Monthly Archives: September 2009

The Spare

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Some ambulances you love, and some you hate. Most are just tools of the trade to us, but today I found myself getting a bit sentimental. Maybe it was the view on the way in this morning:

 

 

Anyway, we’re driving The Spare. Her seats are ripped, her steering wheel is cracked and not straight, her carpet has holes worn in it, and the red lights in her grille actually droop. She has an odd rattle when idling, and she just looks sad.

 

She’s had a lot of hard miles pass under her wheels, but she’s still going strong. The mechanical division has kept her running well, and her suspension and brakes still feel solid. She’s got the old 7.3l diesel, which I prefer.

 

She’s not well loved by the crews. We carry more equipment than she can comfortably store, so her compartments are jumbled and overflowing. She looks like she hasn’t been washed in weeks.

 

We will be nice to her. We’ll give her a bath, straighten her compartments, and feed her fresh diesel conditioner. Together the three of us will get through this day. Our new rig is due any day now, and then our trusty Spare can go back to Fleet Services for a well-earned rest.

——-

And thus ends my single busiest month of blogging yet. Stay tuned, more to come as time permits.

 

Number Eight

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“Medic 9, take the response. 24 Right in Front of You Drive for the difficulty breathing. Enter through the back door.”

Long Lost Sister and I sign out on scene as the dispatcher finishes talking. By dumb luck, the address truly was Right in Front of Us. Computer Aided Dispatch has worked for once. We gather our gear and head around the back of the small ranch house.

The back door leads directly to a set of stairs which descends into a darkened basement apartment. I can hear our patient breathing before I see him. He’s breathing at least twice as fast as he should be, so I start to coach him as we feel our way down the stairs.

“Try to slow your breathing. In through your nose, out through your mouth,” I chant as we enter the room.

“Not

anxiety.” He answers in one-word sentences.

Uh-oh.

Our patient sits on the edge of a couch in a dark room. We flip the light switch as we enter, but of course it doesn’t work. I reach for my trusty mini-Maglite, only to find that it has fallen out of its holster somewhere, probably in the cab of our truck. We can see enough to know that our patient is sitting bolt upright with his hands on his knees in the classic ‘tripod’ position of distress.

LLS begins treatment with high-flow oxygen while I set up a nebulizer. The engine company arrives, and we hear the crew crashing down the basement stairs behind us.

“I’ve

been

in-

tubated

seven

times,” our patient offers.

Oh crap. If an asthmatic has been intubated once, the chances of him crashing and needing it again increase astronomically.

The firemen enter the room with their flashlights, and we can now see that the patient is blue. As blue as my uniform.

“Please

no

tube.”

He knows where this is leading.

Crap. Crap. Crap. Our portable radio won’t reach the dispatcher from here, but Fire Alarm is closer. “El Tee, get us some backup please. BLS, priority 1.” The message is relayed, and the cavalry is dispatched.

We throw all of our pharmacological tricks at Mr. Tripod and load him onto the stair chair. The firefighters whisk him up the stairs into the sunlight in what seems like record time. As we load him into the ambulance, our backup arrives. O.T. hops in the front seat and glances in the mirror for instructions. “Local Community Hospital, O.T., and don’t spare the diesel.”

Diesel is our last line drug; when all else fails you drive quickly.

Mr. Tripod is fading fast. His middle-aged body can’t keep breathing at this pace, and he’s not getting enough oxygen to his brain. He needs a breathing tube, but we can’t do it. As long as he’s conscious, I don’t have the tools or medications I need. In our area, the hospital is the only one who can paralyze patients.

We ride a medical knife edge – if he gets better he won’t need the tube, but we can’t tube him until he gets worse.

It’s a short, wild ride to LCH. We call ahead to have the doctor and respiratory therapist ready. Our patient is getting sleepy, but he still protests when he hears the radio patch.

“No

tube.”

We attempt to use a bag-valve-mask to force supplemental oxygen into his lungs, but he fights us off. Confusion is mixing with sleepiness; a sure sign that he’s close to crashing.

We wheel quickly into the trauma room at LCH to find the entire team waiting. The doctor has the necessary drugs ready, and Mr. Tripod receives endotracheal tube #8 before we can gather our equipment and leave the room.

Now we can all breathe easier.

OK, NBC, I watched it.

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I was working last night. No helicopters crashed, nothing blew up, and I certainly did not get laid. In fact, we treated one seizure patient and watched Monday Night Football. Thanks to the magic that is TiVo, I finally got the chance to watch Trauma this afternoon.

