Monthly Archives: August 2009

Oh.

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She met us at the door, with a suitcase in each hand, what we call a Positive Samsonite Sign. Angry Partner had been muttering to himself since we were dispatched. She was easily as large as both of us combined.

“I don’t feel safe,” she whined in a voice more suitable to someone 1/3 her size. The staff member from the group home, visible over her left shoulder, simply shrugged and turned away. He and AP both new her well. I, as a rookie, hadn’t met her before.


Before we could ask any more questions, she pushed between us and began a leisurely stroll down the steps to the waiting ambulance, with a suitcase in each hand. As we stared, she walked directly to the back of our rig, opened the doors, placed her suitcases inside, then turned to us. “You’ll have to lift me. I have bad knees.”

I heard the door of the group home slam behind us.

“I don’t feel safe,” she moaned again in the ambulance.

They don’t teach much psych stuff in basic EMT classes. Perhaps it’s because they don’t think we’d believe it. Perhaps they don’t know what to say; I often don’t. Part of me wonders if they withhold it so that our senior partners can get a good laugh out of us rookies.

“Why, what’s wrong? Is someone hurting you at the group home?” I doubted it, but it’s not impossible.

“No, the voices keep telling me to hurt myself.”

OK, definitely not in the manual. A quick glance around the ambulance confirmed that there was nothing handy which she could use to hurt herself or me.

“Well, just ignore them. We’re taking you someplace safe.”

“The voices are telling me to throw myself out of the ambulance.”

I could see AP watching me in the mirror. Something told me he’d been here before.

“You can’t,” I answered. “The doors are locked.”

“Oh.”

“Gakkkk.”

I looked up to see my patient attempting to choke herself with her own hands.

My rookie brain sprang into action. Choking = no airway. No airway = dead patient. This is NOT GOO- wait a minute! You can’t choke yourself to death, it’s like a toddler holding his breath to get what he wants. The absolute worst case is that you will pass out, loosen your grip, and wake up again.

I felt the ambulance swerve slightly, and I looked up to see AP laughing at me in the mirror. He saw me jump, and had probably seen the entire train of thought pass across my face.

*sigh* “Knock it off. We both know that won’t work.” She did.

We arrived downtown at Local Psych Facility with 10 minutes left in our midnight shift. We assisted the patient out of the truck, and my partner took her suitcases. I sensed he wanted to get this call completed as soon as possible.

The patient began to shuffle across the parking lot with both of us in tow. Halfway to the entrance, she suddenly spun on her heel, shouting, “I’m going to throw myself in front of a car!” and began to run toward the street. I didn’t know she could move that fast!

I dropped my clipboard and began to sprint after her. My partner froze and dropped her luggage. Before I’d gone two steps, I heard him bellow. “YOU CAN’T!”

The patient and I both stopped in our tracks and turned to him. Angry Partner stood with his arms crossed and his feet spread in his best parental I’ve-had-enough-of-this stance. “IT’S MIDNIGHT! DO YOU SEE ANY F***ING CARS?”

Our patient looked around briefly at the empty city. “Oh,” she said, and resumed her shuffle towards the door.

The Handover

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This month’s edition of the Handover EMS Blog Carnival is up at over at Medic999.

This month’s topic is ‘Your First Emergency.’ Thanks to a guest post, we here at NfMH have two posts included! (Thanks, Mark.)
Why not pop over to Medic999 and see what everyone else wrote about?
If you enjoy what you see here or elsewhere in the Handover, I encourage you to check out my Blogroll in the sidebar. I’ve been slowly adding lots of good stuff to it.

Some Random Observations

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A Powerstroke Diesel makes a cool ‘loping’ sound when running on only 7 cylinders.

It’s possible to waterski behind a fishing boat in shallow tidal water.

Shaving cuts do not need to be treated at the ER.

People will ask anyway. And be serious about it.

It’s possible to be suicidal and afraid of dying from chest pain at the same time.

Time spent posting in the cab of the truck is inversely proportional to the amount of reading/listening/viewing material with which you are equipped. (Forgetting your cell phone charger guarantees spending the whole day in the truck.)

My wife has a psychic ability to call me while I’m busy with a patient. The sicker the patient, the more likely she will call. (You know I love you, hon.)

