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.

Who Needs A Helmet?

Dispatch gave us an update while we were rolling. We were responding with Engine 110 for a traffic collision. Unfortunately the collision was between a vehicle and a high school student on her way to school.

Engine 110 arrived just before us. They were kneeling at the patient who was sprawled out on the street. The street was busy. It is a major artery in the city and cars get moving fast.A few feet away from the knot of firefighters there is a skateboard. Well, half of a skateboard. The other half was no where to be found.

The young woman was unconscious. The medic checked to see if she responded to painful stimulus.  She did. She contorted her body in decorticate posturing which is indicative of severe brain trauma. WE placed her in full spinal immobilization and loaded her up into the ambulance.

Since engine 110's crew only had 1 medic and we had two on my crew I road in to the hospital with the ambulance. In the back we started two IV's, placed her on the heart monitor and checked her CO2 levels. A more detailed head to toe exam was also done. There were no other injuries that were visible other than a bad goose egg on here head.

During transport the patients condition continued to worsen. She started having decerebrate posturing. Her brain was swelling and causing further injury.

At the trauma center we were met by the trauma doc and the neuro-surgeon. We gave our report and answered a couple of questions regarding the scene including probable speed of the vehicle that hit her. The surgical team whisked her away to CT for a brain scan and then I assume she went into surgery. The neurologist didn't have high hopes for a positive outcome.

She probably would have been at school the next day if she had been wearing a helmet.....correctly.

No Relaxing

All of the chairs were pushed back out of the way and the table had been moved near the wall. In the middle of the conference room was our patient. He was sitting on a chair cradling his left arm. 

I introduced myself and asked him what had happened. He said that during a meeting he had leaned back in his chair and stretched both of his arms toward the ceiling (I guess is was a boring meeting). During mid stretch his left arm popped out of its socket.

I asked if he had ever dislocated his shoulder before. He hadn't. He had no medical history and wasn't taking any medications. But he was in a lot of pain.

After starting an IV I gave him some morphine. My patient felt much better after that. So much so that he started cracking jokes. Hr started asking if I would write a note to his wife stating that his injury would preclude him from changing any diapers for the next 6-8 weeks.

Good luck with that one.

Dexter?

We were toned out for a 35 year old male with cuts to his hands.

As we pulled up to the scene just after midnight we could see our patient leaning on the back of a car holding a towel on his hand. There was also a small knot of people on the sidewalk looking on.

Approaching the man I could tell he was inebriated. I stayed a couple feet back (because I don't trust drunk people) and asked what was going on. The man explained that he had been drinking and got angry. Not angry at anything in particular but just angry. In his fit of rage he decided he would take out his frustrations by hitting the bedroom window.

I then had the man remove the towel. His hand was covered in dried blood and there was a little but of fresh blood still dripping from his pinky. Wanting to know how much blood he had lost I did a quick walk through of the house. The entire time the man's uncle mumbled and complained about how his nephew was a drunk and never did anything. Inside the scene appeared to be something that Dexter would love. The guy had, after discovering that his finger was bleeding, decided to walk through the entire house shaking his hand essentially throwing blood on the floor, walls and ceiling in each room.

Outside the ambulance and PD had arrived. With the help of a garden hose the medic had washed off the hand to find that the patient had a decent size cut to his pinky but that was it. After a quick bandage the patient refused transport. We explained that he still needed stitches. The drunk said that he would drive himself. We quickly pointed out that he was too intoxicated to drive. Evidently still not wanting to go to the hospital the drunk turned to the closest cop and pointed at him saying, "I'll get a ride from him."

Without missing a beat the officer grabbed the outstretched hand, twisted it behind the back of the belligerent man and cuffed him. That pretty much ended my call.

Know When To Fold 'Em

The tones awoke me from a deep sleep. I groggily put on my socks, grabbed my watch and headed for the truck. We were responding for an assault victim. The AMR crew must have been posting nearby because they were bearing down on the station as we were pulling our. We let them have the lead.

About a block out the dispatcher let us know that there were multiple victims of a domestic dispute. He asked if we wanted another engine. We declined and said we'd ask for one if we needed it.

