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Thursday, October 28, 2010

Genetic Predisposition?

While I was upstairs I heard my daughter (who is 6) scream for Daddy. When I asked what was going on she said there was a bug! And it was on the couch.

Not 5 seconds later my oldest son (who is 4) loudly proclaimed, "I got it Daddy!"

Even at this young age the boys are the ones taking care of the creepy crawlies.

Wednesday, October 27, 2010

Breaking And Not Entering

At 0115 the tones went off. The lights on my room slowly started to brighten. I could hear the automated voice starting to dispatch us. "Truck 71......"

When we arrived on scene we could see several PD officers standing on the grass next to an apartment building. We could also hear music loudly thumping away. The officers explained that they were responding to a noise complaint but there had been no answer at the door. They could tell that the window to the second story apartment was open. That's where we came in.

I grabbed the 16' ladder and laddered the trellis under the window. I climbed up and called out loudly, "FIRE DEPARTMENT!" The last thing I want to happen is scaring some guy with a knife or a gun. No one appeared to be home. The computer was on and playing loud music. The officer in charge told me not to enter the residence.I climbed down the ladder and then put it away. The poor neighbors were going to have to put up with the noise all night. I was headed back to bed (but I wouldn't stay there long).

Tuesday, October 26, 2010

Bar Fight Turned Ugly

It was just after 2 in the morning. As we started out of the barn the radio crackled to life. Dispatch was talking to another unit about a first alarm assignment. There seemed to be some confusion about who was responding where. Then we heard that Truck 71 (which is station in the neighboring district) was also responding to the call. It seemed that something big was going on and we were in the dark. Dispatch informed us that we were responding to a different location around the corner from their incident. Truck 71 then asked that the next due engine be dispatched as well. Whatever was going on had a lot of resources moving.

We soon figured out that another city that uses our dispatch was working a structure fire and we caught their radio traffic before they switched to a tactical channel. As we turned the last corner we saw several PD units. Dispatch finally came through with an update as well. We were responding to a stabbing with multiple victims. We had the truck and another engine on the way, which meant a BC as well.

I jumped out of the rig and grabbed my gear. As we approached the scene we could see one victim laying in the street in handcuffs bleeding from the hands. An officer could be heard, almost screaming with urgency, that the other one had his guts hanging out. Since patient #1 wasn't so bad off we kept going.

On the side of the street we found patient #2. He was laying under a tree in the weeds. A police officer knelt beside him holding a trauma dressing down on the victim's abdomen as if his life depended on it. As I approached the cop started to move. I'm sure he was hoping to escape but I told him to stay right where he was. I did a quick 360 of the scene to look for any other patients and didn't see any. I also knew the truck should be pulling up any second so if there was another patient out of sight they would help him.

Patient #2 was covered in blood from his head to his knees. His shirt had been pulled up around his chest to expose wounds. I knelt beside him and asked his name. He was very lethargic. Not a good sign. Soon my engineer showed up and relieved the officer of his duties. I pulled out my trauma shears and started removing all the patient's clothes, looking for every injury. By now the external bleeding had stopped. I think this was more due to a lack of blood than anything we did.

I found 6 stab wounds in my patient. Two were to the side of the chest but appeared superficial. He had two more shallow wounds the left side of his abdomen near his hip. Another one was just to the left of his navel. The one that I was worried about was just under his rib cage on his left side. It was more than 2" wide and deep. I checked lung sounds to make sure he didn't have a pneumothorax. His lungs were okay.

We quickly strapped the young man to the backboard. Once he was secure we moved him to the ambulance. As soon as I jumped in the back with the AMR medic he directed his partner to drive. We would be taking care of everything while racing to the trauma center.

We both started IVs at the same time, one in each arm. While we were doing this our patient became unresponsive. Now that we had IV access we poured in the fluids. We wouldn't normally do this but our patient had no blood pressure. We were losing him. After a couple of minutes he perked right up. His blood pressure was 70/P, not good but better than it was.The victim actually tried to argue with us as to where we were taking him. We informed him that he was going to a trauma center because his hospital of choice was not capable of handling wounds of this nature.

Arriving at the ER we found several ambulance crews lining the hall. Word had spread that we had a good trauma patient and everyone wanted to get a look. As I helped to slide the patient over to the hospital bed, I gave my report to the MD. I could see that victim #3 (the one I never saw) was in the neighboring trauma bay already intubated. The RT was waiting on a ventilator breathing for the patient by hand.

That was the last I saw of my patient. I headed back to the station where I checked my gear for blood. Thankfully I had managed to not get any on me. I helped finish restocking our rig then went back to bed, 2 hours after the call came in.

