Elevator Etiquette and the EPD

The last few months have placed me at the mercy of very busy elevators at Boston Hospitals. This has proved to be an experience akin to eating glass, or allowing a vicious canine to slowly tear an appendage from my conscious and unwilling body. Part of the torture is the sheer amount of time spent waiting for the elevator to arrive, especially when facing more than 6 sets of double doors leading into the cars. One would think with that many elevators patrons would be zinging in and out like ping pong balls. Instead, it’s like the pace is set by turtles riding on snails’ backs. 

Regardless of how quickly a person can move into and out of the sluggish cars, some basic rules of etiquette must be observed! If the budget were unlimited and I were the lawmaker, I would even appoint “Elevator Police,” to enforce the rules. The first, and most blatantly disregarded courtesy of elevator etiquette is STANDING IN FRONT OF THE DOORS AS THEY OPEN SO YOU CAN BOARD THE ELEVATOR. Hello, Captain Obvious? Ever consider that people might need to get OFF the elevator, and they can’t do that if you’re blocking the only exit with your impatient body mass? Doesn’t it make more sense to give them a few precious seconds to egress, thereby making more room for your impetuous frame? Press Button. Stand near button just pressed. Watch passengers depart. Board elevator. All too easy. 

If elevators had ears they would probably jam a traction cable into their tympanic membrane. The elevator police would definitely be working overtime writing out tickets for inappropriate conversations. An elevator ride usually lasts anywhere from a few seconds to a few minutes. During that minuscule expanse of time, please refrain from discussing the intricacies of your surgeries, bowel movements, or elderly mothers’ dental insufficiencies. Save the complaints about your mate’s sexual inadequacies for a nice conversation from the privacy of home. Standing in the corner attempting to chat discreetly about your drunken debauchery doesn’t cut it, either. It’s an ELEVATOR. We can hear you, no matter where you stand. 

Policing the elevator would be a full-time job. Ticket writing alone would account for a large portion of duties. Sizable fines would be solicited for discharging bodily functions in the elevator.  The amount of funds collected would be directly proportional to the vileness of the body function expelled into the confined elevator space. Egg Salad Burp? $100 fine. Blowing your sinus infection into a tissue then looking at the nasty green mucous? $200 fine. Passing the undigested gassy remnants of a black bean and cabbage lunch from your most distal hole into the only oxygenated air source elevator patrons have to breathe? $400 fine, at MINIMUM. Keep your bodily ejections contained until you’re off the elevator, even if it means severe cheek-squeezing and abdominal cramps!

The elevator officers will also be writing tickets for moving violations. If you called the elevator at the 3rd floor and plan on riding to the 19th, stand at the back of the elevator. If you called it at the 1st and need to get to the 2nd, take the stairs. If you have a twin stroller with two drooling infants crammed into it and the elevator is already 3/4 full, wait for the next one. When you board the elevator, if it’s not possible to reach the number buttons, politely ask the elevator rider closest to the buttons to push “5.” And by Cracky, if you are the human responsible for reproducing the pediatric cretin who just lit up every floor with their curious, stubby little finger do NOT expect the rest of the elevator population to think it’s cute or endearing in any way. Don’t teach your offspring to push buttons by pushing ours. Elevator PD, arrest them! 

The elevator is not the place for racing, discussing, exposing, or expelling. It’s a bad time to attempt to fit a round body through a square hole. It’s not the environment for flirty or casual conversation. It’s not a playground, dumping ground, or breeding ground. It’s not a cafeteria, kitchen, or dining room table. Don’t use it as a classroom, chatroom, or bathroom. Keep your hands in, your eyes down, and your holes closed. The EPD may be patrolling an elevator near you!

Anyone interested in applying to the EPD (Elevator Police Department), send applications to: nichole@paramediccooks.com :)

Keep It, Tool

I saw you there, in the shadows. You were unformed, shapeless; yet I could see your crouched position, ready to pounce. I saw you watching me, but I pretended not to notice. Though you had no face, I could see your empty gaze and the grainy orbits where your eyes would be. From your amorphous mass I could discern venomous fangs, gnarled and arcing over an illusory bottom lip, the sharp points at the distal edges piercing back into your own skin. 

By pretending to afford your privacy and avoid exposing your voyeuristic nature, I hoped   to quell your inherent compulsion to scrutinize opportunities to cause misery and despair.  My plan will never be realized. Into your core a thread of utter depravity has been weaved, and you thrive on any molecule of angst you can create. 

There in the shadows, you are content to wait. There are many others like you that are with you, yet you’re alone. You feel alone, you know you’re alone, you don’t want to be alone, but you can’t be any other way. Suddenly, your misery-radar goes off! You spy a chance to make someone completely hopeless, and despaired. In this case, you can take something that person wants, even though you don’t need it, or want it. When you acquire things you have no use for, an unrivaled feeling of accomplishment comes over you. You feel powerful. Successful. Iconic. 

You’re an utter failure.

Your unformed shadow moves. It is excited. It occupies space though it is not fat, or tall, or round. You slink across the expanse of space like a large jungle cat. Your mouth gapes open and a silent scream pervades the air. Your plan is foiled. I am the successor. You have what I wanted, for that moment. Keep it. Store it in your curio cabinet of vile immorality. I’m already over it. I have my sights set so far beyond your 

oppressive blackness, not even the dispersion of your oily filth could smother me. 

You lose, loser.  We’ve both made spectacles of ourselves. But mine glitters. 

House Hunting!

Front Door (pre-moving in)

       Why is home buying such a grueling process? I’m certain the amount of papers to sign, initial, review and “keep for your files,” are equivalent to more dead trees than it would take to build 17 log cabins. I understand the importance of documentation to protect the interests of all involved, but is all the lawyer jargon really necessary? I’m not a simpleton but wouldn’t it be easier to just list questions directly instead of all the useless political, constitutional, and ceremonial technobabble? For example, because apparently the threat of Natives of this Land quick marching to claim the property you just purchased is a tangible, highly conceivable possibility, you are encouraged to pay an extra fee to buy the insurance that protects against this event. Instead of pages of explanations, clauses, and provisions, why not just state the questions, unfluffed: 

1. Do you want Peaceful Ancient Tribal Men or Women appearing unexpectedly to claim the land you just bought?                                                                              

_____YES  _____NO     

     2. Would you like to spend ____ amount of dollars to feebly protect the land you just bought in the event the aforementioned claim is staked?  

                   _____YES        _____NO

Done. Was that so hard? One thousand, four hundred sixty-eight trees will thank you!

Personally, I am DELIGHTED the home-buying process is over! Not just because I feel as though I have purchased my dream house, also because I’m happy not to be dealing with all the personalities involved in the house search. There are so many real estate agents, lawyers, brokers, lenders, sellers, appraisers, home inspectors, insurers, permitters, and town hall personnel to deal with, it’s like a day at DIsney, except without the “best place on earth” theme! Almost every one of them listed comes complete with their own set of paperwork, fees, and (sometimes offensive) personalities. Not to mention all of the time spent attending house showings, meetings, signings, phone call placing and returning, emailing, and internet searching. It’s like having another full time job, only I’m paying the (competitive) salary to SOMEONE ELSE! 

