Monthly Archives: July 2009

Reciprocation, and perspective

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This morning I’ve received my first official outside link. Kal over at TraumaQueen.net accepted my submission for this month’s edition of the Handover Blog Carnival. Read the post, and check out what some other great EMS bloggers are doing. From there you can follow the links to past monthly editions and see some of my inspiration.

It feels wonderful. I imagine this must be somewhat like getting your first magazine article published. Now people other than family members and those looking to install an iPod in their GMC will see my little blog. (You’d be amazed how many hits that one gets.)
In housekeeping notes, for my longer-term readers I hope you enjoy the new look. It was just installed last night.
And finally some notes on perspective for any new readers. I’ve been in EMS for 10 years and the fire service for 20. I’ve served on a fire company in a rural town which is transitioning to a suburban bedroom community. I’ve worked for two private ambulance companies in the neighboring metropolitan area, serving as both an EMT and Paramedic, doing 911/emergency work and routine transfers. What this all means is that stories from my career and life will be told from varied perspectives as a firefighter/lieutenant/EMT/Paramedic riding the Engine/Ladder/Ambulance in a rural/suburban/metro area. Got it? Good. Enjoy.

Olive Oyl

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The patient lay emaciated in her own bed, propped up on pillows, with her head lolled to one side and her mouth wide open. I had to look twice to see if she was breathing. The firefighters said they couldn’t hear a blood pressure, and I wasn’t surprised.

Her husband was a wiry and determined looking little guy who only came up to my shoulder, a Popeye without the cartoon muscles. He told us the story. She had been diagnosed with an incurable degenerative condition almost a year ago. As we questioned him further, a picture began to emerge.

My initial feeling was that this poor woman belonged in a nursing home. She had had little or no outside medical care in the intervening months. The home was clean and orderly, but it bore none of the signs of a chronically ill patient. There was no hospital bed, no medical supplies, no chart or folder for the visiting nurse, no shoebox of pills, no commode by the bedside.

What she did have, however, was one incredibly dedicated caregiver. Her husband had seen to her every need, helping her to the bathroom and feeding her for as long as he could. Her degeneration had progressed to the point that he had to carry her upstairs to the toilet, yet he continued single-handedly. I began to realize that while I didn’t see much to the medical side of her care, he had been providing personal care at a level nursing homes can only dream about.

As we loaded her into the ambulance for the short ride to the local hospital, I wondered if she would survive the trip. We brought her husband along in the front seat, and I silently prayed we would not have to resuscitate her within his earshot.

He stayed right by her side as long as possible, all the way into the bay at the emergency room. He joined me in the hall as I made up my stretcher, standing in the doorway and staring back at his wife.

I was there when the doctor came out to discuss intubation, lifesaving measures, and Do Not Resuscitate orders. I will never forget his answer, “Doc, you do whatever is in her best interest.” And then I saw the spark in his eyes begin to fade.

Some necessary medical procedures are best not witnessed by family or friends; when the curtain was drawn across the doorway he suddenly looked like a lost, scared little boy. I led him to the special family waiting room, sat him down in a comfortable chair, and found a newspaper I knew he wouldn’t read.

I shook his hand, wished him all the best, and silently wished I could do more. When I left he was staring out the windows at the ambulances arriving and departing.

I made sure to give a small wave and nod as we drove out

A bear in the park

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“Engine 3, Rescue 1, Medic 2: respond for the reported serious motor vehicle crash with entrapment.”


A chill ran through the room. We had just finished cleaning up from last night’s double-fatal crash. The equipment was all cleaned and back on the rigs, the coffee was fresh, and we had just sat down to begin the stress debriefing process.


This is a small town; one fatal crash per year is a lot. Two in eight hours, in the same location, was unthinkable. Cruel coincidence? Distraught friend of last night’s victims? Only one way to know.

We rolled out the door with the same three crews as before, unsure but expecting the worst.


There is an adage about the press: It’s like a bear in the park. If you feed it, it will stay where you want. If you don’t, it will be digging through your trash cans in no time.


The police arrived in the area first and found nothing. We all downgraded to a ‘non-emergency response,’ continuing to the scene without lights and sirens.


One of our local media outlets has a muckraking reputation. They are well known for their “If it bleeds, it leads” style, and they have no qualms about shoving their cameras in the faces of grieving widows/parents/children. I won’t identify them, but if you live in the USA the odds are very good that you have a similar local TV station.


