Saudi Paramedics

As most of my readers know, I'm an American Expat, here in the Kingdom to train Paramedics. My students are all Saudi, and the first group are preparing to graduate and move onto their internships.

For the most part, were going to be turning lose a great group of guys (and girls, but that's a whole 'nother can of worms, for a whole 'nother blog post). They will begin their internship year in September, check in with us monthly, and be given some pretty intensive on the job training. At the end of the year, they will take their exam with the Saudi Commission for Health Specialties. Upon passing they will be licensed as Paramedics, designated as Specialists and will be the people who respond to your emergency, (God forbid you have one!).

What I wanted to tell you about though, was the great bunch of Saudi Paramedics I've met lately, yes that's right they already exist. Lets break them down and see what they're made of.

Skills: 1st rate, every one of them that I've seen, have first rate skills. Just as good, if not better than any American paramedic.

Language: High quality Arabic and English, fully able to understand and communicate in the two most commonly used languages in the Kingdom.

Years of training: 4-6 years, yes that's right, 4-6 years! They have knowledge sets closer to that of a PA than a Paramedic. Many were initially educated here in the Kingdom and then sent to the US for further training. They've trained at Eastern Kentucky University http://emc.eku.edu/emc-bs-paramedicscience-option University of Maryland Baltimore County http://ehs.umbc.edu/  and others.

Certifications: NREMT-P/NRP, PHTLS, American Heart Association BLS, ACLS, PALS Many also carry the CCEMT-P though I've yet to see one with the elusive and exclusive FP-C, or CC-P. However they also carry multiple optional certs that are industry appropriate.

Where they work: This is where it gets a little funny, if you want to see Saudi Paramedics with the above resumes, chances are you'll have to be dying or very seriously injured. They work on Helicopters with the SRCA and its contract helicopter services (Alpha Star and PHI). They work for the National Guard Hospital, and the Security Forces Hospital. Pretty much, they work exclusively for the government.

In summary, the Saudi Paramedics I've had the pleasure of meeting over the past month have been first rate providers that can take care of a loved one of mine any day. I'm hoping, that the program I've been working with is going to give the Kingdom a lot more of them to go around!

Orderlies, Kitchen Staff, and Janitors

Waaayyy "back in the day", as in, New York Circa 1869 or so...Bellvue Hospital was running Physicians and Surgeons on horse drawn ambulances.  This didn't last all that long before running low on physicians became a problem.  The hospital then tried using untrained staff to go out and get the patients.  These staff were often times orderlies, kitchen staff and janitors.  Death rates soared.  As time went on, training was added, and ambulance crews became "dedicated" crews with one orderly in charge of driving and one in charge of patient care.  Surely even in this the dark days of EMS, that orderly in charge of the patient sometimes spoke to a physician about what kind of basic level treatment they expected from the responders. 

Ladies and Gentlemen of EMS, this is where you came from, this and the battlefields of the Napoleonic Wars, the US Civil War, World War I and II field hospitals and ambulances, Korea, Vietnam, and maybe even as far back as the Crusades (firefighters did at least).  The US model of Civilian EMS system, which is what were trying to duplicate here, really got cooking in 1969 in Miami, and then Los Angeles, Seattle, and Columbus Ohio. 

OK, now that were done with the really basic history, lets get to the point...

I give my students hell, its my job.  Some days, maybe I take it to extremes, some days, maybe I'm a little too serious and surely some days I'm a little too pessimistic.  I say this, not because my students have done anything fantastic lately, far from it, they're on vacation either relaxing, preparing for a pilgrimage of a lifetime, or getting drunk, chasing girls and doing all those things they're really not supposed to do.  3 or 4 of them have cracked a book, the rest are otherwise occupied.  So why do I write this then?  Simple, because today I was reminded by a facebook thread of all things, that US EMS "professionals" who learn in their own language, and have had the benefit of excellent hospitals and ambulances to learn on and have had experienced nurses and physicians to learn from are capable of being and are perfectly WILLING to be dumber than my students who come from a completely different culture, learn in a second language, and often have to "make do" with supplies and trainers that happen to be available. 