I have to say I wasn’t as disappointed as I had expected. That’s not saying much, as my expectations could not have been much lower after the promos. The medicine was bad; the special effects were overdone. The sex scene was a cliché, as was Nancy’s uniform. The MCI was a joke, and the gratuitous helicopter crash was in very poor taste. We in EMS are a bit sensitive about the safety of helicopter transportation lately, and Americans in general are still sensitive about aircraft crashing into skyscrapers.

BUT. . .

I’m not ready to write the DNR order yet. I’m keeping in mind that this is TV. It’s a show about paramedics in the sense that House is a doctor show, CSI is about the crime lab, or Rescue Me is about the FDNY. Paramedicine provides the setting and dramatic fodder, but it’s not the story. I expect the story to overshadow the medicine.

I’m also keeping in mind that it was the pilot episode. Pilots must establish the scene, give background to the characters, and sell the show to the network and the audience. Hopefully the later episodes will focus more on the characters and less on the stunts.

So I’m willing to give it a few more episodes.

HOWEVER

NBC, I do have a few suggestions:

  • Hire a technical advisor. The medicine doesn’t have to be great and it need not displace the story, but if it’s chronically bad you will eventually lose me and the rest of my profession. You don’t have to be 100% authentic, but please be believable.

  • Lose the helicopters. We don’t believe them flying in a major urban area. It’s unsafe (as you over-dramatized) and unnecessary. If your Rebel-with-a-cause needs a special ride, put him in a cool Charger like Wake County EMS and let him rip around the city. Or let the SPFX guys cook up a Rabbitmobile.

  • Develop the characters, but don’t get too lost in their private lives. I want to see how paramedics act when they’re being paramedics. Don’t let the setting become just a prop for some unrelated story.

  • Please let Boone’s character come out and play. Any of us who have been in EMS for a while have ghosts. We didn’t acquire them in such a dramatic manner, but how we deal with them is epic story fodder. I can root for Boone.

  • Remember that EMS is about people, not explosions or defibrillations. If you read a few EMS blogs, you will see that there are hundreds of great human stories out there. There are also hundreds of characters and personalities on both sides of the stethoscope.

So NBC, good luck. You could have another ER here if you focus on good situational drama instead of blowing things up. Please don’t disappoint me like you did with Third Watch.

Today’s weather -FAIL

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“Now
At 6 am…partly sunny. Temperature around 61. West winds around 10 mph.”

Should I be worried that the weather guys don’t know it’s still dark?

If they can’t predict the sunrise. . .

HIPAA Mad Libs

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Happy over at HMHQ penned a ‘HIPAA Friendly Post’ recently. He commented that if he removed anything potentially identifiable (instead of changing it), his resulting posts would look like Mad Libs.

I love Mad Libs.
Read his post, then come back.
I sent the resulting blanks to a few friends, and here are the results.
First up is Mrs. Mack505. She has no medical training, but has lived with me for a long time:

We arrived at 167 Dyke Mtn Rd for a reported ETOH with extreme wooziness. The reporting party said their brother’s son’s uncle in law was polishing the floor when he lost his balance, resulting in a defenestration that caused a subdermal hematoma.

The Maine DOT moved quickly to apply barf bag and extricated the patient to the awaiting belt-driven hay baler. In the back I started a subdermal follicle removal and rapidly shifted gears to the oxomometer. I charged the Banana Bag to 42 dark and pressed the red button. The smell was intense. The elbow had caught fire, literally, as a result of the application of adhesive dermal patch, despite my use of 26ml of Ringer’s Lactate.

Needless to say the accepting Family Clinic at Deep South Maine Hospice was not at all amused at our predicament and immediately started 12ml demerol.


More results when I get them.

Pet therapy

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“Humor me,” I said to Partner du Jour as I pulled a U-turn in the ambulance. I pulled up at an angle, blocking the breakdown lane and right lane of the four-lane road. I activated the primary strobes, grabbed a pair of gloves, and stepped out.

 

Fluffy lay with his head on the fog line; cold, stiff, and unquestionably dead. I’d seen his body three times now as we had passed this spot, lying there without a mark on him. I knew if I left it there he would be a red stain on the highway by lunchtime, and I just couldn’t do it.

 

I moved his body onto the grassy shoulder, then I placed a hand on his chest and said a brief silent prayer. For his soul, for his people, and in part for me.

 

Then it was back to work. Amazingly, PdJ didn’t think I was nuts.

 

(Of course ‘Fluffy’s name has been changed for the sake of patient confidentiality.)





 

 

 

I don’t know why, but my animals keep me grounded. My family is the most important thing in my life, but they understand that after a bad day I need my cats or my dog. My wife listens and is sympathetic, but I feel the need to make her understand things. My daughter is always good for an honest hug, but she’s too young to burden with the troubles of a paramedic. (And she always will be.)