The AMR unit pulled up to the sea of police vehicles first. They jumped out and were ushered to a man laying on the ground and in handcuffs. We were told that there was another patient up the street that wanted to be signed out AMA.

As we made our way up to the second knot of people we found out there was more than just one other victim. We checked on 4 people, all of whom had been in some sort of physical altercation. They all had some minor scrapes and bruises but were ok.

Once everyone in our little group had signed the appropriate paperwork we made our way back to the AMR crew. They were just getting their patient settled onto the gurney.

Since they didn't need our help I asked one of the officers what had transpired. I was told that the guy AMR was treating had presumably ("all suspects are innocent until proven guilty in a court of law") had a domestic altercation with his girlfriend. He then continued to assault several other family members until they realized it was 5 on 1. At this point the suspect was chased down the block and was "detained" (the officers verbiage, not mine) by the family. While they were "detaining" him (hehehe) a passerby called 911. PD arrived to assume custody of the detainee and called us for an EMS check on all parties involved.

Even when drunk, you should remember that 5 on 1 is almost always bad odds.

Someone Hit My Station?

The tones went off at oh dark thirty. I must have been still in my sleepy daze because I thought I heard the tones for a traffic accident and my station address. Did someone really hit my station?!

I jumped into my bunker pants and grabbed my jacket. I looked out the windows on the apparatus bay doors to look and see if there was anything right out front. Nothing. My captain had checked the front door on his way to the rig. Again, nothing.

We pulled out of the station and saw a vehicle that had crashed into building down the block. I guess the 911 caller used our station as the reference when reporting the location of the accident.

The car had crossed oncoming traffic lanes, hit a power pole and then went head long into a cinder block building, oddly enough, an auto repair shop. The woman that had been driving (term used loosely) was just about the legal drinking age. And she was drunk. Plastered.

She was still wearing her seatbelt and the front airbags had deployed. My engineer immediately went for the car battery (disconnecting it helps to reduce the chance of another airbag going off and injuring us). I poked my head in the car and turned off the vehicle. I also placed it into park and set the emergency brake.

While trying to stay out of the airbag deployment zones as much as possible I did a quick assessment. I noted that the patient had a fractured right arm and that she was bleeding on her right leg. AMR was on scene and getting the backboard ready. Their EMT grabbed c-spine and I applied the collar. Once she was out of the car and onto the backboard we were able to do a strip and flip (this is where all of the patients clothes are removed to look for any injuries that may not have been so obvious). We found that the young woman had managed to break the bones in her lower leg and now they were protruding through the skin. This was the source of the blood I found earlier.

With the patient packaged and on her way to the ER we were free to make sure the vehicle wasn't leaking any fluids. Since we had already disconnected the battery there wasn't anything else for us to do. We headed back to the barn to try and get some more shut eye.

No sooner had we stripped out of our turnouts then the phone rang. It was dispatch saying that PD was requesting are presence on the scene of the accident we just left. Evidently the car was pinned against a power box of some sort.

We walked back over and looked. The car wasn't against a box. In fact, it had bounced back off of the wall and wasn't touching anything. And PD said that they didn't ask for us. Maybe dispatch was bored.

Assault With Bodily Fluids

I am usually a very cool customer when it comes to dealing with patients. Even the ones that are really annoying and/or offensive. But there are times when my limits are stretched.

Or both

We were called to one of our local dive bars for a 'man down.' As we pulled up we could see that PD was there talking to a man sitting on the sidewalk. There was blood all over the concrete.

My patient was walking out of the bar and was supposedly hit in the back of the head by someone with something. He then fell to the ground and hit his head causing a 4 inch laceration. Being a head wound there was quite a bit of blood.

I knelt down next to my patient and inspected his head wound while holding his head and neck still. The bleeding had mostly stopped. I asked my engineer to bandage it up and I started my assessment to see if I could clear c-spine. I asked my patient if he had any pain in his head or neck? He responded by swearing at me and telling me that he was bleeding.

No ****ing duh Sherlock.

I tried again and got the same response. After a couple of other questions to determine if he was alert and oriented (he was) I asked him how many drinks he had had. In response he reached his hand up to his head, covered his hand in blood and proceeded to wipe on my turnouts.