So I'm going to make my point perfectly clear to my USA EMS brethren.  Medicine at any level is a profession not a job.  You should advance to the highest level your tiny, pea sized, dinosaur brain and your wallet can achieve.  At that point however, you don't stop.  You must continue reading, you must continue studying, you must continue perfecting.  As you progress in your professional development, you become responsible for teaching as well. Whether formally in a classroom or by example in the field, your knowledge, skills and abilities need to be top notch so that you can set a proper example of how to treat patients and practice medicine (at whatever level) in general.

In today's world of social media, you are responsible for setting some kind of example or providing some form of encouragement to those trying to learn and eventually take the reins from your old, liver spotted, arthritic hands.  When they ask a legitimate question, try providing them a legitimate answer, not an idiotic opinion.  Try encouraging them to do some additional research, point them in the direction of studies that have been conducted, try explaining the reasoning behind certain procedures.

BUT PLEASE, FOR THE LOVE OF ALL THAT IS HOLY (can I say that here?) Stop spreading and regurgitating the same old non evidence based crap that you were taught, just because someone told you and you never bothered to research it!

So I leave you with these thoughts.  

Q:  Why do we backboard every patient who so much as hurt his wrist in a "trauma".

A:  Because we started as Orderlies, Kitchen Staff and Janitors who regardless of intelligence level were given a very specific set of instructions to follow.  IF A, than perform B.  IF C than perform D.

No empirical evidence exists showing the benefit of non specific back-boarding of all trauma patients.  In fact, it exists to the contrary, that we actually do damage this way.  In modern prehospital medicine, we are not Orderlies, Kitchen Staff or Janitors, we are now capable of and responsible for study, thorough assessment, research, and evidence based practice approved by our medical control physician. Don't like it?  The old jobs are hiring and probably pay better. 

Q:  Why is the Square Root of PI 1.77245xxxxx?

A:  I have NO CLUE!  I'm a Critical Care Paramedic, and Paramedic Instructor.  But you can bet your ass if I called myself a mathematician, I'd know the answer.

You want to call yourself a medical professional?  Act like one.  Do your research, stay current, learn a little more every day, perfect your skills until the day the good Lord turns you back into dust and your time on this earth is over.  

 https://www.facebook.com/sincitymedic/posts/481378318563817

Here's to the Heroes

I had a squad leader once define courage as "doing what needs to be done when its the scariest fucking option out there".  Somehow a civilized definition of that just doesn't pack the same punch...

Lots has been written about EMS and Fire and PD and safety and LODD's, and all sorts of blah, blah, really important stuff.  Every 2nd week EMT candidate recites the words "BSI, scene safe" in his or her sleep.  As an instructor, I try and make it come alive and say that Scene Safety is not about some mythical bad guy hiding in the shadows at a domestic violence call, but rather its about the unsecured street that your working in, the abandoned building you just entered, the blood that is soaking through your boots and pants while you kneel down and hold someones hand as they die.  Those are the real issues of scene safety.  "Forget about the DV call, the cops already got that guy all hemmed up."  I try and educate and instill a higher order of thinking that allows them to be prepared in advance for the crazy things they're going to face.  For the most part this works.  For the most part we are able to educate unsafe practices out of folks, and for the most part we're able to protect ourselves from most "icky stuff" even in the field.  But sometimes, just sometimes, a situation arises in which a hero is needed.  Every day all over the entire world, men and women step up to be just that.  Later on they are Monday morning quarterbacked to death, their actions portrayed in the media as foolish, the talk around the base or the station about how "we would have done it".  The Lawyers already seeing dollar signs regarding the mistakes that have been revealed. Some of us though know the truth, that at that particular moment in time, a hero was needed.  