 

Our animals, however, provide unconditional therapy. Each of the cats has a different personality, yet all will allow me a large hug when I need one. Noah and Sebby are big lovable fluff-balls, Chang will sit on my shoulders, Clarabel actually wags her tail like a dog, and a well-timed rub from the feral adolescent Hal can bring me to tears.

 

And then there’s the dog. Cricket is normally a frantic bundle of beagle/terrier energy, yet when I’m having a bad day she will sit at my feet, lean on my legs, and soak it all in. This post came to me tonight as she sat there, letting me scratch between her ears, calming my soul. Eighteen months ago she was a scared stray, homeless and unwanted.

 

All of our cats were equally unvalued; three were born in the wild, one was rescued from abuse, and one was sick and given up for adoption after 12 years with her previous owner.

 

Medicine can wear on you. My family thinks my obsession with the animals is some type of transference; that I place an extra importance on them because of all the things I witness which are out of my control. All I know is they help keep me sane. They ask little of us, yet give unconditionally. Some days they even know I need a little ‘therapy’ before I do.

 

You may think I’m already around the bend, but I’d wager my readers with pets know exactly what I mean. Go on, go give them a hug for me.

Camp Fires

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It’s a cold night of epic proportions. The temperature dips below 0 degrees F. It’s not actively snowing, but a brisk wind stirs the recently fallen snow, obscuring the world outside our plate-glass windows.

I feel like a Civil War era soldier. My issued uniform is woefully inadequate for the conditions we face. Instead of layers of homespun wool, I am fortified with multiple layers of nylon and polypropylene. My version of the blue tunic is a bright lime sweatshirt, and my slouch hat is a black Navy watch cap.

Regular Partner and I do have some Civil War era technology: we pile three extra blankets on the stretcher, and we fold two more into a ‘burrito wrap.’ Any patients we see tonight will be cold.

Instead of a camp fire, RP and I huddle in front of our TV. The night passes slowly. RP retires to his bunk, and I fall asleep in the cathode ray glow.

–

I am awakened in the early hours of the morning, not by a bugle but by alert tones on the fire radio. The Late Late Movie is giving way to the Early Early News.

“Fire Alarm has dispatched Engines 681, 682, and Truck 68; mutual aid to Major Highway at Nearby Side Street.”

I pad over to the fire radio in my stocking feet and stand bathed in its orange LCD glow. This is unusual. Fire Alarm would never send the entire on-duty shift out of town. As my brain slowly awakens, I realize the address is in town, not far from here.

“Command to Engine 682, you work east of Nearby Side Street. We’ll work west. Truck 68, split up and assist us both.”

Dear God, they’re working a search pattern. Please, not tonight. It’s not mutual aid to another fire department; they’re working a grid search with the police.

I grab my boots, then pad to the garage to check the fluids in the IV warmer. Anyone caught in this weather without shelter will be near death, if not there already.

I knock on RP’s door to wake him. He joins me in front of the radio as we listen to the search progressing. I stare at the radio, with my head slightly cocked, like the dog in the old RCA Victor ads. His Master’s Voice, indeed.

“Command to Fire Alarm, get EMS down here NOW!!”

Here we go.

Proof that I need a vacation

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I had a dream. Not in the Martin Luther King sense, but the good old “I was asleep” sense.
For background, we have a new private ambulance contract in my town. I’ll call them Company X.

I was at home, riding Engine 68 as a call Lt. We were dispatched to a medical; the patient was having a big Myocardial Infarction (heart attack, for my non-medical readers.) This patient needed to be in the hospital NOW, and Company X wouldn’t send an ambulance.

No excuses, no explanations, no alternatives; just no ambulance. I personally made multiple phone calls from the scene with no luck.

Eventually I called our old service, Company Y. They agreed to help, but could only send Basic Life Support. The BLS unit duly arrived, crewed by two of my friends from Company Z, where I work.

I woke up before they got the patient to the ER, so I don’t know how she fared.

No vacation scheduled until Thanksgiving, and I’m back at work in the morning.

Rant redux

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Last week I published a brief rant about drivers doing dumb things in traffic when I approach in my ambulance.

The other day I had a wonderful experience. As we approached a major bottleneck intersection, the driver immediately in front of me began to pull to the left, effectively blocking our progress. I reached down into the console, extracted the PA microphone from the jumble, and firmly stated “Please pull to the RIGHT.”
I felt like Moses parting the Red Sea. The next dozen or so cars immediately pulled to the right and stopped! I wish Paramedic 9 had a dash camera so I could show you. It was amazing.
I won’t say my faith in humanity has been restored, because I’m sure it was a fluke. It was a great feeling, though.