do you do this?” or “Why don’t you retire?”

I have a tee shirt that states, “Of course I’m crazy.  No sane person wants to do this job.”  It is a little bit of humor in a life full of just the right amount of helping others and the satisfaction of doing your best to help your friends and neighbors.  That is the only motive for this paramedic living on the most remote inhabited island in the Great Lakes.

(After thousands of hours of volunteering at the medical center and hundreds of emergencies, it seems that old age is creeping up on me.  I will still volunteer, but there will be a limit to what I can and what I will do.)

West Side Color

The view of the island from above shown in another story down below incited a desire to view this color from the ground level. The trip around the island was for this purpose, but getting the car covered in mud was not part of the plan. Thank goodness for the car wash, not the location, but the automatic sprayer one. It cost twice as much as normal due to the caked mud all over the new car. The colors were unbelievable. It was a great way to spend part of the afternoon. Not too exciting for some, but well worth the trip for those of us into the beauty of the island.

Barney's Lake

West side from the airport to Fox Lake

Fox Lake

Headed south past Greene's Lake

Looked like a giant spider's web

On the way to the Lighthouse School and South Head Light

A unique view of the lighthouse at the South End

Video Clip of the fall colors for this trip

 

CHRISTMAS BAZAAR 2015

Sunday, November 15, 2015, is the date for this year’s Christmas Bazaar at the Gregg Fellowship Center.  Doors open at 11:00am.

There will be a lot of returning vendors as well as a few new vendors.  You will have your choice of a wide variety of Christmas gifts for family, friends—and yourself!  Candles, stuffed animals, evergreen wreaths and swags, jewelry, Flattail Furs, Pampered Chef, Rustic Heart, baked goods and much, much more.
Each vendor will donate n item for a drawing.  Tickets are $0.25.  All proceeds from the drawing will go to the Beaver Island Food Pantry.  If you place a donation for the Food Pantry under the Christmas tree, you will receive a free ticket (s) for the drawing.  You can also place an unwrapped toy, game, book, etc. under the tree to be distributed to local children.  (Thank you!!)
Shop ‘til you’re hungry—then take your choice of a number of delicious soups—and support the Food Pantry.
Music—voting for the best decorated table—something for everyone!!
Sunday, November 25, 11:00 – 2:00
See you there!!

Reservation forms for tables will be at the Community Center, the District Library, and the mailbox at Jean Kinsley’s real-estate office starting Saturday morning, October 31.

BICS Searching for Substitute Teachers

Events Coming to Gregg Fellowship Center and the Christian Church

The Annual Thanksgiving Dinner will be on November 26, 2015 at 6:00PM  at the Gregg Fellowship Center  If possible bring a dish to pass or a dessert to share.  We furnish Turkey, Stuffing, Mashed Potatoes, Gravy also punch and coffee or tea

The Annual Christmas Cantata at the Beaver Island Christian Church wil be on December 5 & 6, 2015, at 2:00PM.

The Annual Cookie Carnival at the Gregg Fellowship Center will start at NOON and go until 4:00pm on Thursday, December 10, 2015.  This year, anyone wanting Nutmeg Logs and/or Party Cookies are asked to pre-order.  You can call Jean Carpenter at 448-2893 to pre-order. 

BOBI (BIDL Book Club)

BOBI (BIDL Book Club)

For TUESDAY, 11/17 @7p: discussing Knocking On Heaven's Door by Katy Butler
For Tuesday, 12/15 @7p: An Irish Country Christmas by Patrick Taylor 
For Tuesday, 1/19 @7p: Gutenberg's Apprentice by Alix Christie 

For February (date tbd): In The Unlikely Event by Judy Blume

Special St. James Meeting-Auditor Report

This long awaited meeting of the results of an independent audit of the St. James funds specifically related to the Sewer Fund borrowing from the Road Fund and the General Fund took place at the St. James Township Hall today, October 20, 2015, beginning at 9:30 p.m. and lasting until just before 11 a.m. Questions from the board were answered as the auditor made his presentation. The auditor was Stephen M. Peacock, CPA, from Rehmann Robson from Traverse City, Michigan.

Stephen Peacock before the meeting

Several questions were asked regarding the report and when it would be available to the public. It was determined that the draft report would be posted on the St. James Township website this afternoon. The board will have to decide if they want any changes or any other review, but will finalize the report likely at the November board meeting.

The facts show that mistakes were made, certain billings were not done, and that the actual legal responsibility was not completed in a timely manner. The township attorney was asked to answer a question from the public: "When does negligence become criminal?" The lawyer's answer was not the one that was expected by some in the audience of twenty-nine people. "Negligence never becomes criminal." So as many people view this situation, mistakes were made, and efforts are being made to recover as much money as possible from the participants in the sewer running from the Holy Cross Hall down to the King Strang Hotel including Ray Matella's house.

Early on group attending the meeting

Mr. Peacock giving recommendations

Just a few of the people asking questions

This plan for collection will also be discussed, possibly at another special meeting as soon as tomorrow, but definitely another item on the agenda for the November meeting of the board.

Link to Auditor Draft Report

Video of Special Meeting HERE

Donate to the Food Pantry