Earlier, I discussed the disproportionate use of lights and sirens in our responses. Sure enough, someone just has to prove me wrong.
We are responding to a doc-in-the-box that calls our service at least once a day. This clinic doesn't have a stellar reputation, nor does it have a terrible reputation. Just another urgent care facility.
Apparently, they called my dispatch center directly and requested an ambulance. Somewhere during that conversation, an employee at said urgent care facility mentioned that the patient was complaining of chest pain. And difficulty breathing. And has a history of PE. And an abnormal EKG.
...And wants us to come non emergency.
This patient was genuinely sick. She was in sinus tach at 130, and in obvious distress. Her room air O2 saturations were very easy to take, as the clinic staff hadn't bothered to administer any, much less check her SpO2. It was 88. The staff did, however, start a 24 gauge INT for me. Sweet.
Her 12-lead, physical exam and history all scream PE. And this doctor either:
A. Didn't know it. (Which makes me wonder why not)
B. Wasn't that concerned about it. (Which makes me want to ask him why) ...or...
C. Knew that I personally would be the one to respond and take care of the patient. (Which makes me want to shake his hand.)
Maybe I'm just complaining too much.
Monday, August 29, 2011
Sunday, August 28, 2011
Not a happy Hanukkah
It was Christmas season, only a few days before. Actually, it was in the middle of Hanukkah, which is pertinent, given the Star of David around his neck.
It was late evening, when most normal people are winding down, in bed, perhaps with a snack, or watching some late news. The address was for a fairly nice neighborhood, full of upper-middle class homes, and successful people. For a man "not feeling well."
Cupcake and I arrived only a few minutes behind the first-in Engine and Rescue units. We took our stretcher and first-in bag with us into the well-appointed home, and were directed through a
kitchen, full of pictures of children and what appeared to be a new grandchild.
As I rounded the corner, Elrod and I made eye contact, and I saw the distinct look of fear in his eyes. The look that says "this guy is sick something bad." Elrod is a career paramedic, with 20 years under his belt. He has seen some sick people before. His eyes tell me enough. Elrod is starting a line while Tim is hooking up the monitor and Kevin puts a nonrebreather on him. I look at the wife. "What's going on?"
"He hasn't felt good for a few days. He just took the trash out, and came in and said he couldn't breathe."
"No, he doesn't take any medications."
I get a glimpse of the patient in the dim light, with the glow of Fox News in the background. He looks terrible. Like, as my father would say, "death eatin' a cracker." His skin is grey. An amalgamation of pale, cyanotic, diaphoretic and dusky.
"Forget the line, Elrod. Let's get him on the stretcher."
Cupcake and I are out of the house with the patient within 4 minutes of walking in. She asks if I want a rider to the hospital, which is 10 minutes away. 6 minutes with her heavy foot.
"I want to leave. If there is a rider in the back with me when you get up front, so be it. Otherwise, lets get the hell out of here."
No rider.
O2 saturation is 88% with 15 liters going. I get a blood pressure that is terrible. 82/50. His carotid is incredibly fast and weak. The monitor is counting out 140. A minute later I have two 16 gauge lines going. I don't know how I found those veins, but I did. His skin still looks terrible.
I'm throwing the 12-lead on as fast as I possibly can.
"I can't breathe."
"I know, buddy. I can breathe for you if you would like, so you can try and relax."
"Okay."
I drop an NPA in and start bagging him. "Data quality prohibits interpretation" says the monitor. Shit. I don't need a crappy algorithm to tell me this guy had a massive MI over the past few days. B/P cycles again: 73/49.
Cupcake tells me we are 2 minutes away from the hospital. That's two minutes too long. He should have been there 2 days ago.
We unload him from the truck. "I'm about to die."
Cupcake says "no you aren't, there are really good doctors in here, and they are going to take great care of you."
We walk with incredible alacrity into the ER, and the receiving doc sees my NPA, and shows us to a room close by. "Let's get RSI."
"I'm going to put you to sleep and put a tube in your throat so we can breathe for you."
"Okay."
The drugs are in, and the tube follows quickly. As does the noises from the monitor. V-tach. "He have a pulse?" "No." "Start CPR."
Normally, I am out of the room at this point, so the more educated people can do their jobs. Usually, I am just in the way. Not this time. I'm right there. I haven't had time to leave yet, and the crash cart is blocking my exit. I start compressions, pushing hard and fast on this man that was talking to me just moments ago.