At that point I was done. I asked my captain to throw a c collar on the guy. By this time AMR was pulling up. I walked over and gave them a rundown on the call. Basically I told them that the....patient was hit and the head, was bleeding, was alert and oriented and being a prick. Since he didn't want to answer questions he was going to have to be placed on a backboard. Just precautionary. Usually I don't like placing people on a board because it's really uncomfortable, even painful. This time I was happy to do it.

While I was talking to the AMR guys I could hear my captain yelling at the patient not to grab him. At least the drunk wasn't just being difficult with me.

While strapping him to the board the pain in the caboose kept trying to sit up and yell that we should be trying to find the guy that hit him. We assured him the the police were doing just that. We finally got him good and strapped down and loaded in the ambulance. The last thing I heard from him was him yelling obscenities at the medic in the back of the ambulance.

Stupid patients.

Why So Serious?

There were cops everywhere. The blue and red lights on their vehicles mixing with our red and white lights caused an almost strobing effect on the scene.

A sergeant met us at the sidewalk and said the guy was inside on the floor. The assailant was gone. Walking around the outside of the house were several other officers. From the back of the K-9 unit a police dog could be heard excitedly barking. In the front yard a woman sat in a state of shock.

The blood trail started on the walkway to the house. As we followed it up the three steps to the front door the splotches of reddish brown grew in size. Through the door I could see my patient laying on his right side. He was wearing a sweatshirt and Levi's which were both soaked with blood. The man was trying to cradle the side of his face and head with a towel.

I squatted down (I didn't want to kneel like I would normally do because of all the blood on the floor) next to my patient and introduced myself. He was alert and oriented but understandably a little panicked. He said that he had been stabbed at least once and then had walked into the bathroom to get a towel. On his way back outside he had only made it to the living room.

I had the man remove his hands and his towel so I could get a look at what I was dealing with. He had a full thickness laceration starting about 2 inches behind his left ear. The knife had sliced forward from that point just missing the ear lobe and stopping less than an inch away from the corner of the mouth. It looked like the knife wielding bad guy had tried to slit my patients throat but was thwarted by a downward tilted head. Unfortunately for my patient the bleeding had stopped. He was too low on blood the keep bleeding from this serious wound.

My engineer started cutting the clothes off my patient while I applied a trauma dressing. As we rolled the patient off of his right side we discovered another stab wound. This one was in the upper right quadrant of his abdomen right where his liver should be. It was bleeding quite a bit and his skin was bulging from blood that had accumulated it. In my mind my patient just went from very serious to critical.

Thankfully AMR showed up just then. The paramedic had been told outside that it was a bad facial wound but realized as soon as he saw us working that it was more serious. We placed a hasty dressing on the abdominal wound and lifted the patient onto the gurney. On the way out we put him on oxygen. Since we couldn't strap the mask to his face we simply tried to balance it as best we could.

In the back of the ambulance I checked lung sounds to make sure the knife hadn't caused a pneumothorax. The EMT had everything set up for an IV so I went for it. I heard the driver jump in the front seat. She asked if we were ready to roll. I asked for 5 seconds. Within three seconds there was a large bore IV in his left arm. We then rolled code 3 to the trauma center at the local university.

The patient was compensating well for the loss of blood. While his heart rate had increased his BP stayed above 110 systolic. We watched his BP closely. If it fell too far we would have to give him some fluids to make up for the loss of blood.

With one IV in and dressings on the wounds I found I had the time to do another quick head to toe.I hadn't missed any other wounds. Then I focused on keeping the oxygen mask on my patient and talking to him. Both to reassure him and to continually assess his mental status. An altered mental status would probably be one of the earliest signs that he was losing too much blood.

While talking to my patient I noticed there was some blood coming out from the bandage on his face. A lot of blood. I asked for another trauma dressing and held both in place with direct pressure. The patient was now becoming slow to respond to my questions. His BP was falling. We gave him a fluid challenge to keep it up. The problem with that is that blood carries several vital things to and from the body which saline is not capable of doing. At best we were stop gapping. The patient needed blood and surgery, fast.