---Follow Up---

I found out that my patient was in the ER for about 3 hours before taking a turn for the worse. While being stitched up he coded. The ER doc cracked the guy's chest to try to save him. When he did the doctor discovered that the stab wound had actually punctured the heart. He died there on the table. There is an ongoing police investigation.

Monday, October 25, 2010

Does Not Play Well With Others

One of the major reasons that I became a paramedic is that I love helping people. I'm good at it. I don't fluster easily in emergency situations. One of the reasons I became a firefighter is I love to help people. Shocking huh?! I take my position as a civil servant very seriously. As a medic I am a staunch patient advocate. As a firefighter, I try to do what is best for the citizen that I am serving.

I was once naive enough to think that that was the way all fire departments work. It's been a while since I thought this way but I still get angry when I see the way some cities/departments provide emergency care.

Let me give you an example of what I think is a better way of doing things (maybe not the best but better). I grew up in Southern California. There are many largish fire departments (between 6 and 10 stations each) in the area that I called home. These departments all started using one dispatch center, reducing response times because you don't have to transfer the call to another dispatch center.

Another way they improved service was to drop all borders. Each unit has a GPS tracker. When a call comes in the computer tells the dispatcher which is the closest unit to the call, regardless of the jurisdiction. The cities and fire departments (and I would think PD as well but I'm not sure) mutually decided that getting help to the citizen in need was of more importance than who provided the help.

We'd love to help you but you're on the wrong side of the dotted line on the map.

This is not always the case. There are several departments with which we share borders. For various reasons (in some cases noses of some politicians have been bent out of shape, another case, the members of the FD act as if they are better than us) these smaller departments feel that they do not need to have the closest unit respond to an emergency instead electing to have their own unit respond.

In one of the cities my department has a station within their city limits. Yet, if the person that lives next door to our station calls 911, he will have the engine from almost 2 miles away respond. The captain on that engine may or may not request that we be dispatched since we're closer.

One day, while working overtime at that station, we had one of the residents from a half block down stop by with his son for a station visit. The dad was telling his son that if they had an emergency we would come help. I stopped him and explained that we would probably not get dispatched to the call even though we are the closest unit.

It's frustrating and childish to me. I would love to be able to sit the people in charge down and ask them if they think they are really trying to provide better care to the people. Stop getting into pissing contests like you're 13 and start doing what's right for your communities.

Progress is coming but it's slow.

Tuesday, October 19, 2010

Death And Dignity

 The call came in just after 9 in the morning. A possible DOA.

As we pulled up to the house there was no one to greet us, no one outside in a panic, no one screaming in panic.

Inside, the body of a nearly 90 year old man lay in a hospital bed. He had died sometime during the night. His wife and daughters were solemn but not openly crying. His death had been expected. This was why he had come home.

As I went through the motions of checking for signs of life the family explained that he had had severe respiratory problems. He had been on hospice care and had recently come home from the hospital. Rigor had set in, there was nothing we could do for him.

After verifying that he had died we switched gears and turned to the family. We asked if there was anything that we could do for them. If there was someone we could call. The oldest daughter explained that they had already contacted hospice. His wife explained that they were one week shy of their 69th anniversary.

The widow did have one request. They had tried to get her husbands wedding band off of his finger but were unable to do it. I bent over the body, reaching for the far hand. I found the ring, and with some struggle, removed it for her. This started the tears.

As we were leaving I couldn't help but notice the wall in the front room. It was covered with photographs of different sizes documenting almost 70 years of marriage.

At least he had come home to die on his own terms, surrounded by those he loved. A little more dignity in death than dying at the hospital.

Monday, October 18, 2010

Dazed And Confused

I wake up and look around. Very confused. It's 0328 hours.

Where am I?

It takes my brain about 2 seconds to come up with the answer. I'm at station 72 (working an overtime shift).

Why are the lights on?

About half way through this question my brain burns through the mental fog. I must have a call.

I get up and groggily stumble towards the apparatus bay. Time to go help someone. Hopefully by the time I get there I will be mostly awake.

Wednesday, October 13, 2010

Live Fire Demonstration

This is a couple of videos of a night time fire demonstration. I thought it was a fun to watch and decided to "borrow" it from It makes me want to have my department put on a demo of our own.

Notice that the cop was the first one racing to the scene? Even during demonstrations there's evidence that all police officers want to be firefighters (I hope my buds in blue know that I'm kidding).

Being able to do stuff like this makes up for the vomit.