My absolute least favorite part about the whole process was the bidding war. I expected the sellers wanted top dollar for their property, and I’m sure they expected I wanted to pay bottom dollar. After about a year of internet searches and actual home showings, not to mention a several month hiatus when it became just too overwhelming, I stepped foot in the house, and knew it was THE one. Our first offer probably sent the sellers into intense paroxysms of laughter, followed by two letters that would be used ad nauseum throughout the bidding combat: “N-O” In the end, we paid a few cents shy of the asking price, I got my dream house, my husband got a few ulcers, and the sellers probably got a night filled with champagne glass clinks, sneers, and snickering finger pointing to the suckers who just bought their property. More of my least favorites include the fact that we had to pay closing costs (on HGTV the buyers NEVER pay closing costs, what’s up with that?), the hugely extended closing date (sellers insistence), the problems found at inspection, and especially the unprofessional, unknowledgeable, unseemly, amateurish, smarmy, and acutely obnoxious sellers agent.

My Recipe Nook (pre-moving in)

My favorite part about the whole process of course, is the end result: MY NEW HOUSE! I attended many home showings before being introduced to “The One.” Within minutes of walking through the door, I knew it was The One. I consider it my Dream House, even though I looked at many houses that were bigger, more expensive, and newer. We close June 17th and I am counting down the days by milliseconds! I’m so excited, every time I look at pictures of the house I get butterflies in my stomach, a faraway look in my eyes, and the words “I do,” automatically form on my lips. My kitchen has SPARKLY granite countertops, slate stone flooring, and a built in “recipe nook” complete with desk, book shelves, and its own sparkly granite desktop. There’s a custom pantry built around the refrigerator that has shelves that slide out, and the dishwasher....Oh, the dishwasher is TWO DRAWERS that can both be loaded and set separately. How awesome is that?!! There is two bathrooms that are completely updated with beautiful stonework, one with a jetted tub, and the other with a huge stone tile shower and cedar closet! 4 bedrooms, a fireplaced living room open to the kitchen, huge upstairs bedrooms with cute little dormer alcoves, and while the cellar is clean and free of water damage, it isn’t finished but has a half wall of built-in cabinets and a work bench/counter. The garage enters right into the kitchen, I even love the stairs leading to the kitchen entrance. The backyard is absolutely amazing, and has the potential to be the “outdoor oasis” I fantasize about. I already have paint colors and themes picked out for every room, a whole boatload of brand new furniture waiting to be delivered, and holiday/party menus planned! I CAN’T WAIT! This is the second most excited I have ever been in my life! The first was waiting to see what my little baby girl would look like :) 

Start flexing....cause come June 17th I’m going to need plenty of muscle to move all of this Internet Shopping into my new house! Expect good food, friends, and fun...and plenty of parties in Lakeville, MA! WOOOOO-HOOOOOO! 

Waste Space: A Paramedic's modern interpretation of how wee should pee

Why do women always complain about men leaving the toilet seat up? By the same standard, shouldn’t men complain that women leave it down? I’ve never understood that gripe. I couldn't care less about where the hell the toilet seat points. What I feel piqued about is the urine droplets that splatter all over my makeup, perfume bottles, clothes, flat iron, and toilet paper that I’m going to use next time I go to the bathroom. Seriously? Who decided that men should joggle the urine from their bits? It’s like a pee windmill that glazes every surface within a 10 foot radius! Eww? 

Okay, so due to some relatively significant gender plumbing discrepancies, men have the option of standing when they urinate. Does that mean they have to stand? Cmon men, we won’t think less of you if you sit down on the toilet seat to pee. You sit on it for other things, right? (Thank heavens there’s no “shaking” to clean that !!) Furthermore, if standing is just too monumental an advantage and convenience to renounce, whats wrong with taking a square of toilet paper and gently dabbing at the bits? Did the inventor of toilet paper intend that only women should use it in excess? No. Blot the moisture away with TP, the same way royalty might dab at the corners of their mouth with a vicuña linen napkin.  

Let’s examine the real issues here. I have two. One is in the present, one is in the past. The present one is the urine that my personal belongings are showered with multiple times a day. I’m not talking about perceived scientific molecules that may or may not be found on my toothbrush following a specific and rare laboratory test. I’m talking about the actual alligator tears of pee that encoat my personal effects....you know, the ones that I use EVERYDAY. Yes. I ingest large amounts of others peoples’ urine over time, from the light spray that mists my beloved items repeatedly. Daily. Endlessly. So do YOU.

The past issue is with the person who taught, retaught, and enforced the practice of jarring urine from the male bits with an obnoxious amount of convulsing. Where is this human, and what gave them the idea that useless kidney scraps should be drizzled in bathrooms across the world? Possibly when the reality of a satisfactory homestead was a fair amount of rock also capable of absorbing the mineral nutrients of kidney excretion, it was acceptable to sprinkle the living space with renal detritus, but no more! Pee belongs in the septic system, and nowhere else. 

This blog is my challenge to Mommy’s, Daddy’s, Nana’s, Vavoa’s and the like: Stop teaching male counterparts to shake the waste from their fritter-sticks! Teach them to blot, dab, sit, or any other means to evacuate the urine from their bits! Make for cleaner bathrooms. And homes. And places of waste! Don’t think co-ed bathrooms...think co-ed places of position, designed for modern interpretation waste spaces. Waste spaces with toilet seats that neither go up, nor down. I’m not saying it should be communal, but if it were it would be alot cleaner if one gender didn’t atomize urine. 

I DARE you to innovate the way we pee. See you in waste! :)

How Dare you judge ME?!

ParamedicCooks.com is proud to conclude our FIRST Recipe Contest, complete with recipes collected, judging executed, and prizes awarded! I’m glad to see this first contest reach its final destination, and I learned much in the process. For me, the best part was accumulating a phenomenal collection of recipes! The hardest part was judging. I knew I didn’t want to judge recipes myself, for several reasons: 1. Too Personal: I predicted my first contest would yield alot of recipes from friends, (yes, I haunted them. No shame :) and I didn’t want to be put in the position of choosing favorites. 2. Little Resources: I felt strongly about judging recipes on taste. That would mean cooking all recipes, which is impossible in a residential kitchen with one (amateur) cook. 3. Criterion: Besides taste, I wracked my brain on other criteria to judge recipes. The best things I initially came up with were: Taste, Name, Appearance. These proved to be the most unreliable criteria possible, as you will see. 

Collecting recipes was the easiest part, and fun! For my colleagues, I goaded and harassed them until they proffered their best recipes. I conducted mini-contests on the website and gave away ParamedicCooks.com pens, planners, t-shirts and other prizes as rewards for submitting recipes. I emailed the Human Resource departments at major EMS departments and procured local supporters and recipes in other states. I advertised in JEMS and established a presence in Canada. I cooked boatloads of the recipes being submitted, and learned a whole slew of stuff about cooking techniques and different ingredients. Submissions came in waves, and I more than welcomed the high waves. One of my favorite recipes that I had a chance to cook was Mulligan Stew. Not only did I get schooled in roux creation, that stew has one of the best, most unique flavors I have ever tasted! There are so many more I want to cook. One of the most interesting recipes I received was a steamed pudding. I haven’t cooked it yet, but I did a bit of research on steamed pudding. There’s an amazing lot of history behind this dish! Unfortunately, the young cook who submitted this recipe was neither 18 years of age, nor EMT certified which were both part of the guidelines for submitting a recipe for this contest. However, I hope cooks near and far, young and old, use that young persons’ passion and boldness as an inspiration for getting in the kitchen and getting to work! 