The AMR medic started a second line, put the patient on the heart monitor and rechecked vitals. He also called ahead to the medical center to let them know we were coming.

Just a few never ending minutes later we pulled up to the ER. Everyone cleared out of our way and stared at out blood covered patient and gurney. Inside we were met by an army of hospital staff. We swapped the patient over to the hospital gurney and I started to give my report to the MD.

Now I don't mean to offend trauma docs but you guys are arrogant pricks. At least a lot of you are.

I had not even finished my first sentence and the doctor put up his hand and ssshhhhh'ed me. He didn't want to hear a thing I had to say. No chief complaint, vitals, treatments....not a thing. He wanted his trauma nurse to do a once over on the patient and to tell him what she had found. The last thing I heard was the MD yelling (so much for staying calm, cool, and collected) that he wasn't interested in the laceration to the patients face.

After the call the AMR crew cleaned their rig and did paperwork. They were kind enough to drop me off at my station as well. When I got back to the station I had to swap out my turnouts so I could wash out the blood on the ones I was wearing. Then it was back to bed.

There And Back Again

It was right out of the commercial. Out patient had fallen and couldn't get up so she used her call button to summon help. The operator even informed us that the woman had a key hidden in one of her flower pots. Seemed like this was going to be an easy call.

Not so much.

She lived on the second floor of her apartment building. As we made our way to the front door we started looking for the specific flower pot. Carefully looking around the fake plant we spied the key. The wrong key. It wasn't even the right type of key. Although if we wanted to take her Toyota for a joy ride we could. Fortunately for our patient firefighters aren't easily discouraged. Getting into her home was now a challenge.

The first thing we did was to check the kitchen window. We were able to do this just by leaning over the railing. It was locked. The next step was to check the balcony on the back of the apartment. Of course to do this I needed the ladder. Off the the rig I went.

On my way to the rear of the building my captain stopped me. He said that a neighbor had a key. The poor guy had to wake up at 1 in the morning, get dressed, find the key and give it to us. So back to the rig I went to put away the ladder. On my way I ran into the AMR crew that had just shown up. I pointed them in the right direction and then put the ladder away.

Meanwhile, back at the front door, my captain tried the newly found key on the door. After getting the security door open he was unable to unlock the front door. Perhaps it was a different key. So while he continued the frontal assault I decided to go get the ladder.....again.

By the time I made it to the bottom of the stairs the front door clicked open. It had just been a sticky lock.

Inside we found the 84 year old woman laying on the floor at the foot of her bed. She was alert and oriented and said that she just stumbled and fell. She denied any loss of consciousnesses but was complaining that her left hip hurt really bad. After the AMR medic cleared C-Spine we discussed how we were going to get her out.

I suggested that we use a KED device around her hips to stabilize them (her left side was dislocated or fractured) and then try to move her on a carry all (a large tarp with handles). I watched as the AMR crew started to move the old lady. She immediately winced in pain.

The AMR medic looked at me and said that she didn't think this was going to work and then asked for ideas. I suggested that she start an IV and give her some morphine before we move her. That way we have done everything we could to make her comfortable.

After a couple of doses of the narcotic was placed the patient in the KED and moved her downstairs to the gurney. Needless to say after all that I had a tough time falling back to sleep.

When To Roll Your Vehicle

The best way to survive a vehicle accident is not to be in one. Other things you can do is to use the safety equipment installed in your car. Doing something as simple as putting on your seatbelt can save your life.

If only you could control when the accident were to occur. I would tell you to have it sometime between 7 and 9 in the morning, at least in the city. That's because this is prime off duty firefighter commute time. If something bad happens, qualified help is probably right behind you.

After working an overtime shift I hopped on the freeway and headed home. I was about 15 miles into my commute. I was in the zone. All the windows in my truck were down, the music was blasting away. It was a beautiful morning.

Then things seemed to slow down. I watched as the black car to vehicles up was hit in the side by the car next to it. The driver hit her brakes and slid into the K-rails.

