Before long, a week had passed. Meghan and Fred had gotten back into the routine of classes, and had made pretty good progress with getting caught up with the course material. Fred was understandably bummed that he was going to be losing his teaching partner for the medic classes, but he knew how much it meant to Meghan to be going back onto the ambulance.

Thursday saw Meghan printing off handouts for the class she was going to teach at the staff meeting the next day. She had the handouts on injection angles, a handout on Epi Pen administration, and a handout she had created on Addison’s disease. She had already compiled information for her lecture onto a PowerPoint presentation, and had rounded up their muscle torso in the backseat of her car.

Fred tapped her on the shoulder at the copier. “Yikes! Fred, don’t scare me like that!”

He laughed. “Think you’re ready for tomorrow? You look nervous.”

“Considering I feel like the whole class I’m teaching is about me, yeah, I’m nervous and self-conscious.”

“Brandi surprised me with this request,” Fred answered, nodding. “It’s more efficient, but it is kinda thrusting you into an unwelcome spotlight. But you’ll get through it. Just pretend it’s the medic class.”

Meghan nodded and finished collating her handouts, making sure they were stapled together. “I understand why she wants it, and I’ll admit that it’s a lot easier to educate everyone together than each partner at the beginning of a shift. But it does feel like I’m in the spotlight, under scrutiny, unlike other times I teach.”

“You’ll survive, and you’ll do a good job.” He looked at the pile of handouts. “Done? Let’s go grab some lunch.”

Meghan arrived an hour early for the staff meeting. She stuck her head in Brandi’s office so she knew she was there, and headed to the meeting room/classroom. She set up her laptop and connected in to the projector system, making sure her PowerPoint was going to play correctly. She set up her muscle model, and then put her backpack on the table by the small podium in the front of the room. She pulled out her handouts and stacked them neatly on the table.

Brandi came in with a box of supplies and 3 bags of oranges. “I’d suggest leaving the oranges in the bags, or they’ll think they’re snacks.”

Meghan nodded. “Good idea. I’ll set the leftover ones in the kitchen later.” She arranged supplies so they’d be easy to pass out, then headed for the supply room to grab boxes of gloves. Satisfied she was set up and ready to go, she went in search of coffee.

People started trickling in to the meeting room as they arrived. Conversations soon started, with coffee and donuts making the rounds from the kitchen. At 10:30, Brandi shooed the rest of the stragglers into the room and got everyone quieted down.

She started off with talking about the past month’s statistics and important calls. She touched on housekeeping issues, supply issues, and answered questions from the staff. Finally, she motioned to Meghan. “Since people have been asking for it, we are going to be starting to have teaching topics at the meeting to help us with skills and expand our knowledge base. I’m going to be getting Meghan and Fred from the college over to do classes each month at the end of staff meetings. Meghan, it’s all yours.”

Meghan smiled and took over the class. She had chosen to wear her College polo shirt today with uniform pants and boots.

“Hey everyone! It’s good to be here and start offering training each month. I have a suggestion box over there by the door that you can write down topic suggestions. I’ll review them and see what we can cover each month.

“This month, Brandi has asked to cover two topics: injections and Addison’s disease. EMTs, you’ll want to pay attention, because this is hands-on for the entire department.” She grinned and waited for the chatter to die down. She started passing out handouts as she continued.

“Yes, we’re going to practice injections and then give one to each other. Hopefully no one here is squeamish at a bit of blood.” This got a lot of laughter.

“But first, we’re going to talk about Addison’s disease. It’s not a super-common diagnosis we come across on the ambulance, but it’s important that we have an idea as to what may be going on with a patient presenting with it. And, as full disclosure, Brandi wanted us to talk about it because I have recently been diagnosed with Addison’s. I’d like to know that you could recognize that I’m having problems and take care of me.” Meghan paused until the murmurs quieted down.

“So, Addison’s disease is an endocrine disorder that can originate from one of two sources: the pituitary gland or the adrenal glands,” she started, pulling up her PowerPoint.