After wracking my brain for weeks, and the contest deadline drawing near I had an epiphany: Who better to judge a recipe contest than REAL Chefs? Sure, it may sound obvious but for me, it was genius. I set my mind to the task of gathering up all the chefs I knew personally and I came up with a total of: ZERO. That’s when I remembered a wonderful resource nearby, who’s facilities I had in fact (unsuccessfully) attended during  my high school years: Greater New Bedford Regional Vocational Technical High School!   I whirled off an email to Voc, which was answered within 1 day directing me to the chefs of the culinary department. In the span of another 24 hours, a real Chef Instructor had read and answered my email, by the name of Henry Bousquet. Henry and I agreed to meet 2 days henceforth, at GNB Voc-Tech, and I arrived with laptop, flyers, pens, and planners on the ready. Chef Henry, like a true Chef, zeroed in on the main elements of my visit: how to judge a recipe contest?! I felt inadequate about my own ideas for judging because I knew I couldn’t cook and taste every recipe, many of them had been renamed by me to incorporate some quirky medical terminology (eg. “Sebaceous Sausage Bread and Tachycardic Enchiladas), and only some entrants included pictures. Henry and I developed judging rubrics and a plan. The rubrics consisted of specific criteria to judge all submissions. The plan included two phases of judgement. During the second phase, Chef Henry proposed to cook the final 8 recipes, and invited me to come TASTE them all! I felt like an Iron Chef America judge! And then, with an open heart and empty stomach, I said unto Chef Henry in the words of the Chairman’s uncle: “ALLEZ CUISINE!” :)

Unfortunately, judgement tasting never came, overshadowed by other priorities and resources for a school that serves 1800+ students. Luckily, the two judging rubrics the chefs and I had originally created served well, and actual judging was completed in two rounds: The first round used specific criteria to judge down to the final 8, and the second round used different criteria to judge down to the final 4 winners! The final judging round incorporated the freshmen class of 2014 to assign a points score to the final 8 recipes. Congratulations Falgoust, Brody, Guidry, Richard, Shelton, Norcross, Bourg! Special Thanks to Ms. Andrews for her time and dedication to the field of culinary arts! Keep Cooking!

I’m very proud to still retain those judging rubrics and the criteria I learned to judge with from Chef Henry Bousquet! There aren’t enough words in the dictionary to express my profound thanks to Chef Henry and the Chef Instructors of the culinary arts department at GNB Voc-Tech, and to the awesome up and coming Chefs of the Freshmen class of 2014. THANK YOU SO MUCH! I can’t wait to welcome more, and more winners of ParamedicCooks.com recipe contests! Good Luck Everyone! 

Dear Stupendous Students 4,

Myself and Mark McGraw, Director of New Bedford EMS
and one of my "expert" consultants on intubation. 

How do you feel about intubation? Do you think it’s important? Is it one of those skills that can be taught, or does it have to be practiced to be learned? Why do so many practitioners fail at intubation? Before we can answer those questions, lets talk about who is required intubate. Paramedics? Yes, all of them. Nurses? Only some of them. Doctors? Only some of them. Stew on that.

So every Paramedic can intubate, and we learn to intubate during our relatively short approximate 2 year training. Anesthesiologists train for over a decade. Certified Registered Nurse Anesthetists train for close to a decade. Does Captain Obvious need to make a sudden appearance to point out which way I’m going with this? Treat intubation like the privileged skill that it is, and do it right every time. My Paramedic Instructor used to always say, “There’s no excuse for a bad tube.” He didn’t mean you will never intubate the esophagus, he meant have the proficiency to recognize and reverse an esophageal intubation immediately, and the professional responsibility to check tube placement efficiently and frequently. He s right. There is NO ever-loving excuse for a bad tube. There is no pothole, patient movement, or “someone else’s,” fault for walking into the ED with a misplaced ETT. This is precisely the reason we have stethoscopes, capnography, end tidal Co2 caps, esophageal detector devices, visualization, condensation....etc! I mean really, with all of these tools at our disposal to check placement, IS there any excuse for a bad tube? 

For this blog, I sent out a survey to a select few Paramedics I know, that I would consider “experts” in the skill of intubation. It is interesting to see that 4 of the 5 answered the same exact to some of the questions. The fifth didn’t answer any at all and only said “Read Dr. Bledsoe’s articles on ‘The Disappearing Endotracheal Tube.” The questions were as follows, and the answers are summed up by me from the 4 that offered their advice. 

Q: What blade do you prefer and why?

A: Unanimously every medic preferred the Macintosh 4. All surveyors agree it has the versatility to give or take away “blade room” with more or less fingers applied to the base, alternately making it a Mac 3. It was also noted to easily lift the epiglottis when necessary, easily displace the tongue when necessary, give a “light” touch to a more delicate airway, and be used a straight or curved blade. Stellar advice to this question: “Don’t get married to a blade, folks. Anatomy differs and that’s why there are so many blades.” 

Q: Tips for holding the laryngoscope?

A: The majority agreed to hold the blade close to the handle next to the hinge, or at the bottom of the blade in the palm of your hand. One described it as placing your baby finger off the handle and under the blade to “choke up,” on the handle and get better control of the blade, lessening the tendency to lever back on the handle. Stellar advice to this question: “Hold it firm and keep your wrist locked. When you lift, go up and out. Pretend you’re aiming the handle at the intersection where the wall meets the ceiling. Not up, not forward, but right in the middle.” 

Q: Tips for identifying landmarks/cords?

A: Most agree it is most important to recognize anatomy, look at lots of pictures, and realize people have different anatomy that is not always text book looking. One very experienced Paramedic says “Don’t crawl into the patient’s mouth-get back from the patient to improve your visual perspective.” That line of thinking gives perspective to the “difficult tube” scenario because how often do we want to take a closer peep at that which we don’t understand, such as the mucous/blood filled airway?! In other words, step off! Check it out from a distance. Stellar advice to this question: “Know your cuneiform and corniculate cartilages ; where they are, what they look like and where they are in relation to the vocal cords. It helps greatly to recognize them especially with a deep, anterior patient. If you can identify them then you know the cords are above.”

Q: If you had to summarize successful intubation into one sentence, what would it be?

A: Everyone agrees that preparation and positioning are 2 of the most important considerations for consistent success. Here are the 4 sentences: 

1. It is imperative to be 100 percent familiar with the anatomy, don't play with it and move purposefully, watch the tube pass the cords, don't let go of the tube until its secure and recheck often.

