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Thursday, August 13, 2020

Groundhog Day

A little before lunch we were toned out for an unconscious male. 

We arrived on scene to find the patient laying on his stomach in his bedroom. He was completely unresponsive and had vomited. Fortunately for him he was on his stomach so he didn't aspirate.

The family, not wanting to see their father in his condition, went outside as soon as we arrived. Our repeated attempts to get information from them failed. We were totally in the blind. 

Eventually we found a bottle of Carisoprodol (Soma) that was empty and shouldn't have been. 

After controlling the airway with an NPA an IV was started and Narcan was administered. This brought the patient around a little to the point where he could kinda protect his own airway. AMR then transported him to the hospital.

7 hours later we returned to the same address for an unconscious male. 

Same story as before. He had been discharged from the hospital and on returning home, decided to take more pills. This time, when we arrived, the patient was still alert enough to be able refuse treatment and transport to the hospital. We even had PD there but they said there wasn't enough to put him on a 5150 hold. So we had to sign him out against medical advice and leave knowing we'd be back.

3 hours later we returned to the same address for an unconscious male. 

This time when we arrived the male patient had taken yet more pills. He was now on the floor of his room, face up, and had hurled again. This time he aspirated the vomit. On scene and en route to the hospital we were supporting his breathing with a BVM and an OPA. We were unable to get him stable.

I have no idea what the outcome was for this patient but I do know that I haven't been back to that address in years. I still think of the patient every time we have a call on that street.

Wednesday, July 29, 2020

Attach Truck 51 To The Call

While on a medical call for a man with runny nose we heard Engine 52 get dispatched to a smoke investigation. Almost always a BS call....almost. No specific address but there was an address for the RP (reporting party). We listened in as Engine 52 arrived on scene and reported the smell of smoke in the area. Now our ears perked up both for the next radio report from the Engine and for the sound of our ambulance.

Both showed up at once.

Engine 52 announced that they had smoke coming from the eves of a house mid block and asked dispatch for a first alarm assignment and a tactical channel. They had a working structure fire.

As our ambulance crew exited their vehicle I gave a short but sweet pass along (thankfully my patient wasn't critical). 62 year old male, runny nose times 12 hours. The crew, having also been listening to Engine 52 said, "We got it, GO!"

"Dispatch, Truck 51, attach Truck 51 to the call with Engine 52."

Now 1 minute out we let Engine 52 know that we are approaching the scene with Engine 53 right behind us. We get assigned to vertically ventilate the house while Engine 53 is assigned to tag a hydrant.

As we were throwing a ladder to the roof we received word from Engine 53 stating that a neighbor reported that the homeowner was still inside the burning house. We immediately switched from vent group to search group.

My crew and I entered the house and I made contact with the Captain from Engine 52. He said that they had found several different fires inside the residence. He said that he would search the left side of the house if we searched the right. 

Inside the first bedroom I looked through the thermal imager and saw a man laying on the the bed. I stepped back out of the way next to the door and directed my firefighter and engineer to the victim. They grabbed him by the arms and legs and carried him outside.

Outside in the grass, we started a quick assessment of the patient. He was not breathing and he had no pulse. I directed my crew to grab the EMS gear while I started CPR, still masked up and breathing through my SCBA.

After 3 minutes of excellent EMS care the patient's heart started beating again. Fortunately the ambulance was just arriving on scene. It seems just as soon as we arrived on scene we were leaving again, this time in the back of the ambulance taking out patient to the ER.

After the call we found out the the victim had intended suicide. He had also set some booby traps for us. Behind each bedroom door, he had set a 5 gallon bucket full of gasoline with sheets tacked to the ceiling leading to the bucket. He had also poured gasoline all over the house and started several fires. Fortunately for us, the house was well insulated. There was so much smoke in the house that it smothered the fire. If we had been able to ventilate the house the outcome may have been totally different.

Friday, March 10, 2017

Gravity Lessons

I was working overtime at a station on the other side of my department. One of the things we covered in that district was an off road park. While not a lot of calls are generated there when they do come in they're usually fairly serious.

Around lunch time we heard the radio from the State Park Rangers crackle (we monitored it to get a head start on calls). We heard a Ranger say that they had a person over the side and to dispatch Fire. As we were leaving the station we could hear the tones going off. Not a bad response time.

As we arrived at the park we were met by another ranger in a 4x4 pick up. He led us to the correct trail and then told us it was way at the back of the park. He wasn't kidding. 25 minutes later and we still had yet to reach our patient. Narrow dirt roads, steep hills, and other riders all slowed us down.

As we neared the scene we could see where our patients path diverged from the trail. We saw a knot of people we down below. A couple minutes later we were dismounting from the rig next to the mountainside. 

Our patient, a 25 year old woman, had accidentally left the trail and went down the side. She was able to ride about 50 feet down a near vertical cliff before going over her handlebars. She came to rest 40 feet later just short of the 30 foot sheer cliff that surely would have changed the nature of this call.

As it was the patient had a flail chest on her right side, a broken shoulder blade and a possible spine injury. What the woman had going for her was that there was no neurological damage that we could tell, she didn't have a pneumothorax, and her vitals were stable. She was in a lot of pain however.

On the side of the hill I started an IV and administered some morphine. It wasn't enough to take the pain away but it did take the edge off. Once that was set we placed her on a backboard, strapped her in and then placed her in a stokes basket. With the help of a couple of other riders we were able to get our patient down the hill.