"It’s 9 o’clock. Do you know where your children are?"

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The big Sikorsky emerges out of the setting sun with a roar. Every head outside the hospital swivels to follow its gravity-defying progress as it circles above the helipad. Paradoxically, the sound of the twin turboprop engines increases as it slowly approaches the ground and the single waiting ambulance.

The ‘bird’ touches its wheels lightly to the ground, then ponderously settles onto its shock absorbing landing gear. Gravity gradually takes over from aerodynamic lift, tethering it once again to the earth. The whine of the twin jet engines diminishes, but the rotors never stop turning.

After 30 seconds which seems like an eternity, the door opens and the flight crew jogs to the waiting ambulance, using a peculiar hunched gait. This is a big helicopter, and it’s not necessary to duck under the rotors. Human instinct, however, will not allow the head any closer to those lethally spinning blades than absolutely necessary.

The crew disappears into the back of the ambulance, and the scene becomes a still life in motion. The ambulance with its blinking red lights and the helicopter with its wildly spinning rotors sit frozen alone on the tarmac, with not a soul in sight.

Inside the ambulance is a parent’s worst nightmare. He needs angels; the best we have to offer is a helicopter.

Shortly the ‘bird’ will reverse the drama of its arrival. The paramedics will retreat to the safety of their ambulance as the flight crew locks their own doors. The turboprops will increase their ferocity from whine to roar, and the parking lot will be swept clean of any remaining sand, leaves, and debris. This time there will be no dramatic circling; as soon as the wheels are clear of the treetops, the pilot will tilt the nose and begin a full-throttle run across the setting sun, directly for Big City Trauma Center. Hopefully the angels can keep up.


Somewhere tonight, a parent’s worst fear will come true. Johnny won’t come home for dinner. His parents will call his cell phone but not get any answer. They will wait a while and probably gently curse him for being so irresponsible. Then the doubt will begin. A phone call to his best friend, to Grandma, to the school. No answers. The doubt will slowly turn to fear. Eventually there will be a 911 call to report him missing, followed by a police officer and perhaps a priest arriving on someone’s front doorstep. Hopefully it will not be too late.

I resolve to hug my wife and daughter when I get home in the morning.

Stop Assaulting Me!

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Firstly, my apologies to those who come here looking for my regular wit and wisdom. Normal programming will resume after this brief interruption.

I have a message for Corporate America: LEAVE ME ALONE!

It all started with the gas pumps. I remember a time, not that long ago, when Muzak was confined to the big stores at the mall. Then the gas pumps began playing it. I was annoyed, but I put up with it. Then they switched from music to advertising.

More recently, the pumps we use at work started running video advertising. Now there are TVs on the ceiling at Wal-Mart, the mall, the train station, and the airport. This afternoon I rode a C&J bus which had four televisions within my field of view, all showing the same episode of Gomer Pyle, USMC. Arrrgh!

Advertisers know that the human eye is drawn to motion. This human MIND, however, has had enough. I have an iPhone, an iPod, and a laptop computer. I’ve owned every personal entertainment device since the original Walkman. If I want audiovisual entertainment, I will provide my own. More importantly, if I don’t I will TURN IT OFF.

So hear me, Corporate America: I will not shop at your establishment if you assault my senses with unwanted audible and visual stimuli. I’m even willing to pay slightly more money for gas which comes from a quiet pump, and I already shop online and pay shipping costs to avoid stores which overwhelm.

If you want my business, turn off the TV. Who’s with me?

We now return you to our regularly scheduled blogging.

Tyvek

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“Ambulance 79, take the response, along with Ladder 2 and Sin City Medics. Report of a man fallen from the roof.”

It looked like it would be one of those days. My partner and I were 10 minutes into our shift, and we hadn’t finished checking out the rig. Coffee (or in my case iced tea) was now at least 90 minutes in the future. We saddled up and headed out across town to be met by our first obstacle, a split street.

We could see the ladder company pulling up at the scene, but between us and them was the pedestrian mall of a high-school campus. As it was summer, the area was deserted; however, it has a small flight of stairs in the middle. I didn’t doubt A79′s ability to descend a flight of four steps, but the mechanic would have me drawn and quartered if he found out.