2. Pre-planning, help, pre-positioning, insertion, confirmation, and affixing.

3. Successful intubation is the ability to manipulate the airway with a laryngoscope, visualize the cords, place an ET through, inflate, secure and confirm.

4. Set your patient up for success, positioning is the key. 

Q: Other advice/wisdoms/experiences?

A:  All 4 agree that intubation is a true skill that requires plenty of practice. It is one of the most important skills we perform and should be mastered. Line up ears to sternum for difficult intubations and create a ramp like towel or blanket roll to prop the shoulders up. In the absence of C-spine precautions, don’t be afraid to manipulate the head, flexing and extending while visualizing with the laryngoscope and noting how the different movements open and close the airway. Always use a stylet! Most patients with an anterior airway are usually deviated to the left. Stellar advice to this question: “Take 10 sec and set your patient up for success!!!”   

I’m so glad I sent out that survey, and thank you very much to the medics who answered. You guys are so awesome your middle initials are A, you should work for Awesome EMS, people should address you as “your awesomeness,” your cell phone carriers should be Awesome T&T and you should talk on an A-phone, you should have your own TV Network called “The Awesome Channel” that features only shows about how awesome you are, and you should all have a talking mirror that says “you look Awesome today,” every time you look in it! 

It was interesting to see the same advice being repeated consistently among the 4, especially know your anatomy, prepare yourself and your patient for intubation, prop the shoulders, hold the blade with your hand near the hinges, and check and recheck your tube! For the students who ride at NBEMS: The airway bag on all of our trucks is in an outside compartment on the drivers side of the ambulance. That means the driver almost always carries that bag. For that reason, oftentimes it is the driver who intubates, although some medics prefer to intubate their own patient since they will ultimately be responsible for transferring and documenting the tube. Familiarize yourself with the location and contents of this bag, possibly even feel out the crew for what their preferences are when it comes time to intubate. Don’t wait until you’re smack in the middle of a cluster to fumble around for equipment or permission! 

I hope this blog has made you recognize the importance of mastering this very difficult skill. Study airway anatomy repetitiously! Go back to the classroom and practice. Talk to other Paramedics, Nurses, Doctors, Respiratory Therapists and anyone else that intubates about their successes...and failures. NEVER deliver a bad tube. Stellar advice on this subject:

“Think before acting; it is better to come in with no tube than a bad tube...” 

Dear Stupendous Students 3,

It’s the moment you’ve been waiting for! That time of the blog when we talk about your two favorite things: Intubation and starting I.V.’s! I’ve pondered: why do Paramedic Students, and Paramedics, for that matter, have such a doting infatuation with these two skills? Sure, doing them, and especially doing them well is important but are they really worth writing home about? The best thing I can come with is these two skills are a couple of things that really separate Medics from Basics, Nurses, and other related health care providers, and elevate the practice. In this way our anxious, desperate little egos are sated and stroked with all the vigor of the overweight birthday boy eating cake!  

Because IV Chapters in most texts have to focus on more than just venipuncture, and the fact that its a skill that requires hands on practice, I see alot of students struggling. Mostly they make the same common mistakes, which are easy to correct. Over the years, I’ve developed some reliable tactics that have made a better puncture-er out of me, and will make a better puncture-er out of you! First, I’m going to challenge some of those narrow, tunnel visioned little minds out there with my IV philosophies: 

HEINOUS and BOGUS I.V. MYTH #1: “Go Big, or Go Home.”  When I hear the utterance of this faulty logic, my blood boils redder than the words they are typed in. I hear the distant wail of a cargo barge’s horn, and I have to block my ears so the steam doesn’t scald the person standing near me! That is the single most ignorant, uneducated, egotistical, pathetic, my-life-is-so-worthless-and-my-self-esteem-is-lower-than-a-dead-persons-blood-pressure-but-I-try-to-be-cool-to-impress-people *deep, cleansing breath,* declaration I could possibly hear someone say. The fact of the matter is, introducing intravenous catheters into the different arms, and different skin, and different vasculature, and different circumstances of different people (noting the pattern, here?) requires skill that goes beyond plucking the green package from the I.V. tray. Yes, I said it, in case you only inferred: Professionals who choose to blindly start large bore I.V.’s with no indication of necessity are weak, mindless robots who lack the skill to adapt to the situation at hand (no pun intended, lol).  For precisely the reason there is different sized catheters, there are different sized situations that justify them. 

A “shock trauma” pt with a significant mechanism and a pressure in the toilet, large bore I.V.? YES! 

A 90 year old female that weighs 85 lbs and has a tummy ache, and her arthritis is acting up, and she hasn’t moved her bowels in 3 hours, and....large bore I.V.? NEGATIVE. 

A 56 year old male, pale and diophoretic with persistent chest pain after fixing that gutter his wife has been nagging him about, radiating down his L arm, unrelieved post NTG, with ST elevations on the 12 lead, large bore I.V.? IF YOU CAN, 2 of ‘em, EN ROUTE and transport to a cath lab. If you can only get 1-2 20g, that is fine, you have lots more to worry about with this patient than sticking in an 18g, and a 20g works JUST AS WELL.

A 24 year old female with chronic abdominal pain d/t intestinal HAE requesting pain control (out of Percocets), otherwise in stable condition in no obvious distress, large bore I.V.? SERIOUSLY? Do you have to do it just because you can? Will you go big or go home? I would rather see you go home. Blood transfusions, fluid resuscitation,  and CT dye can all be infused just as easily through a #20 as they can a #18. Bottom Line: It is BARBARIC to use large bore I.V.’s outside of necessity, just because you can, especially in the hand. Get over yourself.

HEINOUS and BOGUS I.V. MYTH #2: “They pissed me off, so they got a 16 in the hand.” Ok, Romper Room is closed for today, come back in 9,742,886 hours after you grow up! I understand why some people say this, it’s to just to let off a little steam and vent a bit. I’m all about that, hey this is a tough job, right? It’s the folks out there who actually do it and brag about it that make me want to cannulate their sclera veins. Which I would do, because they “piss me off.” Haha, kidding! Seriously, students and medics: If you think saying or doing this makes you look ultra snazzy and powerful, it doesn’t. It is a naive and weak way to practice, even when you’re mad because American Idol just got interrupted to haul around the obtunded ETOH illegal citizen. Get over yourself. 

HEINOUS and BOGUS I.V. MYTH #3: “Well, they were gonna do it the hospital, probably.” This statement can go both ways, it can actually be applicable, or it can indicate Cookbook medic practice. What I want to emphasize is: Do it because you feel it’s appropriate, not because you know someone else will. Own your decisions, skills, and actions. Outside of gross incompetence or assault, I can’t think of many circumstances where starting an I.V. would be negligent, but I still want to encourage students to start developing confidence in their own assessments, interventions, and decisions. Get into yourself! 