Once there we loaded her in the back of the waiting pickup that the Rangers brought up initially. I hopped into the back with her. After making her as comfortable as possible we started the long bouncy drive down the the waiting air ambulance (and you thought the days of riding in the bed of pickup trucks was a thing of the past).

As we approached the helicopter the truck stopped. The RN jumped into the back and I gave her a quick report. She asked the patient a few questions and attached a few cables to the patient. We then pulled up closer the the chopper and stopped. 

The whine of the turbine and the whir of the blades made communication a little more difficult. As a team we transferred the patient from the stokes basket to the helicopters loading board. We then strapped her in tight and carried her to the waiting bird. 

Once she was loaded we retreated to a safe distance. 3 minutes later the engine revved up and the pitch of the rotor blades changed. We all turned our backed to keep our faces from getting sand blasted from the down wash. And with the familiar thump thump thump of the helicopter the patient was off to the trauma center.

Saturday, February 25, 2017

Every Day Heroes

We were toned out for a medical aid on the freeway that runs through our district. It's a bit unusual to be sent to the freeway for a medical aid instead of an accident but it's not unheard of.

We pulled up to the silver quad cab Tacoma which was sitting the side of the road. The rain was really coming down. Visibility was really limited. I approached the truck from the passenger side and opened the front door. Inside I found a woman about 30 years old sitting on her husbands lap with his seat reclined almost all the way. She was shaking and in tears and he was unresponsive.

I moved to the back seat and encourage the wife to sit in the front seat. She explained that her husband had been driving and then had had a grand mal seizure. This woman couldn't have done things more right.

She had first reached over and taken control of the steering wheel. She then stretched with her left foot and tried to find the brake pedal. After first depressing the emergency brake she was able to slow the car down to a stop, still in traffic lanes, before shifting the transmission into park. She quickly unbuckled her seat-belt and reclined the drivers seat. She was then able to hop onto her husbands lap and drive the truck to the side of the road. At that point she broke down and cried from all the stress.

Once I got to the patient I was able to determine that he was post-ictal. Within a few minutes he was able to answer basic questions. By the time the ambulance arrived on scene he was completely alert and oriented. His sugar had been checked and a head to toe exam performed.

Five minutes later the patient was on his way to the hospital and we were on our way back to the station discussing how that lady was a hero. Because of all the rain we wouldn't make it home. Dispatch had yet another traffic accident for us to respond to.

Tuesday, February 14, 2017

Truck 51, Responding.

The tones chime around 21:30. A medical aid. I've picked up an overtime shift and am driving at my own station. Always a plus. I listened to the address and go to the map. I knew the street but I want to check exactly which house it was. As I stepped into the rig my captain said in a tense voice, "Get us there!"

In the dispatch notes my captain had read that we were headed to a pediatric full arrest. In plain English we were headed out for a baby that no longer was breathing or had a beating heart. 

Normally when driving a fire truck with lights and sirens there's a lot of caution involved. A 70,000 pound vehicle rolling through red lights can be dangerous. On the way to this call the limits were pushed. Seconds counted. We listened above the growl of the siren to the dispatcher rattle off all the units that were responding. Truck 51, PD, AMR, AMR Supervisor and at our request, Engine 52. Dispatch informed all responding units that CPR instructions were being given and that this was for an 8 month old boy. 

One police officer made it to the scene before us, He had just enough time to go in and grab the lifeless kid and bring him out to us. I started chest compressions while my firefighter set up the BLS airway. After a minute of CPR the AMR unit pulled up. Without hesitation we moved. As a cohesive unit we transferred the entire operation from the front of the house to the back of the ambulance.

On our way to the hospital, in the back of the ambulance, there were three medics and an EMT. My firefighter continued with compressions gently forcing the child's heart to pump blood. I inserted an intubation tube into the airway of my patient. With that in I then connected the end tidal CO2 tubing and continued to breath for the baby. The AMR supervisor used a drill gun to sink in an IO needle for vascular access. He then was able to administer what we hoped would be life saving drugs. The AMR medic watched the heart monitor for a rhythm and kept track of time for us. It's remarkable easy to lose track of time on a full arrest.

By the time that we reached the hospital the RNs were waiting for us at the door. Our ACLS protocols had been followed perfectly. Even better than they would have been in the hospital. This is what we do.

Inside the ER the staff takes over continuing with ACLS. Another 20 minutes go by and there's been no change. The family has arrived. Mom and dad stand in the hallway looking for a miracle. As I come out of the room they look to me for answers. The hospital staff hasn't had time to talk to them yet and I'm the one the parents remember rushing their baby away giving them hope. The father asked what his vitals were in a way that told me they had heard that on a medical show on TV and were sure their boy was supposed to have some sort of vitals.

I take my time with the family explaining what was going on. I prepared them for the worst because I knew it's coming. Years of experience told me what the end result of this call would be. After a few questions another ER doc came by and took over for me. As he was talking I slipped away.

I headed back out to the ambulance bay and helped my firefighter put all of our gear back together. Just as we were leaving the AMR supervisor came out, caught my eye, and shook his head. Nothing more needed to be said.

The ride back to our station was quiet. Somber. None of the usual banter and at times dark humor that usually follows a serious call. None of us talk about it but we're all fathers. This one hit close to home. As we approached the station the radio beeped and the dispatcher came on.

"Truck 51, medical response...." I knew where were headed. I reached up and flipped on our lights. My foot stepped on the floor button that winds up the siren. Over its high pitched scream I hit the air horn.

Truck 51, responding.
© FireMedic and Firefighter/Paramedic Stories, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to FireMedic and Firefighter/Paramedic Stories with appropriate and specific direction to the original content.

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