We hung a left, adding four blocks to the route, then pulled into the block immediately behind the arriving paramedics. One look at the house told us this one could be interesting. What had been a two-story house now ended at the top of the first floor. There was no roof to fall from. Workmen were framing a whole new second story. There was construction paraphernalia strewn about and a demolition dumpster in the driveway. There was no sign of the patient, but the firefighters were already inside.

The interesting scene continued inside the house. Directly above the entryway was a four foot square hole, with sky and bits of flapping plastic visible. The staircase began directly below the hole, heading up to the flat deck and space beyond. It had a heavy wooden railing, with a decorative newel cap the size of a large melon, which was broken off and lying on the floor.

The floor. Wow. The floor consisted of random planks and pieces of plywood nailed to the floor joists, covering most (but not all) of the first floor. At least I hope they were nailed in place.

One of the stations in our state EMT exam involves c-spine immobilization. A patient/volunteer sits in a folding chair and we must secure his spine, without moving him, using a short spine board or Kendrick Extrication Device (KED). The technique is supposed to be used to safely remove a spine injury patient from a crashed car or other tight space. We laugh that only in the exam will you ever immobilize a patient sitting in a folding chair in the middle of a room, with plenty of space to work on all sides.

Our patient sat on a folding chair in the middle of the of the room, with plenty of space to work on all sides.

He was holding his left side and screaming in pain whenever he moved or even breathed. In between screams he threatened the life of the Tyvek guy.

Remember the bits of plastic hanging over the front door? Our patient had arrived for work this morning with his Dunkin Donuts ‘Great One’ in hand, trooped up the stairs with his tools, turned the corner, and stepped right into the unmarked, plastic covered hole. Gravity did what it always does, returning him to the first floor in the most expedient manner. Along the way he struck his chest on the railing, breaking off the newel cap and flailing at least three ribs in the process.

Not only did this resemble the state exam, but the KED was the perfect tool for the job. It allowed us to immobilize both his spine and his flail chest at the same time. Then the fun began. Protocol requires us to secure the injured fall patient to a long spine board, but this patient wouldn’t tolerate the pain. When we tried to complete the immobilization he screamed, swore, and tried to come up swinging. I can’t say I blamed him.

In the end we secured him as well as possible in light of his pain and potential injuries. We used the KED, placed him on the stretcher partially laid back, secured his head and torso to an inverted short spine board, and let him bend his knees to relieve the pain. I confess I was happy the medics would be explaining this one to the trauma team and not me.

We all loaded up into the Sin City medic unit, and off we went to Big City Trauma Center. At 0730 on a Tuesday morning. What fun!

When we rolled into the trauma room with our patient trussed up like a Christmas goose, the doctor leading the team puffed up and raised one finger to begin shouting at us, “What the. . .”

The Sin City medic, one of the nicest guys I know, curtly shut him down. “Shut up! There’s a reason for all this!” He went on to explain the patient’s injuries and circumstances.

The bosses at the construction site were justifiably worried about OSHA investigating the incident. If I were them I’d be more worried about our patient’s reaction when he returned to work.

And by the way, Big City Trauma Center has great iced tea.

Cancel Truck 127

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Captain Stanley is my hero. There, I’ve said it.

For those not of the generation to immediately recognize the name, Captain Henry ‘Hank’ Stanley was the fictional character in charge of Los Angeles County Fire Station 51 in the 1970′s TV series ‘Emergency!’ He guided Gage, DeSoto, Kelley, Lopez and Stoker through more than 100 hour-long episodes and brought everyone safely home in the end.

In the past I’ve joked about using ‘Cap’ as a role model. Everyone laughs. This week as I was watching an old episode in syndication, I began to quantify what I meant.

Consider the following:

  • Captain Stanley never gets unduly excited or yells on the radio. Never.
  • He always has a plan. And it always works.
  • He’s fair.
  • He’s a nice guy, but still the boss. Everyone respects him.
  • He keeps his crews well trained. Most incidents are handled with a simple order or two: “Chet, Marco; inch and a half in the front door.” Done.
  • He leaves his personal life at home.
  • When blown across the room by an exploding {whatever}, he picks himself up and goes right back to work.

You could do much worse in a fire officer. Of course it’s easier when someone else scripts it all for you.

I know he’s a fictional character, but I’d be honored to serve with such a man. As a Lieutenant, I strive to embody those qualities myself. Especially the one about not yelling on the radio.