Monday, October 11, 2010

Not On The....Boots

Engine 551, respond to the clock tower for a woman in and out of consciousness.

Once again someone decided to do a little too much at the fair. We pulled up to find the patient sitting in those chairs that have the foot massage (for something like $45 dollars per foot I'm sure). Her family was a little anxious. To be more blunt, they were annoying and were more in the way than anything else.

My patient was weak and dizzy. She looked pale. Mid assessment she passed out. This really set her family off. They were screaming for us to do something. Little did they know that we had switched gears and were now making sure that she was still breathing and that she had a pulse. I held her up while the rest of the crew grabbed the gurney. She started to come around just before we moved her. When she did regain consciousness she first looked around, confused. That look morphed into another, very recognizable facial expression. The one that people get right before the vomit.

The rest of my crew had seen it as well and jumped away faster than a rat off of a sinking ship. I was holding her up so I had no where to run. All I could think, just as she started to throw up was not on the....vomit splatters all over my

We loaded her up and took her back to the aid station to wait for the AMR unit. One of the other medics was kind enough to take over for me while I went and decontaminated my boots.

Have I mentioned lately that I love my job?

Friday, October 8, 2010

The Lighter Side Of Medicine

After the last couple of serious posts I think a little more humor is called for. I found this video in the comment section of another blog. It's hilarious. More so if you have ever treated a patient like this!

Thursday, October 7, 2010

Email From The Man

This is an email that was sent by one of my readers to Kenneth Stokes (click on his name if you would like to email him as well) in response to his criticism of the way the paramedics did their job. Read the original post here.

Mr. Stokes,

I am befuddled and appalled by your criticism of the Paramedics in Jackson.  This of course is in regards to your press conference where you lambasted the company AMR and stated that the paramedics needed to, "...take the risk, you can't let citizens die, or sit here wounded because you're sayin' 'I'm not safe.'"

I applaud your camera-op heroics, because I assume that if you were on scene at the Pleasant Oaks Apartments you would do all in your power to help that young man.  Even if it meant you getting shot yourself, right?  

I ask you this, what good is a downed paramedic going to do for you?  In recent years we've all heard the news reports of gun violence.  Now think with me, if someone took the initiative to shoot this young man, don't you think that person would use the gun again.

Now continue to think with me, if only there were a force that was highly trained on how to deal with gun violence.  Maybe a group that had protection and guns of their own.  Maybe we could call them the Police.  

The Police have a job to do, and from what I've seen and read they did it effectively, allowing medics to treat the young man within 8 minutes after receiving the call.  NOT the 21 minutes you claim. 

You see everyone has a job to do.  The Police secure the scene.  The Medics treat the victim(s).  The City Council member then has the job of placing blame on a group to make themselves look more important.  Or maybe, just maybe, the City Councilman should instead make the city safer by curbing the violence which ravishes the city they serve.

The Man

To "The Man," I loved the letter. Hopefully more people are writing this jackhole (a term a good friend used to describe Mr Stokes).

Wednesday, October 6, 2010

Watch It Burn

It's a sad story when ever someone loses their home, no matter what the cause. But this story has caused some heated emotions. Understandably so.

But, sad as it is, the situation was brought on because of several factors. The South Fulton City Fire Department is a pay for service fire department for citizens in the local rural area outside of their jurisdiction. They charge an annual fee of $75 for the contract. If someone lives in the area and doesn't pay for the services, they don't get them.

I know that a lot of smaller departments will charge for services rendered to people that don't live and pay taxes in the area. Such as when someone passing through on the highway has an accident. It's a way for them to recoup the costs of helping someone out that hasn't paid for services.

I'm glad that the local citizens reportedly aren't upset at the firefighters. I know that firefighters want to fight fires. Period. We don't care where, when, whose it is, who paid....we just want to fight fire. The issue is with those in power above us.

So the question is was the city of South Fulton justified in refusing service. I think that they were. Let me explain why I believe this way.

To start with, it is a service offered for a fee. If you don't pay the fee, you don't get the service. So why not let Gene Cranick pay the fee now that he has a need for the fire department. In order to answer this question you have to be able to look at the situation from a large scale perspective. The fire department uses the money generated from these fees to help pay for training, upkeep and equipment.

So why not let Mr. Cranick pay the $75 fee as his house is burning down? If the department allowed that then the only people that would pay money into the system would be those actually having the fires. This would dramatically increase the service fee. Also, according to the Onion County statistics, there are several departments that do just this. That is bill for services rendered. They are only paid 50% of the time.