Let me state clearly, I am not trying to bash my fellow medics, or single out any one person. I know plenty of Paramedics who I think are super fabulous, that I have learned alot from, who I have known to advocate one or more of these philosophies. Maybe they learned from their mentors, or maybe they have other arguments to support their convictions. These are solely the opinions of my own shattered, pea-brained little mind! ☺ 

Starting from the Top: 

1. Do a Skin Assessment: Does it look/feel papery thin? Use less pressure puncturing the skin. Does it look/feel thick and coarse, and the pt. tells you they are a construction worker, or someone who stays out in the elements alot? Use more pressure puncturing the skin. Is the pt. on coumadin/lovenox/other “blood thinners”? Be wary of the increased risk for bleeding/infiltration/hematoma. Is the pt. on Prednisone? Even a small gauge needle will obliterate the vein, it will look like subdermal vein implosion, be wicked careful! Is the pt. hyperglycemic? If so, their veins can be hardened and very difficult to cannulate. Think of it like this: high blood sugar=candy-coated veins. Doing a thorough skin assessment takes about 10 seconds, and will dramatically increase your I.V. success rate. 
2. Get Gabby: Nothing makes a patient, or any human for that matter, more uncomfortable than a muted caregiver performing foreign and painful procedures on them while they’re in pain, distress, or discomfort. If you’re feeling kind of nervous and awkward being a student with 2 or more medics, firefighters, and police officers watching and judging your actions, can you imagine how intimidated the patient feels with all of these unfamiliar people, plus the addition of painful or misunderstood interventions?! Use your voice: explain what you’re doing, talk about their complaint, give some feed back, use humor, etc...the more at ease you appear, the more at ease they will feel and trust me, you will get more thanks and acknowledgment for simply making someone feel comfortable than you will for “saving their life.” 
3. Applying the Tourniquet: I’ve found that applying the tourniquet about 4-5 inches above the elbow is the most practical and effective practice. It effectively engorges the veins from the distal end of the arm to above the AC. It also prevents unnecessary relocation of the tourniquet after unsuccessful attempts or poor vasculature. Also, that tight tourniquet hurts! If possible, tie it over the sleeve. A tip on using a blood pressure cuff as a tourniquet: I don’t advocate this as a rule, but it works in a pinch. Apply the cuff around the upper arm like you normally would, and pump it up slowly to about 40 mmHg or until veins are distended. Do not inflate it completely as it will cause pain and possibly bruising, and become an arterial tourniquet restricting blood flow to the whole arm. Also for veins that just refuse to appear, a second tourniquet placed distal to the initial tourniquet but proximal to the area you will be scouting works well. 
4. Get Prepared: Gather all of the equipment you expect to need for this I.V. start, including 2x2’s, tape, even the glucometer if you routinely check CBG’s with the sharps. Set up and prime the lock set, or drip set or whatever you use to flush the line. Open the alcohol prep, betadine swab, bioclusive dressing and whatever else you use, except the angio cath (for sterility). I cannot stress enough how this simple act of gathering, preparing, and placing your equipment next to you will help your success. It also gives that tourniquet time to work, and keeps you focused and organized. 
5. Find a Vein: Here is the single best I.V. tip I can offer, but it won’t help a lick in your internship: Learn how to feel the vein. Palpate it with the pads of your fingers. My absolute golden nugget of wisdom is to train one hand to have your palp fingertips. I use my non-dominant hand, so my L hand can feel a vein decades before my eyes can even see it. Start practicing with your “tactile vein hand,” on EVERY I.V. start, even when a vein is standing up and getting its flirt on, to get used the feel of them. It is described as “spongy,” “springy,” or that it “gives” under pressure. To me, they feel like little tubes of moon bounce material, and I visualize what the distended, engorged vein looks like underneath the skin. It won’t take long before your palp hand is heavy, and “this pt. has NO VEINS, dude,” will be a thing of the past. 
6. Prepare the Vein: Veins need love, too. Please do not forcefully slap, spank, thump, or flick them. Flattened veins may need a little help perking up, and I agree it is acceptable to use the pads of 2 or 3 fingers and tap to plump them a bit, but roundhouse kicking them in the face is not acceptable. Hanging the arm down and employing dependent gravity, having the pt. pump their fist, even using a few extra alcohol preps and rubbing briskly over the site (get some friction heat going) are all options to get that vein really engorged. Use care and discretion when applying brute force to a vein, and remember: it hurts!
7. Feel that Strrrrretchhhhh: The second most valuable tip I can offer is a simple one: Hold the skin taut! Whether you’re initiating in the hand, forearm, AC, or foot this rule applies:  Apply enough counter tension to the skin to anchor the vein, and set up a smooth surface for the needle to pierce through the skin. This is the most common mistake I see students make! HOLD THE SKIN TAUT. Be sure not to press into the vein causing it to occlude and collapse, just pull the skin with enough tension to anchor the tissue and vein underneath it. 
8. Venipuncture: Telling a patient “Ok, it’s going to be a biiig stick,” is the equivalent of telling the drivers seat “Ok, here comes my biiig butt!” Make it understandable or at least relatable, “This is going to feel like a pinch on your arm,” or “It’s going to sting/hurt for just a sec,” etc...just don’t say it’s going to be a “big stick.” A big stick comes from a tree limb, and if you go after a patient with one, you’ll have more to worry about then the semantics of your I.V. starts! On holding the angio cath: Familiarize yourself with the equipment you’re using. Too often I see students who are not holding the equipment properly, and we carry the same I.V.s as St. Luke’s where I just saw them for weeks doing hospital internship?! I don’t get it, but I am more than happy to happy to demonstrate and explain how to use the equipment I carry. Simply put: Bevel up, which coordinates nicely with the little tab sticking up near the top of the colored catheter hub. KEEP YOUR FINGER ON THAT TAB AT ALL TIMES, until it’s time to advance the catheter. 
9. Stay Focused: The rest is home plate material, but stay focused! At NBEMS we routinely use I.V. sharps to check CBG so don’t lose it, throw it on the floor, or get something all bloody with it. Hand to one of us, or set it near the glucometer. If possible, clean up after yourself!  Staying focused and following simple actions through to the end trains your mind to do so on auto pilot, even on the more complex actions, such as intubating. If you’re always cognizant of where you place the laryngoscope after ET placement, you won’t lose, cross contaminate, or damage it. Stay focused, and follow all tasks through to completion. 
10. I pick things up, I put them down: Or, in this case I put things in your vein, I take them back out. With the exception of discontinuing an unsuccessful or “blown” line, in the field we don’t pull too many I.V. catheters, but it’s still worth saying: When you do remove a catheter, apply pressure with the 2x2 directly after the catheter is out, not during the removal. If you apply pressure while removing the cath you risk complete transection of an already sheared catheter (causing a foreign body embolism, yikes!), and for a long dwelling cath, you basically squeegee off all of that biological goo clinging to the catheter and expel it into the pt. Eww! Plus, it plain old hurts more to apply pressure while pulling the line, so don’t do it!

Read, study, print these tips, if you like! I guarantee they will make a better “sticker” out of you! These tips are designed to enhance your skill, not teach it! Now, get out there and make me proud, EMT-Paramedic Interns! Tune in next week for my Intubation tips and tricks and blog! 

Dear Stupendous Students 2,

Typos, much? Oh, well it still works! This
little Information Gatherer is whipped out
by the driver on almost every call. 