“LA, Engine 51. Cancel Truck 127. Station 51 out 20 minutes.”

More dangerous than drunk drivers (or at least more numerous)

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It had been a hard year for my VFD. We’d had at least 4 fatal crashes and a number more where we’d had to use the Jaws of Life. We hadn’t had any big fires ourselves, but all of our neighboring cities had, and we’d been right in the middle of every one.

I was headed home from a 24 hour shift at my paramedic job, and running a bit late, when the tones went off for a possible rollover crash. The location was the scene of a particularly messy recent fatal crash. It was also directly on my way to the firehouse.

As I approached the scene, traffic started to back up. That was a bad sign, but the worse sign was that no traffic was coming the other way. I flipped on my red LEDs, honked my horn, and gingerly snuck around the blind curve on the wrong side of the road.

The vehicle was an old Saturn, on its roof across the road and missing its right front wheel. One of our police officers was on his knees talking to the driver, who was trapped in the front seat. There was no patrol unit in sight. I parked my pickup in the travel lanes to protect us, and went to talk to the officer.

“Phil, what do we have?” I asked.
“She’s OK, but she’s trapped in her seat belt.”
“OK. Do you have a radio?”
“Nope, I was on my way to a detail job,” he replied.

Me neither. It seems like that portable radio is never around when I need it. I used my cell instead, to call our dispatch center and advise them that we would need the Jaws when the engine arrived.

I crawled into the car through the missing rear window. If you turned my car upside down and shook it, all kinds of strange stuff would fall out. This woman was incredibly neat; all I found was a purse, a pack of cigarettes, a lighter, and her cell phone. As Phil had said, she seemed OK but was hanging upside down in her seatbelt. I reassured her that help was right around the corner, and then I crawled back out to meet the now-arriving engine.

I explained the situation to the Chief and the day crew on the engine. They looked surprised to see me in full uniform for my other job. The next thing I knew, I was back in the car with Mrs. Smith, and the crew was attacking the car with the hydraulic rescue tool.

In the middle of the large racket, Mrs. Smith (still hanging upside down) handed me her open cell phone. “Can you talk to my sister?” What?! No. I’m kind of busy here. . .

“Just tell her you’re fine, the car’s not, and you’ll be at Local Community Hospital,” I said.

We extricated her without incident, and I handed her over to the local paramedics. They took her to the hospital. Care to guess why she crashed on a smooth road on a nice morning? Her cell phone rang, of course.

Just keep squeezing. . .

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The ambulance lurches as we leave the parking lot of Local Suburban Hospital. Partner du Jour looks at me with resignation in his eyes. “You know how this ends?” he asks.

“Yeah, I know.” I squeeze another bagful of oxygen into the patient’s lungs.

**SQUEEZE**

The patient fell last evening, tripping over a child’s toy. He’s apologetic for calling, but he’s done this before and knows his medications make him susceptible to internal bleeding. He doesn’t know that he has called at shift change and that my partner should be halfway home by now. We don’t tell him.

He’s very nice and wants to walk down the stairs to the ambulance.

**SQUEEZE**

Behind the wheel, Supervisor knows exactly what we need. She strives for the perfect balance between smoothness and speed. At this time of night, the quickest route to Big City Trauma Center is straight through the heart of the city, then up onto the highway. She does a good job, missing most of the potholes and making decent speed.

**SQUEEZE**

The patient identifies herself as pregnant, but doesn’t show it. She felt dizzy in the sun and almost lost consciousness. She leaned against the front wall of the supermarket and then slumped to the ground, scraping her face against the bricks.

She tells us that she doesn’t know who her doctor is, but her mother knows.

**SQUEEZE**

The patient’s blood pressure begins to drop. We infuse saline though his IV in hopes of raising it.

**SQUEEZE**

The patient sits on the floor of the gym, holding his knee and grimacing in pain. It was a simple foul shot gone horribly wrong. He’s been injured before, but never with this level of pain. He’s a tough guy, but today he’s near tears.

We splint his knee as gently as possible. En route to Local Suburban Hospital, we give him his first dose of morphine, but it doesn’t even begin to touch the pain.