Epi is in. Charge. Shock. Asystole.
More compressions. Something catches my eye at the door to the room. It's Cupcake, and she has turned her head. I hear a vaguely familiar, polite voice: "Is he doing better?..." as I see his wife come around the curtain.
We make eye contact and she sees me doing chest compressions on her husband of 30 years.
What followed was the most terrible, shrill, eardrum piercing sound I have ever heard. The sound that all of my fellow EMSers have heard, and dread hearing again. It's the sound that still, to this day, awakens me occasionally from a still sleep.
The next few minutes were a blur. More drugs are pushed, more joules are administered, all with no effect. The wife has since come into the room, and is sitting on a chair next to her husband, talking to him, as I continue to compress his heart, and respiratory continues to inflate his lungs.
"You can't go now, you need to come back. You can't leave me."
"It's okay if you need to go, honey. I understand. You are a wonderful husband."
I can't believe I am seeing these stages of grief happen in front of me. She looks at the doctor.
"I think he's gone. He's not coming back."
Doctor and I make eye contact, and he gives me an almost imperceptible nod. I stop, and walk out the room, then I hear the wife again.
"Wait."
I turn around, and she looks through my eyes, hers full of tears, and mine full of failure.
"You did a great job. I know you took good care of Danny, and you did everything you could. Make sure you go home and hug your wife real good, and kiss that sweet boy of yours."
How on earth did she know I was married, with a young child? Oh, damn, his 3 month picture is on my nametag.
She hugged me hard. For what seemed like an eternity, and I returned to my ambulance with her tears soaking my shirt, and a few of mine on my cheeks.
3 days later I read his obituary. He was a lawyer. His office was only blocks from mine. He was an avid tennis player, and a father of 3, with a baby granddaughter.
I wish he would have called earlier.
It was late evening, when most normal people are winding down, in bed, perhaps with a snack, or watching some late news. The address was for a fairly nice neighborhood, full of upper-middle class homes, and successful people. For a man "not feeling well."
Cupcake and I arrived only a few minutes behind the first-in Engine and Rescue units. We took our stretcher and first-in bag with us into the well-appointed home, and were directed through a
kitchen, full of pictures of children and what appeared to be a new grandchild.
As I rounded the corner, Elrod and I made eye contact, and I saw the distinct look of fear in his eyes. The look that says "this guy is sick something bad." Elrod is a career paramedic, with 20 years under his belt. He has seen some sick people before. His eyes tell me enough. Elrod is starting a line while Tim is hooking up the monitor and Kevin puts a nonrebreather on him. I look at the wife. "What's going on?"
"He hasn't felt good for a few days. He just took the trash out, and came in and said he couldn't breathe."
"No, he doesn't take any medications."
I get a glimpse of the patient in the dim light, with the glow of Fox News in the background. He looks terrible. Like, as my father would say, "death eatin' a cracker." His skin is grey. An amalgamation of pale, cyanotic, diaphoretic and dusky.
"Forget the line, Elrod. Let's get him on the stretcher."
Cupcake and I are out of the house with the patient within 4 minutes of walking in. She asks if I want a rider to the hospital, which is 10 minutes away. 6 minutes with her heavy foot.
"I want to leave. If there is a rider in the back with me when you get up front, so be it. Otherwise, lets get the hell out of here."
No rider.
O2 saturation is 88% with 15 liters going. I get a blood pressure that is terrible. 82/50. His carotid is incredibly fast and weak. The monitor is counting out 140. A minute later I have two 16 gauge lines going. I don't know how I found those veins, but I did. His skin still looks terrible.
I'm throwing the 12-lead on as fast as I possibly can.
"I can't breathe."
"I know, buddy. I can breathe for you if you would like, so you can try and relax."
"Okay."
I drop an NPA in and start bagging him. "Data quality prohibits interpretation" says the monitor. Shit. I don't need a crappy algorithm to tell me this guy had a massive MI over the past few days. B/P cycles again: 73/49.
Cupcake tells me we are 2 minutes away from the hospital. That's two minutes too long. He should have been there 2 days ago.
We unload him from the truck. "I'm about to die."
Cupcake says "no you aren't, there are really good doctors in here, and they are going to take great care of you."
We walk with incredible alacrity into the ER, and the receiving doc sees my NPA, and shows us to a room close by. "Let's get RSI."