K-rails are designed to "...both to minimise damage in incidental accidents and reduce the likelihood of a car crossing into oncoming lanes in the event of a collision." It did exactly as it was designed to do. But in the process of preventing the car from entering oncoming traffic it caused the vehicle to flip. The car rolled over one and a half times ending up on its roof sliding down the number 2 lane. The vehicle that caused the accident pulled over to the right shoulder without incident.

I hit the brakes and my hazards and made sure the person behind me wasn't going to try and use my tailgate as a hood ornament.I slowly picked my way through the debris field and stopped just past the upside down car. As I exited the truck I noticed another off duty firefighter from a neighboring department mirroring my actions. We approached the drivers side window and saw that she appeared mostly uninjured and that she was climbing out on her own.

She had been wearing her seat belt and the airbags had done their job. I did a quick assessment on here and found that she had only a little bit of pain to her right arm, probably from the airbag. After a few minutes the first due engine pulled up. I gave the captain a quick rundown and headed back to the commute.

If you have to get into an accident, between 7 and 9 in the mornings would be the time to do it.

Shots Fired

It's been less than a week since the tragedy in Aurora, CO. It's been a hot topic at the fire house just like everywhere else. But here we talk about what we would do in that situation. How would we respond? What can we learn from those that responded that day? Would we be ready?

We were across the street getting lunch. We had placed our order at a great little restaurant and were waiting for our food when we heard engine 57 (from the neighboring district) get dispatched on a medical call. The follow up information is what got us out of our seats and headed that way. Dispatch had engine 57 stage because there were reports of shots fired at the mall.

Immediately the worst case scenario starts running through my mind. Multiple victims, triage tags, ICS, sucking chest wounds, etc. 

When we arrived on scene we met the IC at the staging point. Within a couple minutes an officer came over and filled us in. One of the stores in the mall had been robbed at gunpoint and shots were fired. At this point no victims had been identified. 

A few minutes later we were cleared from the scene. Thankfully we still don't know what the first responders in Aurora had to do.

Penetrating Trauma

We pulled out from the driveway as the apparatus bay doors started to close. Dispatch immediately raised us on the radio, "Truck 51, possible GSW, staging required."

We pulled up to the gate to the apartment complex. It was one that we visit quite often and we knew more or less where the apartment was. PD had swarmed the location managing to block all entrances with empty patrol cars. I hopped off the truck to see if one of the cruisers was unlocked so I could move it. No such luck.

A few minutes later we received an all clear notice. One of the officers ran out to move some vehicles to allow us access. We pulled in and went around to the back of the complex. I grabbed the medical equipment and looked for the right apartment. Through an open window I saw a couple of uniforms so I headed in that direction.

Once in the apartment I was directed to the front bedroom. Inside an officer somberly shook his head indicating the the suicide attempt had been successful. Rounding the corner of the bed the officer asked me to be careful of the shell casing on the ground for evidence. The 30 year old male was laying on his right side.

I checked for a pulse and breathing just to be sure. I then inspected the wound a little closer. This wasn't morbid curiosity. I was looking for brain matter because its presence would mean we wouldn't be working the mega code. In other words no life saving measures would be done. There was brain matter in several places on the body and the bed. As a matter of protocol my engineer placed the electrodes of the monitor onto the body. We watched as the line on the monitor, that would normally be making predictable jerks up and down, lay flat.

I  called it. Time of death, 2032.

Outside another officer took down our names and unit number. My engineer and I quietly continued our conversation that had been interrupted by the call while my captain finished some paperwork. The scene was turned over to the cops and the coroner was called. We headed back to the station, ready for another call.

`Tis The Season

We were dispatched for a slip and fall. Nice and generic. I've been on "slip and fall" calls ranging from a person needing a hand to get up to a person on the third story roof that had a stroke and fell, and a lot of stuff in between.

This time we pulled up to find a waver. Someone, usually a family member, that is panicked and is out in the middle of the street to wave us in. Potentially a bad sign. In front of the one story house there was a ladder. Someone had been hanging Christmas lights. My patient, a man in his early 70's, lost his balance and took the fast way to the ground.

From 5 feet up he landed on the cement driveway but not before his head came into contact with the brick wall on the side of the driveway. He was alert and oriented and had some minor bleeding from the back of his head. His family, in a near state hysteria, explained that their father had been knocked unconscious when he fell.