So here is my brief ode to the heroes, they go through hell some days, the ones who stop their cars and hold bloody necks still while waiting for the on duty responders, the ones who are covered in blood, shit and vomit at the end of the call because a chief complaint of vomiting wasn't thought to bring about a naked man covered in GI blood and vomit who happened to stop breathing as you pulled up.  The responders who run up to a car on fire with no PPE and only a fire extinguisher, the Paramedics who help a man evacuate his dogs from a burning house while waiting for the FD to arrive after realizing that their only other choice was to tie him down.  The responders who dig through glass and rubble at a building collapse before the USAR team is activated.  The ones who trek through the woods in the winter looking for lost and hurt hunters despite having no special wilderness gear or training.  Here is to the first responders trained and untrained who risk everything to save their fellow man.  Mostly though, here's to the heroes that keep going to work, day in day out, shift after shift they keep putting on their uniforms and boots and go do it all again despite personal problems, despite an imperfect marriage, despite low pay and crappy conditions, despite the fact that if George Clooney walked in to the living room while they were coding someone, the family would probably ask him to save them.  You do us all proud, every day, I am so very proud to have been among you. 

Off Limit Topics...

The first and foremost off limit topic that people want to keep talking to me about...9-11 (September, 11th 2001). 

OK, once and for all, lets get this out,  It would be bad form (to say the least) for a Non-Japanese citizen to wander around Hiroshima and say wow, you can't even tell an Atomic Bomb ever fell here, or a German guy to ask a Jewish guy, "so how bout that holocaust thingy?  You think that really happened?".  I don't see what people don't get about this...I mean its a touchy subject even in America still, it will be for a very long time, maybe forever.  But, here from a non-American to an American its downright rude...and you can stick your theories up you ass for all I care.  You can discuss it amongst other foreigners all you want, but to ask someone of the nationality of the tragedy, if they think maybe their own Government or military "did it".  Is just bad form.  So lets clear up my version of events, and remember I'm a little lefty sometimes, but here it is, just so people can stop asking...

It should be noted that the latest offender of this policy was not Saudi...not Arab....and not Muslim...but was primarily not an American citizen, but would like to be...yeah, I don't think so...

9-11-2001.  A bunch of murderous assholes, got on airplanes, they took over those airplanes by force and threat of force.  Later they crashed those airplanes into easily recognizable and ideologically significant targets in America.  They killed innocent men, women and children because they thought differently than they did.  Brave men and women then attempted to rescue the survivors of the attacks and recover the victims regardless of the nationality, gender, race, sexual preference or religion.  Many of them died in the process, and many more have seriously debilitating and lasting side effects both physical and mental from the events of that day.  That is what happened on 9-11

All of the rest of it, all of the details, citizenship of the hijackers, plots, conspiracy theories, and pardon me...Bull Shit. None of that detracts from or changes the fact that the paragraph above is what really happened on 9-11.  Now do I believe as I've actually been asked: If it was a Zionist plot (called a Jew plot here)?-NO  Do I believe it was perpetrated by the CIA?-NO, Do I believe that the buildings were rigged with explosives and the planes were just decoys?-NO, Do I believe that Osama Bin Laden and the other Hijackers were undercover CIA agents?-NO, Do I believe that the US Government knew about the plot, but allowed it to happen as a pretext to "plunder the Arab world of oil and money?"-NO  "What about Rosie O'Donnel and all of the other Important Americans who think it was a conspiracy?"-Really?  NO SERIOUSLY?  REALLY?  Rosie Fuckin' O'Donnell?  The last time "Rosie" was important in America was at the lunch counter!  Her and all of the other conspiracy theorists can as far as I'm concerned crawl back down their holes, but...They are Americans, and they were there (in the US), so...by my own logic yeah, they can question whatever they want to question...one of those rights afforded to American Citizens.  But not afforded to foreign nationals asking an American these questions in passing as though we were discussing the weather or trading one-liners at a cocktail party...

So, now you know...hopefully we can avoid this conversation next time...And remember the key points presented here.

 

#1:  Assholes got on airplanes

#2:  Assholes hijacked airplanes

#3:  Assholes murdered innocent people

#4:  Heroes risked and lost their lives trying to save people indiscriminately

 

Hello streets...Daddy's home!

Well hell, every now and then God hears your bitching and decides, "well OK fine, I'll cut you a break".  If you haven't been able to tell, I've not been having the greatest past couple of weeks, and all that stress and BS has really started to wear me down.  Works been tough, work's been stressful, I've begun to think this country doesn't want anything better, and life on the home front has been topsy turvy just to ice the cake.  So today when I showed up and found out that even though the weather had cleared up beautifully, the students decided with their ringleader to take the day off of testing...I thought it was just going to be another in a long line of shit days...Boy was I wrong on that one!