"I'm going to put you to sleep and put a tube in your throat so we can breathe for you."
"Okay."
The drugs are in, and the tube follows quickly. As does the noises from the monitor. V-tach. "He have a pulse?" "No." "Start CPR."
Normally, I am out of the room at this point, so the more educated people can do their jobs. Usually, I am just in the way. Not this time. I'm right there. I haven't had time to leave yet, and the crash cart is blocking my exit. I start compressions, pushing hard and fast on this man that was talking to me just moments ago.
Epi is in. Charge. Shock. Asystole.
More compressions. Something catches my eye at the door to the room. It's Cupcake, and she has turned her head. I hear a vaguely familiar, polite voice: "Is he doing better?..." as I see his wife come around the curtain.
We make eye contact and she sees me doing chest compressions on her husband of 30 years.
What followed was the most terrible, shrill, eardrum piercing sound I have ever heard. The sound that all of my fellow EMSers have heard, and dread hearing again. It's the sound that still, to this day, awakens me occasionally from a still sleep.
The next few minutes were a blur. More drugs are pushed, more joules are administered, all with no effect. The wife has since come into the room, and is sitting on a chair next to her husband, talking to him, as I continue to compress his heart, and respiratory continues to inflate his lungs.
"You can't go now, you need to come back. You can't leave me."
"It's okay if you need to go, honey. I understand. You are a wonderful husband."
I can't believe I am seeing these stages of grief happen in front of me. She looks at the doctor.
"I think he's gone. He's not coming back."
Doctor and I make eye contact, and he gives me an almost imperceptible nod. I stop, and walk out the room, then I hear the wife again.
"Wait."
I turn around, and she looks through my eyes, hers full of tears, and mine full of failure.
"You did a great job. I know you took good care of Danny, and you did everything you could. Make sure you go home and hug your wife real good, and kiss that sweet boy of yours."
How on earth did she know I was married, with a young child? Oh, damn, his 3 month picture is on my nametag.
She hugged me hard. For what seemed like an eternity, and I returned to my ambulance with her tears soaking my shirt, and a few of mine on my cheeks.
3 days later I read his obituary. He was a lawyer. His office was only blocks from mine. He was an avid tennis player, and a father of 3, with a baby granddaughter.
I wish he would have called earlier.
You thought texting while driving was bad.
So Slimm and I are awoken from a nap to respond to a man with a piece of a metal fence stuck in his leg.
We were having a good nap. There had better be a humongous piece of metal stuck in this man's leg.
Finally we find the guy. About as far away from the entrance to the scene as you can get. I will, and did, drive my ambulance across a football field, baseball field, and a lacrosse field.
Sure enough, this guy has a piece of a metal fence, the kind used to hold up silk fences around construction sites, impaled in the back of his leg. Well done, man, well done. Thank you for interrupting my nap with a genuine problem.
"How did this happen?"
"I was texting my daughter while walking, and tripped, and fell down. I guess I just landed the right way."
He's gonna be OK. After some surgery, that is.
We were having a good nap. There had better be a humongous piece of metal stuck in this man's leg.
Finally we find the guy. About as far away from the entrance to the scene as you can get. I will, and did, drive my ambulance across a football field, baseball field, and a lacrosse field.
Sure enough, this guy has a piece of a metal fence, the kind used to hold up silk fences around construction sites, impaled in the back of his leg. Well done, man, well done. Thank you for interrupting my nap with a genuine problem.
"How did this happen?"
"I was texting my daughter while walking, and tripped, and fell down. I guess I just landed the right way."
He's gonna be OK. After some surgery, that is.
Pleasant Vomiting
Respond emergency for a female who feels sick, and with a racing heart.
Sounds cool enough. (I like giving adenosine.)
We are met by the fire crew. "Leave your stretcher in the ambulance. She will be sitting on a john boat in the driveway."
Interesting. (What's that bout a john boat?...)
"I vomited violently about an hour ago, and I want to go to the hospital. I laid down, and my heart started racing."
Sinus tach at 113.
"Violent vomiting" was mentioned no fewer than 15 times on the way to the hospital.
Straight to triage.
Sounds cool enough. (I like giving adenosine.)
We are met by the fire crew. "Leave your stretcher in the ambulance. She will be sitting on a john boat in the driveway."
Interesting. (What's that bout a john boat?...)
"I vomited violently about an hour ago, and I want to go to the hospital. I laid down, and my heart started racing."