This particular bear had gone straight for the dumpsters.


We arrived at the scene to find nothing but a camera crew awaiting us. We cruised slowly past, and returned to quarters without further incident.

The police investigated, but of course the press knew nothing. The 911 call had come from down the block; the old lady living there had never seen a thing. Someone had knocked on her door yelling for help and then run away.


We could never prove anything, but to this day I wouldn’t spit on a reporter from that particular TV station if he was on fire.

Steak Tips

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“Medic 9, you’d better take this one in, too. It sounds like they may need some help.”

 

Due to a quirk of geography we were actually closer, but the other crew had a head start. We both arrived on scene at the same time, from opposite directions.

 

“IF YOU’D BEEN HERE SOONER HE WOULDN’T BE DEAD NOW!” I see why the dispatcher thought we should assist. He’s been on the phone listening to the chaos. It’s no use explaining that we responded immediately, or that we were just around the corner. Ninety seconds can seem like an eternity when a loved one is not breathing.

 

All four of us grab our gear and weave through the furniture into the ground-floor apartment. My partner makes an offhand comment that it may be interesting getting the patient back out. Sprawled at the rear of the apartment we find the patient, a tatoo’d off-season Santa Claus in biker garb. I’m instantly sure there must be a Harley-Davidson parked around here somewhere, as the man wouldn’t look right riding or driving anything else.

 

A fireman kneels at his head, attempting to force air into his lungs using a bag-valve-mask without effect. Another checks a pulse and nods; we aren’t too late.

 

A crash occurs behind us as the patient’s adrenaline-high son tosses the kitchen table across the room. He continues throwing furniture across the room and out the front door until the police restrain him. I think he might have started in on the appliances next. Although unorthodox, we appreciate his efforts to assist us.

 

Yoda snaps an extra large blade onto the laryngoscope. He looks into the patient’s airway, muttering something about steak tips. He reaches in with forceps, fumbling briefly, then begins to remove the obstruction. It’s like watching a perverse sort of reverse childbirth, as we marvel that the patient could ever have gotten his lips around such a chunk of meat.

 

With his airway now clear, the patient should begin breathing on his own. After a few assisted breaths, he does. But he doesn’t wake up. Has his brain been deprived of oxygen too long?

 

We all head for the ambulances through the tornado-like path of destruction. We won’t know for a while, if ever, if we have been quick enough to make a difference.

Sunrise and CISD

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The Martin boys were home from college, enjoying a night out on the town. Some time around midnight, the twin brothers decided they were too drunk to drive home. They did the right thing, like their parents taught them, and called their friend and neighbor ‘Joe’ for a ride. Unfortunately, Joe was also too drunk to drive and too drunk to know it.

The intersection had a stop sign. The street approaching it was a 25 MPH zone. The intersection sloped upward, creating a ski jump shape. Joe was a local boy and knew all of this. The accident investigation would reveal Joe’s car was going almost 60 MPH when it left the ground. Continue reading →

Emergency Medical Weather

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We have a term to describe certain EMTs and Paramedics at work: White Cloud. A White Cloud is a crew member who never has anything critical happen around him. This is not to say big things don’t happen when a White Cloud is on duty, but he/she will be busy helping Mrs. Smith off the floor and back into bed when they do. It’s nothing deliberate, but through some strange quirk of probability nothing bad happens when a White Cloud is responsible.

 

Conversely, we also have Black Clouds. Death, destruction, and general mayhem seem to follow our Black Clouds whether on duty in the Big City or the Quiet Suburbs.

 

I know it’s all probability and not real, but we can be a superstitious bunch. It’s not that we want bad things to happen, but we train hard to be ready when they do. We need to use our skills now and then so that we stay sharp.

 

Regular Partner and I had developed a reputation as White Clouds. We had been working together exclusively for almost 8 months, so we weren’t sure which one of us was the good luck charm. We’d started off with a bang, having two major notable incidents during our first month together. Then six months of nothing.

 

We’d been doing minor chest pain calls, old ladies fallen out of bed, drunks, car crashes with no injuries; we had awakened a couple diabetics. I think we went almost 4 months before we had to put anyone on a backboard. We were beginning to get jumpy, feeling that God or karma or probability or whatever was saving up a Really Big One for us. The proverbial ‘bus full of hemophiliac nuns crashes into a plate glass truck’ kind of call.