Hi! Welcome to my official guide to Being a Stupendous Student, Part 2. In the first installment you followed my 10 step program for getting off on the right foot. Part 2 is going to get you on both feet, and keep you there! Being a paramedic student is one of the most stressful, awkward, and invigorating stints of your career in Paramedicine! I want to help relieve some of the tension and uneasiness, and nurture more of the fun and learning with my tried and true tips for the ideal learning environment for Paramedic Students. And I’m not above admitting: The more my students learn, the more I learn. The learning environment is a teaching platform for the learner and teacher as well, and I teach while I learn and learn while I teach.  That wasn’t confusing! Learn it. Then teach it :)

The first thing I see students get tripped up on is going on a simple call. I don’t think it’s because they don’t know how to go on a call, or because they lack the training necessary to successfully accomplish a patient encounter.  I think it’s because they don’t know what’s expected of them, they’re nervous/intimidated, and possibly haven’t had much experience in the 911 response environment. At New Bedford EMS ambulances are staffed with 2 Paramedics who rotate calls and follow a predictable routine for information gathering and patient assessment. With the exception of a severely critical patient or utter chaos, the driver will always start gathering and recording information, checking meds, and interviewing family members/bystanders. The passenger, who will be the tech and document for this event, will begin hands on patient assessment including managing resources, initiating treatments, and developing a working diagnosis. 

Let’s break a relatively simple medical call down into its various parts, and focus only on the pieces the student can manage.  You’re dispatched for a 54 year old male with back pain. Inside the residence you observe a middle aged man sitting upright in a chair, speaking with firefighters and police in no apparent distress, with no obvious trauma noted. At this point some preceptors like to swivel to the intern and sneer, “so whaddya gonna do, Paramedic?” I’m not a fan of this style, and I don’t agree that with an audience of other emergency personnel, family members, or random bystanders, this is the time or place for such a challenge. I prefer to see a student approach the patient respectfully, introduce themselves, and start the survey with open-ended questions while obtaining a baseline set of vitals! *GASP* Real interventional stuff, here! Shouldn’t she be telling me to start an I.V.? I am a PARAMEDIC student, aren’t I? Yes, but we’ll get to that. First I want to see you develop a rapport with the patient, begin a verbal survey of the complaint, and check a blood pressure with a stethoscope! Don’t palp your first pressure. It’s just not acceptable. 

The male is c/o dull lower back pain radiating to L flank, sudden onset at rest about 30 minutes ago. He reports a recent history of dysuria, malodorous urine, and progressing fatigue over the last 4 days, denies recent trauma and all other c/o distress at this time. He confirms past medical history of kidney stones, but states that pain was abdominal and much more intense. He is alert and oriented x4, eupneic with clear, equal bilateral lung sounds, skin is hot to the touch, dry, and intact with a bounding pulse rate of 120, and normotensive. Ok, so we’ve developed a good rapport with our patient who consents to transport to definitive care, and we’re working with tentative diagnoses of UTI vs. kidney infection vs. kidney stone. Time to start the I.V. right? Not yet. While you were performing your ultra fancy BLS skills, you had time to gather your thoughts and reflect on some of the drivel I was babbling about when you first started your student internship 2 hours ago. I was saying how patient assessment and information assimilation are underused, underemphasized skills because they don’t require any wrenching open packages, snazzy cap popping, or firing up the IO drill. On an emergency call, especially when there are concerned family members, or first responders that arrived prior to EMS, it is easy to become overwhelmed with the amount of information 5 people are providing at once. The ability to sift and assimilate these details is an important part of any and every patient encounter, but because this talent is so underwhelming few people give it a second-or even a first-thought. 

Elated with the success of your first call as a semi-ALS provider so far, you reach for the  monitor and prepare both limb and 12 leads for an EKG. Seconds after you acquire, the male clutches his chest with one hand, and covers his mouth with the other. Sinus tachycardia without ectopy is noted on the monitor, the 12 lead is unremarkable, and o2 sats are 99%. Nausea and vomiting clear emesis is observed, and the back/flank pain has worsened to 10/10 scale and is now radiating to the abdomen. ABD is soft and tender to touch on the lateral L quadrants. CSMx4 without deficit, deformity, or edema. Your suspicion of renal calculi has increased, and when you look up to confirm with your preceptor you find the stair chair assembled, and your EMS team packing up the equipment. It’s finally time to start that I.V. and practice all of your other ultra nifty ALS skills in the ambulance. The motivated student will also use this opportunity to practice calling in ALS notes over C-med, and prepare to give an expounded verbal report to MD/Nursing staff. En route you reassess, manage your interventions, and especially be calm and comfortable toward the patient. This whole scenario sounds eerily familiar doesn’t it? Almost like applying the exact steps for patient assessment in almost any medical text..

Something I want to stress to students is don’t buy into the hype and false counsel of “when you become a Paramedic, forget everything you learned in the book and see how real medics work in the field.” While I agree that making the transition from classroom training to applying knowledge hands on in actual emergency situations takes a bit of mindset and motor skill tweaking, by no means forget what you learned in the text! If you didn’t learn in the classroom first, you wouldn’t even have any knowledge to “forget”! Don’t let an arrogant, egotistical, or ignorant experienced clinician mislead you with this unsophisticated attitude. 

Some of this advice is specific to the department I work at and our procedures. The simple act of grabbing a set of vitals while you’re taking a mental step back and assimilating information you’re both observing and being told will convey to your independent practice as well. However, do not misunderstand: There are situations when a leisurely set of vitals must defer to treating the life threats. But, you already know that, of course! You’re more than well on your way to being Stupendous! So, to summarize the fail proof steps a medic student can take on their first call (s) with their preceptors: 

1. Greet the patient, and introduce yourself. 
2. MAKE EYE CONTACT!
3. Ask “How are you feeling/How can we help you today?” or offer “We can help you with that/We’re going to take care of you.”
4. Obtain a baseline set of vitals WITH A STETHOSCOPE.
5. Here’s a fabulous pearl of wisdom: While the scope is still in your ears, move it right over the lung fields...even on a patient in no resp distress. Get used to listening to all lung sounds: normal and adventitious, before and after treatments, when there is a respiratory complaint and when there isn’t. 
6. PALPATE pulses, don’t get complacent with fancy pulse oximetry (though certainly use it liberally). 
7. Information Scaffolds: it is established in layers like the construction of a good club sandwich. Make a conscious effort to train your mind to assimilate details of the patient assessment, call environment, and what is being said to and around you. 
8. Learn how to enter age, gender and other data before acquiring a 12 lead. It’s important to set it accurately for each patient, and it would be unwise to learn during the acute chest pain call. 
9. Don’t wait for someone to ask “What do you want to do?” Even a student can lead by example! (see #1-6 :)
10. BLS before ALS: You've heard this old adage a hundred times! Here's my take on it: BLS finds the problem, ALS fixes the problem! Keep that in mind when you suddenly have the I.V. started before you've acquired a basic set of vitals. If you don't train yourself to BLS find before you ALS fix, you WILL miss something. And it probably won't be pretty...                                                                                                                                                                                                         
11. BONUS ADVICE: In times of sheer panic or boredom, quell anxiety by thinking of or writing down the next recipe you plan on submitting to ParamedicCooks.com! 