Sinus tach at 113.
"Violent vomiting" was mentioned no fewer than 15 times on the way to the hospital.
Straight to triage.
Thursday, August 25, 2011
Red lights for this?
We go "emergency" way to much. Period. My unit is dispatched emergency to well over 95% of our calls. I transport emergency to the hospital maybe once a month.
At my service, the dispatchers will raise a unit for a call by saying "Unit soandso, copy an emergency." It seems that every imaginable complaint under the sun is an "emergency." And when we respond emergency, it means that we are going to a scene with some sort of fire apparatus. It's not the dispatcher's fault.
Perhaps we should better educate the public on the definition of "emergency."
Why do we need 6 EMTs and 2 Paramedics in, collectively, a fire engine, rescue truck, and an ambulance for a 35 year old man with kidney stones? Or for that matter, a child with a fever? Or for the nursing home patient with abnormal labs?
Those people need a taxi, not an ambulance, much less 3 humongous vehicles driving emergency, forcing cars to the side of the road for their bullshit complaint.
I think the call-takers in my county should be able to provide directions to the hospital.
At my service, the dispatchers will raise a unit for a call by saying "Unit soandso, copy an emergency." It seems that every imaginable complaint under the sun is an "emergency." And when we respond emergency, it means that we are going to a scene with some sort of fire apparatus. It's not the dispatcher's fault.
Perhaps we should better educate the public on the definition of "emergency."
Why do we need 6 EMTs and 2 Paramedics in, collectively, a fire engine, rescue truck, and an ambulance for a 35 year old man with kidney stones? Or for that matter, a child with a fever? Or for the nursing home patient with abnormal labs?
Those people need a taxi, not an ambulance, much less 3 humongous vehicles driving emergency, forcing cars to the side of the road for their bullshit complaint.
I think the call-takers in my county should be able to provide directions to the hospital.
Wednesday, August 24, 2011
You can downgrade now.
A call for an infection in the leg. Bullshit.
Not only does this guy have maggots in the open wounds on both legs, but he appears to have been incontinent for several days. DAYS. Literally, covered in shit. The rest of the assessment is unremarkable, with normal vitals.
I know it stinks, and you can smell it up front, but there's not really reason for you to drive emergency to the hospital.
Not only does this guy have maggots in the open wounds on both legs, but he appears to have been incontinent for several days. DAYS. Literally, covered in shit. The rest of the assessment is unremarkable, with normal vitals.
I know it stinks, and you can smell it up front, but there's not really reason for you to drive emergency to the hospital.
Tuesday, August 23, 2011
I like my partner.
I have spent the better part of the past three years working with members of the opposite sex. It seems to work out well for my company, and that's cool with me. We seem to do lots of female psych calls. I mean LOTS. It might be something in the water.
I've had only good partners lately. Well, except for the occasional McTalkalot and McAsksalotofquestions, and Dragon Breath. But whatever.
Recently, I was assigned a new partner, Slimm. This is Slimm's first ALS 911 ambulance. He has some good experience on a non-emergency truck, and a good head on his shoulders. He has been learning how to run 12-leads, set up ventilators, and has gotten some good interventions under his belt. He is going to be a fantastic paramedic one day. We get along well, and our personalities mesh well together. I like to run scenes quickly, and move patients to the ambulance, so the fire crews can go back in service and get back to their games of checkers. Slimm just wants to take people to the hospital.
Slimm laughs at my jokes, too. Which helps.
Plus, he drives as smooth as butter. It will be a sad day when Slimm gets moved.
I've had only good partners lately. Well, except for the occasional McTalkalot and McAsksalotofquestions, and Dragon Breath. But whatever.
Recently, I was assigned a new partner, Slimm. This is Slimm's first ALS 911 ambulance. He has some good experience on a non-emergency truck, and a good head on his shoulders. He has been learning how to run 12-leads, set up ventilators, and has gotten some good interventions under his belt. He is going to be a fantastic paramedic one day. We get along well, and our personalities mesh well together. I like to run scenes quickly, and move patients to the ambulance, so the fire crews can go back in service and get back to their games of checkers. Slimm just wants to take people to the hospital.
Slimm laughs at my jokes, too. Which helps.
Plus, he drives as smooth as butter. It will be a sad day when Slimm gets moved.
Sunday, August 21, 2011
Those pockets aren't for your hands...