**SQUEEZE**

The patient’s blood pressure continues to drop. We have to stop the anesthesia to keep him alive. After a few minutes he begins to show spontaneous movement, but he doesn’t wake up.

**SQUEEZE**

We pound on the door of the house, with 4 firemen and a police officer behind us. The woman who answers looks completely surprised. The call came from a third party, whose friend left a message on his voicemail asking him to call 911 for her, two hours ago. When called back the friend isn’t sure about our patient’s address. It might be in the next block.

The house in question has multiple apartments, and no one answers any of the doors. After circling twice, the firemen hear a faint call for help from the second floor. We try the most likely door and find it locked. One of the firemen goes for the tools while we study the locks. As he returns, the door opens.

Our patient, too weak to dial 911, has walked downstairs to meet us.

**SQUEEZE**

We wheel into the critical care area of Big City Trauma Center and are met by the trauma team. “Is this the patient coming from Out of State Hospital by helicopter?”

Umm, does this look like a flight suit? “Nope, we’re from Local Suburban Hospital by ground.”

**SQUEEZE**

The patient is unresponsive in bed, with evidence of copious vomiting. He doesn’t fit into any of our easy diagnoses. We do everything we can in the bedroom, rule out anything easily fixed, and roll for the hospital.

**SQUEEZE**

We exchange one trauma team for another, just as the helicopter crew from OSH arrives. We give report to our team, transfer the patient to their care, and after one final

**SQUEEZE**

we melt away into the night.

The Show Must Go On

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“We’ve got a fire on the stage!” I tore from the back of the Performing Arts office, sprinting for the Stage Right doors.

I grew up in a firehouse. I always knew someday I’d be not only a firefighter, but that special breed above all else, a ROWLEY firefighter. Episodes of ‘Emergency!’ piqued my interest and stealthily indoctrinated me with the value of EMS. Dad would leave at all hours of the day or night, answering box alarms sounded on the air horn in the center of town. He kept his turnout gear at the top of the back stairs, which he only used when going to fire calls. In later years we had an extension of the Red Base, a pre-911 fire department party-line emergency phone. I could listen in on the dispatchers as the emergencies happened! We could even sound the ‘fire whistle’ from our front hall, although I never succumbed to the temptation.

I used to attend drills on Sunday morning with Dad, learning all I could. I remember checking equipment; my specialty was the batteries in the flashlights. I have one vivid memory of sitting on top of the engine during a pump drill, guiding the deck gun and using it to blast the bark off dead trees.

I don’t exactly remember my first emergency call. I have one vague memory of sitting in the cab of Engine 7′s 1947 Howe on a flooding/service call. That truck was sold in 1980, so I was still pre-teen.

I remember my first call as a driver, and my first call as a Lieutenant.

On the medical side, I remember my first day on the ambulance as an EMT. We did dialysis runs all day long. First call as a newly-minted paramedic: an electrocution. I remember my first cardiac arrest, but that’s a subject for another post. I remember my first cardiac arrest SAVE, which should be yet another post. I remember my first fatal crash, and the first time I used the Jaws of Life.

First emergency, though, ummmmm. . .

First really big fire? Malden Mills, December 10, 1995. I doubt I’ll ever see another like that; it’s a story to tell the grandkids when I have some.

Very first emergency, uhhh. . .

As I rounded the corner, I could see my best friend approaching from Stage Left with a dry chemical extinguisher. He let loose on the small fire, barely missing me in his zeal. The charred remains of a smoke machine sat on the smoldering carpet on the stage riser.


While he unplugged the smoking hulk, I strode to center stage and waved for the sound man to turn up my microphone. I politely asked the milling crowd, waiting for intermission to end and the show to resume, to evacuate the auditorium. They didn’t hear a word, as our sound man had missed the cue.


Returning to the seat of the fire, we peeled back the carpet and checked for extension. Fortunately there was none.


I returned to the office to look up the phone number for the local fire company. This was pre-911 in our area, and it wasn’t a real emergency anyway. Just a little smoke, now.


When the first engine arrived, the Captain was irate we hadn’t pulled the box. We saw no need – the fire was out. What’s a little smoke?


The engine company inspected our work, evacuated the smoke, condemned our smoke machine, and stomped out. Dress rehearsal was over.


The date was March 16, 1989; second Thursday of the month and the night I was appointed to the Rowley Fire Department.