Dear Stupendous Students 1,

To all the Interns..

So you want to be a Paramedic? Here’s a funny story: One of my favorite partners in the world, EMT-Paramedic Dave Gordon and I went to a call for a male possibly overdosed. We had a student that day. Also on scene were a few Police Officers and Firefighters. It is worth noting that the ambulance had to double park against a row of cars in front of the residence, then enter up several stairs and across a very long porch to the front door. The front door also happens to be situated poorly in the architecture of this residence, and has to be fully closed for admittance behind it, and up the stairs, down another long hallway where a male was scattered across his bed. The male, for reasons solely the responsibility of prescribed medications and ETOH, was shall we say, less than cooperative. Because of his state of altered mental status and other circumstances EMS determined it necessary the male seek medical attention at a definitive care facility. However, because of his altered state, the male determined any intervention into his current condition would not go unchallenged. 

The next 15 minutes proceeded thusly: 2 Paramedics, 1 Paramedic Student, 3-4 Police Officers, and a sprinkling of Firefighters wrestling one raging, belligerent, and ruggedly strong male out of the bedroom, down the long hallway, down a flight of carpeted stairs, past the front door to get it open, then through the door, down the long porch and wooden outdoor stairs, across the row of cars and onto the ambulance stretcher where he finally, blessedly began to calm down. It took that many of us only to ensure we did no harm to the innards of the residence, or to the male himself. The ungraceful shuffle through the indoors and out, with hands fluttering, hair whipping, elbows flapping, spittle flying, backs flattening up against the wall then peeling themselves off to dive back into what resembled the dusty tumbleweed of the Tasmanian Devil’s approach, was a visual commodity I will never be able to un-see! By the time Dave, the student, and I collapsed on the vinyl covered bench seat of the ambulance we were sweating, panting, and looking like the three finalists of an IronmanTriathlon. It was then that Dave asked the funniest question in history: He propped elbows up on his knees, and chin up on his hands, looked at the student and asked poignantly, “So you want to be a Paramedic?” LOL!

Field Internship on the ambulance with experienced Paramedics is necessary for every student to pass into practicing Paramedicine. To lessen the pain for both the students and the preceptors, here’s my official guide to Being a Stupendous Student: Let’s begin with before you begin: 

1. Be on Time! Duh, right? No. Be on Time! Don’t know where Medic 2 is located? Find out before you ever think about traveling there and Be on Time! Not sure what traffic is like because you live an hour away? Google it, take a test drive, ask your instructor...whatever it takes to Be on Time! Not only does it reflect heinously on your professionalism, we often get called out 30 seconds or less after reporting for duty so Be on Time OR (see #5 for what might happen if you’re not!) Oh, and by the way folks, Be on Time!!!! 
2. Your uniform should be: clean and free of fading, staining, and holes. It should absolutely represent your school, college, or training center where you received your PARAMEDIC training!  NOT your department, volunteer squad, or favorite beer. 
3. Your paperwork should be in a neat binder, or folder that is easily portable. When it is time for signatures, present it in an organized fashion, already completed with times, dates, and patient care reports written. Not only does the department refuse to pay employees overtime to sit there and redundantly sign off on skills, the employee is not too keen on sitting there and doing it for free! Follow the pattern of the crew you’re riding with: when they document you document, while one crew member is waiting for the other to finish documentation, get that crew member to sign the skills you did with them, etc. 
4. Pack your lunch and snacks. Be prepared to run back to back calls. We may or may not be able to take you to the store for lunch or snacks. The hospital may not be offering your preferred vittles. Set yourself up for success by having food and drinks handy, especially on long shifts where we may run 10 or more calls. 
5. Bring reading materials, study/field guides, or other small items for your personal entertainment. This is not because we are mutes and want to ignore our students, we all love to get our gab on. But if we are 2 or 3 calls deep and have alot of documentation or organization to do, it’s best if you’re not fidgeting around or worse, wandered away somewhere when we get another call. If that does happen, let me apologize in advance: you will get left at the hospital or EMS station! Students are important, but patients come first. Stay with your preceptors!

So, you were on time (yay), you’re wearing appropriate apparel, your paperwork binder is ready to roll, and you have a book, lunch bag, and already introduced yourself to the offgoing and oncoming crew. I like you already! So, what to do now that you’re here...

See #4 :)

1. See that comfortable chair over there? DO NOT sit in it! Help the crew with whatever they’re doing: cleaning quarters, rotating the AutoPulse battery, organizing the stock cabinet. If you’re not assigned a task, offer or inquire where your help might be needed. Even though you’re not getting paid (we’ve all been there, done that...yawn), it’s never ok to watch your preceptors hoof it while you chillax! Within reason, of course! Don’t let anyone make you clean their P.O.V’s, or knit their grandmother a pretty new scarf, or install the latest whacker lightbar on their souped up ride...not saying I’ve seen it attempted...just saying! :)
2. The ambulance is your office. Step into your office and acquaint and acclimate yourself to the environment. Most EMS situations are dynamic, and the inside of the ambulance is no exception. It may look like a purdy little hospital-on-wheels-now but throw one acute patient back there and watch it transformed into a frenetic, mobile snow globe, raining 2x2’s. Make every effort, while you’re helping the crew check off and restock the truck, to know where everything is, including the first-in bag, advanced airway and O2, I.V. therapies, CPAP, spinal immobilization, auto pulse, pediatric/broselow supplies...and pretty much any and everything else that is on the ambulance! 
3. Be courteous and respectful to us, our equipment, and especially our patients! If you feel you are being mistreated or are uncomfortable around a patient, back off and explain later, or go ride up front with the driver. Under no circumstances will disrespectful, unethical, immoral...or any other kind of inappropriate behavior be tolerated. If you have judgements, criticisms, or snarky comments to make about the personal choices or lifestyles of the patient, keep them to yourself or speak to us privately AFTER the call. If you feel like posting personal details about your experiences with us on Facebook or prattling to your friends, DON’T. You will be sent home from the shift, and unwelcome to come back and finish ride time. I have a zero tolerance policy for any molecule of perceived or actual mistreatment of a patient. Be nice!
4. Restoring the ambulance to its ready-for-a-call splendor after a bad trauma or cardiac arrest is a time consuming task, usually the responsibility of the driver on that particular call. You will find yourself with more BFF’s than you can handle if you’re out there helping that medic clean the bloody equipment, disinfect the stretcher, and replace the I.V. start kits from the first-in bag. Know where the garbage is, and empty it. Know where the documentation computers go, and plug them back in. Know where the long boards are kept at the hospital, and replace them. Keep yourself in the mix at all times! Learn how to use the C-med radio, and call in a few med reports over the air. Not only will you learn more by doing, you’ll be helping and gaining the respect of your preceptors, patients, and interactions with hospital staff.
5. This goes without saying, but be knowledgeable! It’s perfectly ok to carry and use your resources...that’s what field guides are made for! If you freeze up and forget the mcg/min for an epi drip, I expect you to have the resources available to look it up.  I always have mine, and even when I’ve been a medic for 20 years I will still carry my resources around. It’s naive to think you will ever know, or ever remember it all. Now, if you forget how to apply a non-rebreather...well, that might be a different blog. ☺