I think that the bigger issue here is that the people of Obion County have decided that they are happy with this type of fire protection. Sure, there are some that don't but they are in the minority. In 2008 the county did a feasibility study seeing if they could form a county wide department instead of having 8 separate departments covering most of the county. Here's a list of those departments:

• Hornbeak Fire Department
• Kenton Fire Department
• Obion Fire Department
• Rives Fire Department
• Samburg Fire Department
• South Fulton Fire Department
• Troy Fire Department
• Union City Fire Department

Of the 8 departments only Union City Fire has career firefighters, 42 of them. The rest of the county is covered by 144 volunteers.

The study showed that with a 0.13 cent property tax the county would be able to provide fire department coverage to the entire county and improve response times. For reason that I was not able to find, this consolidation did not occur. That means the elected officials of the individual communities must have turned it down. So the issue goes back on the voters. They chose their elected officials. Maybe it's time for a change.

Furthermore, Gene Cranick chose to live in an area with sparse fire protection. That is a risk you assume when deciding to live in a rural area. It's like living in California and deciding not to get earthquake insurance on your house. Sure, you may not need it. But if you do and you don't have it you're screwed.

Basically I feel that this is a problem that the people of those communities have allowed to happen. They need to elect people that will make the changes that are needed for better coverage. Maybe they need to be willing to pay a little more in taxes as well.

A little side note. In the news story the homeowner said that the fire started in a pair of 55 gallon drums and then moved to a shed before getting to the house two hours later. I know I'm not getting the full story here. Was someone there when it started? A garden hose should be plenty to stop a fire like this in the early stages. Something doesn't seem right to me with the way the story has been told.

As for the firefighters. I understand why they followed orders and didn't attack that fire. But, as I understand it, those firefighters are all vollies. I would have stepped away from the IC and said that as long as I'm not needed by the department I'm going to go help my neighbor. I may not have had an engine and hose but I would have done what I could. At least I'd like to think that's what I'd do. It's tough to say since I wasn't there in the situation. It's always easy to armchair quarterback things like this.

Monday, October 4, 2010

Is The Scene Safe?

Ask any EMT just out of school to walk through a scenerio with you and it will always start out the same. Is the scene safe?

This is something that is drilled into EMS personnel from day one. In any emergency situation, we need to make sure that we don't add patients to the problem. Another way of looking at it is if I get injured/killed, who is going to take care of the initial problem? No offense to the general public, but my highest priority is going home at the end of my shift. I think most people would understand this position. Not everyone.

There has recently been a mild uproar in the EMS blogging community about the comments made by Kenneth Stokes. Mr Stokes is upset because of the apparent inaction of an ambulance crew in his community. The AMR unit was dispatched to a shooting and were "staging" or waiting until the police officers cleared the scene. Roughly 20 minutes elapsed from the time of the call to the time that the patient was seen. Stokes asserts that the medics had a responsibility to go into harms way to treat the patient.  

Read the news story here.

My question to Mr Stokes is this: Why would you send someone into an emergency situation for which they have not been trained or equipped? Medics (there are exceptions to this) are not trained in police tactics. They aren't issued body armour and a gun. No where in their job description does it say that they are expected to perform under gun fire. Do you ask your police officers to go into a hazardous materials release to get a victim? I bet you wouldn't. And you'd be right not to do that. Without the training and equipment you would just be sending in another body for the FD to drag out. And trust me, the cop would come out before the civilian.

Mr Stokes, our job is dangerous. We do it anyways. We deal with the dangers for which we have been trained. We work on streets, freeways, highways, in upside down vehicles, with blood borne diseases, fires (in the case of fire/medics), electrical hazards, HAZMAT situations and do it all as carefully as we can. We know those risks and do what we can to mitigate them. The way we mitigate a potential violent scene is by calling PD and letting them do what they have been trained to do.

If you agree or especially if you disagree, I'd love to hear from you.

Friday, October 1, 2010

Money Troubles

I've worked in areas where my crew and I were fairly isolated. It regularly took 30 minutes for any additional help to arrive....but we knew they were coming.

For those of you that don't know the city of Detroit is having an EMS crisis. They have very few ambulances that are functioning. Recently there have been several stories in the news and in the blogosphere showing just how bad it is. The city does not have the money to repair the rigs. It's so bad that there have been accidents involving emergency vehicles that may have been caused by brake failure and bald tires.

I'm not going to say that we, the voting public, need to raise taxes to pay for emergency services. I am going to say that we need to look a little closer at the budgets (on a local, state and federal levels) and figure out what needs to be done in order to keep basic needs met. I for one don't want to have to wait for 30 minutes for a paramedic in the middle of a city.
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