Decided to take advantage of the pretty much nothing to do day, play hookey and go get all my paperwork turned in so that I can volunteer ride on the ALS truck with the other Medic or Doc, whomsoever happens to be on that day.  I had started to feel a longing for the streets that I just can't explain.  I'm beginning to think I was actually made to be a paramedic, and just luckily good at it!

Spent the first half of the day cruising around Dammam to about 20 different places getting everything done, had a great student escort in the form of Mr. Z#@%^&  K*&*^.  He kept the process flowing and entertaining, and kept the soundtrack to my Junior High and High School days rocking out courtesy of Saudi Aramco.  Really showed me a side of this place I have never seen!  Invited me to his house and was a gracious host.  It is rare and very nice to see the "real" parts of Saudi.

The guys at the SRCA seemed happy as clams that I wanted to do some volunteer time, and were more than accommodating.  After finally getting everything done, we headed to Khobar to meet up with another student who was working that day and his partner A_____ whose a Doc from Egypt.  Great guys all, met another great guy, a Flight Medic here in the KSA, who is Saudi but has dual citizenship and has done roughly the same amount and type of education I have.  We talked about the problems, the job, the training, my students...all in all had a great time.

Lunch was at "Steak House" which as the name implies is an American style steakhouse, with an impressive soup and salad bar (rare in the KSA).  We laughed and talked and joked for hours.  Towards the middle of this lunch, I realized what a great time I was having and I realized something else as well, I hadn't thought of my recent problems at all, I was just having fun with a bunch of pre-hospital contemporaries.  The day wasn't like something similar to what we do in the US, it was what we do in the US!  Sit around and laugh and joke about things that only Medics and Docs who have been on the street can understand.  Towards the end, Z___ got the great idea that we ought to head to Bahrain tonight when he got off shift, "BUT!" he quickly added "with rules!". We jumped on the idea immediately, and told him that the only rules should be that the first one to pass out buys drinks for the rest of the night!  We all shared a great laugh and went on to listen to his rules...No Booze and No Women!  All at once we said without at least one of those two things, why the heck wold we go to Bahrain?  He laughed and joked and said no seriously, I'm getting married in 2 weeks!  Then we all started in on the sins of marriage and a job like this, laughing, swapping stories, and reciting ultimatums our wives had made over the years.  We decided to postpone Bahrain, but I hope it comes up again in the future.  I think I'm ready for some fun with a group like that...a group like me is I guess a little more accurate.

Heading back to the station, I rode with the guys in the ALS truck...we hadn't gotten 5 minutes into the conversation about how slow it was today when their tones dropped and off we went, first call of the day was a child struck by a car, while we were cleaning up and putting things together from that one our tones dropped again for a hypoglycemic patient.  and we pulled out right behind the ambulance heading to the hospital.  We met another ambulance on scene, and doc did a great job getting the patient all set and ready to go.  2 minutes later, off we went again, this time to a call for two patients who fell from an unknown height.  As we arrived on the scene, we were informed by dispatch that the 1 patient had been transported to the hospital by another ambulance.  We turned around headed home and went to another fall, possible hip fracture.  All in all we left the restaurant at 2:30 and returned to the ambulance station at 6:45.  The guys had another hour and fifteen minutes to go before the shift was over.  I thanked everyone for an awesome first day, and headed home with Z______.

I think this is the most content I've felt in weeks, if not months.  I really hate to admit it after all the money I spent in school and all the years I've been busting my butt to earn degrees, but I think I might just be a Medic...a lifer...

Whatever I think though, I feel pretty damn good.  Foreign EMS is pretty cool.  Oh and BTW that ALS truck I was riding with, it is the ALS response vehicle for Al-Khobar with a population of 360,000 according to the 2009 census and reported by http://en.wikipedia.org/wiki/Khobar
 That ain't to shabby!

Kudos to the SRCA and the dedicated crews that run these trucks, what I saw today was world class!