Being a Paramedic Intern is an exciting and stressful time! Remember that every Paramedic preceptor you have has been in the same exact situation! Follow these 10 steps and I promise you’ll be starting off on the right boot. Tune in next Tuesday to my expanding blog for more information on How to be a Stupendous Student. Next week will feature my advice on how to act on a call, and the importance of good assessment. The week after, Stupendous Student 3 will feature every students favorite subjects: starting I.V.’s and “getting your tube.” See you on the ambulance :)

Snowmobile Part 3

Frankie, on her perch :)

Driving a snowmobile doesn’t seem like that difficult of a task. They look similar to a jet ski with about 4 feet of snow skis jutting out from the front, and a continuous rubber track in the back. A driver has to do no more than hop on, insert the key, pull up the kill switch, push the electric start button or pull the starter cord, and depress the throttle to go. Easy, huh? A child could, and does, do it! If all trails were in a perfect straight line with no twisty turns, slopes, or uneven terrain a person could probably drive with their eyes closed. What a yawn that would be!

Because I crashed twice last year, scared my daughter, and busted up my sled a bit it occurred to me I might be doing something wrong, or at least not doing it as right as possible. Tipping over while speeding around a sharp corner is expected, and people get tossed from their sleds like rag dolls often so it’s not uncommon to have a few crash survival stories under your belt. Unfortunately, my second crash was scary, and expensive to fix. So on my last snowmobiling escapade, I paid careful attention to what I was doing, and why. I also did some internet research, but that didn’t yield much more than the basics such as Put on a Helmet, Have a Snowmobile with Key, Give the Motor some Gas, Use Handlebars to Steer, etc. Yawn.

The main thing I have trouble with is the throttle lever. It’s a thumb throttle mounted just below the right handlebar, so four fingers wrap around the handle for maneuvering and the thumb controls the gas. I don’t think I have freakishly small or girly hands, but my hand has to stay stretched open to be able to hold on and push the throttle, and it gets cramped and fatigued. Plus, I just don’t feel like I have proper control of the vehicle because my right hand can’t grip the handlebar entirely. That’s how I crashed twice last year. When I really needed all of my strength to control the sled, my thumb unintentionally fully engaged the throttle in my attempt to grip the handlebars, giving the sled maximum power and catapulting it out from under me. The best way I found to address this problem is...<don’t laugh>...to chant “Get in a jam, thumb off the throttle, thumb off the throttle,” (repeat obsessively). Ha! I know it’s hardly NASA quality technical advice, but it’s what works for me. There is a throttle extender that can be purchased, but it’s not really the length of the lever that gets me, it’s the orientation of it to the handlebar. I’ve also heard of changing the whole thing to a twist throttle, but firstly I’d lose my heated hand warmer, and lastly I think that would probably be worse, especially going down a hill when alot of forward pressure is placed on the handlebars for controlling and staying on the machine. I imagine a tight and hasty grip on a twist throttle might also accidentally engage it wide open. Also, I doubt “Get in a Jam, don’t twist the throttle” would work since my hand still has to be on the handlebar. So, for now “thumb off the throttle,” is my catchy tune for safety and to prevent Frankie and I from being hurled ungraciously through the air, again. ☺

Another thing I realized I wasn’t doing is engaging my leg muscles enough. Sitting astride a snowmobile for countless hours can get fatiguing. It’s important to remind your legs to stay alert, and hugged up to the machine, not flopping about like a fish’s leg out of water! The same rules applies to the abdominal area, or your “core.” Keep those muscles occupied for better posture and therefore better maneuverability of the sled and a less aching back. When you keep the core muscles flexed and your back straight, your arms are in better relation to the handlebars. Plus, I like to think of it as getting in my exercise: Sled Pilates! I also experimented with different sitting positions. The snowmobile is designed with foot stirrups on each side, a covered retreat for the feet carved into body of the sled useful for keeping feet warm and out of the wind, snow, or rain, and for leverage around corners. Previously I almost always sat with my feet in the stirrups, but I learned that I am also comfortable sitting with my legs at a 90 or a 45 degree angle, and I feel way more in control of the snowmobile that way. 

Taking corners is the trickiest, and most dangerous part of the journey for me. Partly because I always have my daughter riding behind me on our 2 seater snowmobile. She’s learning to lean into the corners with me, but it’s a work in progress since she can’t always see the turns coming, and might be gazing off at some majestic foliage and not paying attention to my body movements. She has a comfortable perch with a back rest and heated hand warmers, and she loves to be in charge of Snowmobile hand etiquette. Because sledders always ride in a single file line, and some are faster than others, or the trail is twisty and visibility is poor, it’s not always possible to see how many sleds are in the oncoming group. It’s an expected courtesy to use a hand signal to display the number of sleds behind you as you pass approaching riders on two-way trails. Because my daughter and I are slower than riders with only one person on their sled, we usually have 1 or 2 people behind us, so she holds up 1 or 2 fingers. If the lead person has more than 5 riders behind him, he can show 5 fingers, then the person behind him will show 5 and so on, until the 5th person from the end will hold up 4, the next person will hold up 3, then 2, then 1. The last person will hold up a closed fist, palm forward, to signify they are the last in procession. 

Corners are probably the trickiest parts of a trail to navigate. Oftentimes, my sled goes up on one ski when I’m twisting around a sharp curve. I always thought angling my body toward the levitated ski was the best way to correct it, and land myself back on both skis. On our last trip, I learned from another rider tapping the brake is also an effective maneuver. I didn’t get a chance to try that out, but I can’t wait for our next trip to put it to use! 

Here’s a numbered list of my top How to Drive a Snowmobile Tips:

Helmet Heads :)

1. Be aware of all of your muscles. Especially, keep your legs and core engaged. 
2. Have a helmet with a heated shield. If you can’t see properly, you can’t drive properly. 
3. When navigating downhill or around corners or other places that are difficult, remind yourself to take your thumb away from the throttle and wrap it around the handlebar grips.
4. If your sled goes up on one ski, shift your weight toward the levitated ski, or tap the hand break.
5. Experiment with your legs in different seated or reclined positions.
6. Be alert, but relaxed. Too much tension in your arms, hands, and legs is fatiguing and no fun.
7. Teach your rider, if you have one, how to follow your body movements and use hand signals. 
8. ALWAYS use hand signals to alert oncoming riders of how many sleds are behind you.
9. Pay close attention to the sled in front of and behind you. If you see the sled in front use hand signals, you’ll know there’s oncoming sleds. Keep tabs on the rider behind you in case anything happens. It’s better to know sooner than later if they crash or break down. It’s not hard to freeze to death in 20 below weather. 
10. Don’t be too nervous. Riding at night or in low visibility can be scary, as can sharp turns or uneven terrain. Make sure you’re not tensing all of your muscles or gripping the handlebars to too tightly. Relax, and go with the trail. It will lead you to places you never dreamed of! ♥