So, Slimm and I had a student third rider the other day. I enjoy having students, I really do. They are, for the most part, sponges for knowledge, tend to ask good questions, and are generally helpful. This one was none of the above.
I'll call him Goofus.
My partner and I started this shift as usual, with a check-off sheet in our hands. Goofus had failed to introduce himself at this point, and stood about 20 feet to the side, with his hands in his pockets. We were prepared to leave him standing there in the parking lot, but he managed to sneak in the side before we could drive off. Then he took a nap.
Granted, this is an early-starting shift, but beginning the shift by napping in the back does not bode well for the rest of the day.
The day started off plainly enough, with a vent transfer from a long-term hospital to another hospital's ICU, then with some driving from post to post, then finally, a call. It turned out to be nothing, with no assistance from the fire department needed or wanted. What was of note, however, was that Goofus kept his hands in his pockets. The entire call.
The rest of the shift was utterly boring. Some schizophrenic man with diarrhea for a week, and no shoes, a known alcoholic drug-seeker with abdominal pain and an incredibly steep and long driveway, and some other calls that were bland to the point of not remembering. Goofus never took his hands out of his pockets, never spoke to the patients, never attempted an assessment, much less an intervention, didn't participate in the hand off of patients to nurses, and didn't help my partner or I put the truck back together in preparation for the next run.
As we were handing off the ambulance to the oncoming crew, Goofus had the nerve to ask me if I would go into the monitor archives and print vitals for all the patients we had transported.
I'm not sure if Goofus ever got his vitals, or if Goofus ever got anyone to sign his paperwork for school. I am pretty confident, however, that Goofus will have a very short, if any, career in EMS.
I'll call him Goofus.
My partner and I started this shift as usual, with a check-off sheet in our hands. Goofus had failed to introduce himself at this point, and stood about 20 feet to the side, with his hands in his pockets. We were prepared to leave him standing there in the parking lot, but he managed to sneak in the side before we could drive off. Then he took a nap.
Granted, this is an early-starting shift, but beginning the shift by napping in the back does not bode well for the rest of the day.
The day started off plainly enough, with a vent transfer from a long-term hospital to another hospital's ICU, then with some driving from post to post, then finally, a call. It turned out to be nothing, with no assistance from the fire department needed or wanted. What was of note, however, was that Goofus kept his hands in his pockets. The entire call.
The rest of the shift was utterly boring. Some schizophrenic man with diarrhea for a week, and no shoes, a known alcoholic drug-seeker with abdominal pain and an incredibly steep and long driveway, and some other calls that were bland to the point of not remembering. Goofus never took his hands out of his pockets, never spoke to the patients, never attempted an assessment, much less an intervention, didn't participate in the hand off of patients to nurses, and didn't help my partner or I put the truck back together in preparation for the next run.
As we were handing off the ambulance to the oncoming crew, Goofus had the nerve to ask me if I would go into the monitor archives and print vitals for all the patients we had transported.
I'm not sure if Goofus ever got his vitals, or if Goofus ever got anyone to sign his paperwork for school. I am pretty confident, however, that Goofus will have a very short, if any, career in EMS.
Saturday, August 20, 2011
We have to start somewhere
Admittedly, I am a blogging idiot. My expertise and experience centers on the reading of others' writings.
Those other blogs out there have served to provide me with some good inspiration, as do the seemingly endless number of dumbasses I encounter in life. I have often said that "I don't like people," which typically gets a humorous response. The fact is, I love people. From a distance. Like, through my television.
I am planning on writing on EMS as viewed from my ambulance, through my eyes. I will try to keep my comments and posts relevant to topics and trends in EMS, but occasionally, something awesome happens totally unrelated to EMS, such as Bubba Watson reaching a 667 yard par-5 in 2. That guy is a S-T-U-D.
They say any journey begins with the first step. This is mine.
Those other blogs out there have served to provide me with some good inspiration, as do the seemingly endless number of dumbasses I encounter in life. I have often said that "I don't like people," which typically gets a humorous response. The fact is, I love people. From a distance. Like, through my television.
I am planning on writing on EMS as viewed from my ambulance, through my eyes. I will try to keep my comments and posts relevant to topics and trends in EMS, but occasionally, something awesome happens totally unrelated to EMS, such as Bubba Watson reaching a 667 yard par-5 in 2. That guy is a S-T-U-D.
They say any journey begins with the first step. This is mine.
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