 

Then it happened. RP got married and left on his honeymoon.

 

In the first 4 hours of my first shift without RP, Partner du Jour and I ran a cardiac arrest and an unresponsive with almost no blood pressure. We capped the evening with a pedestrian struck by a car.

 

So RP, enjoy your honeymoon. You should have plenty of good weather with you.


Edit: Before RP got back, we added an MVC with ejection, a STEMI, an aortic dissection, a CHF patient, and a few more which I don’t remember right now.

LOOOCY!

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“Ambulance 87, take the response. Maplewood Nursing*, on the second, for shortness of breath.”


Patrick* and I worked every Tuesday together and had become good friends. He was about my height, but maybe 30% bigger, and he liked to play hockey in his spare time. We lit up and responded out to the Maplewood.


Normally the Maplewood is an easy place to get in. They are more concerned about the residents getting out. We simply push the alarm-disable button outside and then walk right in. Getting out requires entering a code at an alarm panel, but the code is posted next to the keypad. I guess the theory is that the dementia patients won’t notice it.


All that changes at 8:00 PM. They lock the doors, and you have to use the intercom to get in.


We rang the bell as always. One of the night staff came to the door. I’ll be charitable and say she didn’t speak English as a first language. I’m not sure she spoke English at all. She stared at us, and cocked her head. Two men in uniforms with EMT patches on their sleeves, stretcher, portable oxygen tank, ambulance in the driveway still blinking its lights. Whatever could these guys want?


Patrick yelled through the door: “Let us in!”


She paused, looked at the keypad, and then punched the first number. <BEEP> She looked back at us for a minute. Second digit. <BEEP> Look, pause, <BEEP>. Look, pause, <BEEP>. The whole time, Patrick was yelling, “Just open the door, we can do the alarm,” and pointing to our button.


She punched the numbers so slowly, the system had forgotten the first one by the time she reached the end. She frowned at the keypad, stared at us for a few seconds, and started again. <BEEP>. Look, pause, <BEEP>. Same result.


Patrick was starting to get red. “Just open the damn door!”


She took one more look at us, and walked away.


A minute later a fellow employee arrived. Same language handicap, same lack of a clue, same result.


By now Patrick was livid. He was jumping up and down, pointing at the crash bar, and screaming, “Just open the F***ING door!” I thought he was about to break through the glass with his bare hands. She finally got the hint and pushed the emergency exit bar, but she stood in the doorway blocking our way. Patrick and I stormed in. He checked her out of the way, and we started for the elevator at a trot.


The offended employee ran after us, shouting, “Lucy! Loooooocy!” I have no idea what she wanted, but as the elevator doors closed I looked at Patrick and in my best Ricky-Riccardo accent said, “You got some ‘splainin’ to do.” We both cracked up laughing.


When the doors opened on the second floor, we could hear Mrs. Jones* struggling to breathe. We stopped giggling and went immediately to work. She’d been in severe distress the whole time we’d been negotiating the back door. Five precious minutes wasted because these folks couldn’t understand why an ambulance crew would want to get into a nursing home!

Mommy

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The room is dark and quiet. The other three patients stir in their corners, startled by our raucous arrival among them. They quickly settle, realizing as we make our way to the fourth bed that it is not their time.

Our patient starts awake as we approach. He is small and frail, a mere shadow with physical form. He looks at me with fearful eyes, and recoils when I touch his arm. The staff member says they called because he was hypotensive, but she cannot provide any more information. She hands a stack of papers to my partner.


Demographic sheet, valid Do Not Resuscitate orders, list of medications, and a notation that the patient has dementia.


The patient shows signs of dehydration; the staff admits that he hasn’t been eating or drinking well lately. I prepare to give him IV fluids, and I explain each step of the process. The patient returns a blank, interested stare, like a dog listening to its master.


When the needle penetrates the skin of his arm, he screams out; whether from pain or fear I cannot know. “Mommy! Help me!” We speak soft soothing words, calming him again.


Downstairs in the ambulance, he begins to communicate with me. He asks me where we are going and why. I explain, and he seems to comprehend. For ten seconds. “Mommy! Where are you, Mommy?” I explain again, and again, and again; he seems to understand for a few seconds.


“Mommy! Mommy! Please help me.”

I try a different tack, gently touching his shoulder and asking him where his Mom is.

His eyes focus on me for a second. “She’s dead. Why?”


My heart breaks a little more.