Meghan went through the cause of the disease, signs and symptoms, and emergency treatment. She pulled over her distinctive purple backpack, opened it, and pulled out a slim black case. “In case of emergency, most Addison’s patients carry their emergency cortisone with them, just like someone with anaphylactic reactions carries an Epi Pen.” She unzipped the case and showed the contents. “I carry alcohol prep pads, a syringe, a vial of sterile saline, and a vial of unconstituted cortisone. You need to draw up the water, reconstitute the cortisone, and then give the full vial via intramuscular, or IM, injection.”

A hand raised. “So you keep that kit on you at all times?”

Meghan nodded. “It’s either in my backpack or my purse. I’ve only had to use it twice so far, thankfully.” She then went over other emergency treatment concerns, answered a few more questions, then transitioned into Epi Pen administration.

Finally, it was time to teach injections. She had everyone come up and pick up gloves, an orange, a few alcohol prep pads, 2 syringes, and a vial of sterile saline. Once people were seated again, she changed the PowerPoint slide. She used her muscle model to demonstrate injection sites, talked about various injection angles, talked a bit about solutions and why certain sites were more appropriate than others.

Then she let them loose with one syringe and their vial of sterile saline and the orange. They used the oranges as practice targets. Medics helped out EMTs with angles and such. Finally after about 10 minutes, Meghan called for quiet and brought up her friend Cherie to demo.

“Ready to actually stick someone? Let’s pair up.” She allowed the hubbub for a few minutes. “Okay? So I’m going to demo, and then I’ll watch you give an intramuscular injection. So we’re going to give a deltoid injection.” She indicated on the muscle model, then turned Cherie to the side so people could see her arm. “I can give the IM anywhere between here and here,” indicating the area on Cherie’s arm. “First, I’m going to make sure I have all of my equipment. Gloves,” Meghan said, pulling on a pair. “An alcohol prep pad, a new syringe, and my vial of medication.” She indicated each in turn. “And a bandaid, just in case. I’m going to pop off the top of the vial, removing the plastic piece, and clean it off with a prep pad. Remove the syringe from the wrapping, and I like to make sure that the hub of the needle is securely threaded into the syringe. Then remove the needle cap, pull back the plunger to the correct marking, and insert it into the vial. Push in the air and withdraw the dosage of medication. We’re going to be giving 2 ml of saline to each other today. Make sure there are no air bubbles in the syringe.

“Now, using a clean prep pad, clean the patient’s skin over the site you intend to inject.” She cleaned an area on Cherie’s arm. “You want to use your non-dominant hand to stabilize the muscle, bring the needle to the patient’s arm at a 90-degree angle, and insert it into the muscle. I know we tend to say that we dart the patient, but this isn’t a game of darts! You want a smooth but sure insertion until the needle is firmly inserted, like so.” She demoed the insertion into Cherie’s arm. “They used to direct us to pull back a bit on the plunger to check if we hit a blood vessel, but that has since been dropped. You can or not, your choice. Push the plunger in to inject the medication, and remove the needle from the patient. Most have a safety mechanism to trigger, so you’ll do that now. Apply a bandaid if needed, and the procedure is complete! One final thing – dispose of syringes in the sharps container. Do NOT leave sharps lying around, especially in the back of the ambulance. It’s a health hazard for one thing, and will definitely make the incoming crew irate at you and your partner.” With that, she disposed of the syringe in the nearby sharps container, thanked Cherie for her assistance, and started going around the room, watching people inject each other.

She thanked everyone for their time, and dismissed the class. A few stayed behind to help her clean up. Brandi came up to her. “That was an excellent class. I’m looking forward to seeing what else you come up with to teach.”

Meghan smiled wearily. “You’re welcome. I see several people have dropped suggestions in the box. That will help me to know how to cover what people want or need, and of course I’ll toss in what kinds of hands-on skills I can – keeps it interesting instead of death by PowerPoint.”

She wiped her head, and Brandi looked at her a bit more intently. “Are you okay?”

Meghan nodded. “I think my blood sugar is a bit low. You know me and my snacks. I’ll go grab a peanut butter sandwich and be okay until lunch is here,” referring to the catered lunch arriving in an hour.

“Sounds good. Adam is on KP today – get him to make you one.” Brandi patted her shoulder and headed for her office.