Good advice

On the advice of my good friend, and trusted colleague, Flash Larry, I decided to remove the previous post.

While I stand by what was said in my post, his assertion that such comments might not be in my best interest is a good one. 

Perhaps I will revisit the previous post in the future, but it will be done in a more tactful way. 

I still know that I was right, and the complaint was baseless and ill conceived.

Flash Larry is a smart guy.

ProQA Fail

Partner of the day and I had just finished working an incredibly impossible arrest. 17 defibrillations, and almost a complete drug box used. 17 minutes were spent in the house prior to moving the patient, mainly because the personnel on scene were all waiting for a rhythm change, be it positive or negative. We never got one though. That's a different story.

Seriously, who stays in v-fib for 40 minutes?

So, anyway, we get a non-emergent run dropped on us. These are pretty rare, since I have responded emergency to runny noses, and eye pain. This was for a man who was dizzy, which was also interesting. Usually, if a caller even mentions that someone in the house, or the near vicinity, might even be close to remotely being dizzy, or if they know of someone who has ever been dizzy, then a full response is warranted. A full response being a BLS Engine, an ALS Rescue, and an ALS ambulance. Again, I digress.

Suffice it to say that the call taker must have really thought this call was stupid to call it non-emergency.

So, POD and I drive in to this very nice neighborhood, which isn't rare in this part of the county. The houses probably start in the high 400s, and the house we find is probably nearer to the top of the market in this neighborhood.

We've got a waver!

I love wavers. If we didn't have people jumping up and down screaming at us (as if we can hear them from 800 yards through the rolled-up windows, over the diesel engine, the radio traffic, and our general conversation) I have no idea how we would ever find 123 Main Street.

Except for the numbers on the mailbox.

This is a nice looking gentleman, probably not our patient, since our dispatch information is suggesting a 60ish year old. This guy is probably early 30s.

POD and I decide to take in the monitor and the stretcher. Hey, it's the least we could do, right. This call sounds like utter horseshit, but we might as well grab some equipment. And the computer for a refusal. These people usually just want their blood pressure checked.

The waver walks up to us and begins to talk.

“My father and I got home from the gym about 30 minutes ago, and he's been really dizzy since then.”

Okay, maybe not an utter horseshit call, but it still sounds kinda stupid. Waver has an accent that, coupled with his thick, dark hair and complexion, lead me to believe he is middle eastern. That's about as specific as I can get.  I can hear a Yankee from across a parking lot, however.

It's 68 degrees in the well-appointed home. I know this because I immediately felt cold when we walked in the door, and happened to walk past the thermostat, where I saw the 68. Just into the living room was a man, lying on the floor. He didn't look good.

Okay, maybe it's a genuine call. This guy looks sick. You know how white people turn kinda blue? This guy looked kinda like a blue middle-eastern guy. And he was wet.

Like, just got out of the pool wet. Obviously, I have a real patient.

He seems to be awake, but to compound his sickness, his son tells me that he only speaks Farsi. I most vertainly do not speak Farsi. I ask all the normal questions for a guy who looks like this.

30 minutes onset after coming home from the gym. No chest pain. No difficulty breathing. No nausea. No vomiting. No syncope. Had a stent placed in Iran 7 years ago. No meds. No allergies. Yada, yada, yada.

All this is going on while I do my best to dry off this incredibly diaphoretic, hirsute man, and get the electrodes to stick to him. Times like this I wish I carried tincture of benzoin in the monitor bag. B/P cycles 72/43.

Well, no wonder I couldn't feel a radial pulse.

The monitor is on, and prints it's initial rhythm strip:

Oh, snap! I would be dizzy too if my heart rate was in the 40s. And if it was junctional.

“Can you tell your father I need to shave some of the hair on his skin, and put more stickers on his chest? Mmmkay, thanks.”

The monitor keeps saying something about “Noisy data.” Forget that, print a damned 12-lead.

Okay, time to go. I reach for the combo pads, just in case this goes south, and also because of a lesson taught to me a long time ago by a coworker.

My Farsi-speaking patient now has eyes the size of dinner plates. His eyes look like he knows I am about to "light him up" or something.  He looks at his son and says something incomprehensible to me, and his son in turn looks at me.

“Can you tell me what is going on with my father?”

“He's having a heart attack.”

Surprisingly calm. “Okay. Can we go to Secular Hospital (with no PCI, and notorious for screwing stuff up).

“No, but we can go to Saint Catholic, right down the street.” (World-renowned, PCI-capable, and will actually listen to a paramedic and activate the cath lab on our word.) Thankfully, son agrees.  As if he had a choice.  I am NOT going back in to CQI to explain myself.

POD gives me a nice, smooth ride, which takes about 15 minutes. I get a 16 in an AC somehow, and give him a good, hefty fluid bolus. 324 of aspirin is in. Blood pressure comes up a few points, to 90 systolic. Hey, it's better, but nothing to be too excited about. Thankfully, my service transmits 12-leads, and Saint Catholic felt like answering the phone.

Not only that, they actually hand the phone to not just a physician, but the interventional cardiologist who is awaiting my arrival. I literally transmitted this 12-lead 5 minutes ago, and there is a PCI doc waiting on me?

Cool.

The rest of the story is pretty boring. He went to the cath lab, he got stented, spent the night, then went back home to his son's house. I'd like to check on him, but I probably won't. There's lots of patient's I would like to check on, but I never do.

Sometimes, I start an IV and not much else.

Good call, even with the interesting mistake between 911 call and the actual dispatch.  I'm not a dispatcher, but I wonder how something like that happens. 

Take the bag!

My service has a policy which requires the crew to take in the stretcher, cardiac monitor, and jump bag to every patient.  I have been in the habit of taking said equipment in, even without a written policy. 

While taking a cardiac monitor in to a 10 year old with a twisted ankle may be a little over kill, that's what the bosses want, so we do it.  Or at least I do.

It's also a good practice.  Seriously, what are you going to do for a patient who accidentally stabbed himself in the femoral artery with a turkey baster right before Thanksgiving dinner, and now there is blood squirting every which way, in the squash casserole, and all over the turkey, and the mashed potatoes, and your jump bag is 30 yards away in the ambulance?  And when that call happens (and we all know it will happen, to someone), you just know there is going to be a doctor/nurse/paramedic/personal-injury lawyer watching your big, fat, screw-up.

"Ma'am, can I borrow a towel from you since I'm too lazy to bring in my equipment?"

Take in the damned bag.  Take in the damned monitor.  Put it on the effing stretcher so your lazy ass doesn't hurt your lazy back carrying it.

I hate lazy people.

Non-emergency?

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.

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.