We grabbed c-spine and applied a neck collar. We also placed some 4x4's over the wounds on the back of his head. The trauma assessment revealed that he had a couple of skin tears on his arm as well. Other than that and his head lacerations he appeared to be in stable condition.

The guys at AMR helped up package the patient onto a backboard. The last thing I remember after loading the old man into the ambulance was one of the sons complaining that he had told his dad to let him hang the lights.

Fillet Knife

Engine 52 was off at training and that left us covering their district. First think in the morning the tones went off. We were being dispatched to a stabbing in 52's district.

When we arrived on scene the Barney Fife patrol was already there. They directed me to the top of the stairs in the apartment where, just inside his bedroom, I found my patient.

According to his son the old man was in the late stages of dementia and had been hallucinating. That's when he took a knife and stabbed himself about 3 inches to the left of his belly button. It was very obvious where he had stabbed himself because the fillet knife was still embedded in his abdomen.

While the officers held the hands of my patient I carefully stabilized the knife with bulky dressings and a lot of 2 inch tape. The bleeding had been minimal, at least on the outside, and had already stopped. After taking care of the wound we decided to get a quick check of his vitals. They were all within normal limits.

By that time AMR was there and we packaged him up. On the gurney he was placed into restraints. This was as much for his own protection as for ours. He was obviously willing to stab himself once and we weren't going to take a chance since the knife was well within his reach.

The patient was lucky that he didn't hit anything vital or this call would have been a little more intense.

Wannabe Medic Tries To Fly

It was our 4th call in the first 3 hours of the shift. This time we were headed to the local motor cross park for a fall with injuries. Imagine that.

When we arrived on scene we had to hike a couple hundred yards to where our patient was waiting. He was sprawled out with both arms at 90 degree angles from his body with his palms up. He had his right leg bent at the knee with his right foot tucked under his left knee.

I walked up, introduced myself and asked what hurts. While I did this one of my firefighters knelt behind the rider and held his head in place. My patient told me that he had fractured both of his forearms and had a tib/fib fracture of the left leg. He also denied losing consciousness or hitting his head saying that he had braced himself with his arms preventing a head injury.

Since his assessment of his injuries was really good I asked him if he was an EMT. He said that he was and that he was (that is the key word) in his second month of paramedic school.

After doing a quick once over for life threatening injuries I decided that I had time some time to stay on scene and make life a little better for my patient. I had my engineer spike an IV bag for me while I started the line. I wish all my patients had veins that good. About this time AMR showed up and the newly arrived medic tried to chastise me for starting an IV on the broken arm. I had already told him about the patient's injuries so I asked him witch arm should I use? Then I told him that I was starting the IV high on the upper arm so it wouldn't interfere with splinting or any treatment in the hospital. I wanted to say go away and let me treat my patient.

Once the IV was going I gave my Superman impersonating wannabe medic some morphine for which he was very grateful. The AMR crew splinted his arms while my engineer and captain worked on getting his riding boot off of his left foot. After a couple of minutes he was splinted and strapped to a backboard. The MS helped to keep his pain down to a minimum.

The funny thing is the entire time we were there he was, understandably, worried about medic school and his inability to do anything while both arms were in casts. My entire crew and I passed knowing looks while suppressing a chuckle every time he would complain. We knew what he should be worried about was who was going to be wiping his butt for him.

I'd rather break both my legs.

Stabbing...Kind Of

For the fourth time that afternoon we were toned out to a medical aid with staging. This time it was for a stabbing at Rite Aid. We staged a half block away and watched as PD swarmed the area. They set up a perimeter really fast. They left us waiting for what seemed like an hour.

After about 5 minutes we were cleared to enter. We pulled up and jumped out. There was already caution tape stretched across the entrance. One of the officers raised it so we could slide past. Another officer, just inside the front door, directed us to the center of the store. We asked how bad it was and he said it wasn't.

As we approached the center of the store I noticed random drops of blood on the floor. As I turned onto the center isle I noticed a young man, in a security guard uniform, sitting on the floor. I didn't notice any bleeding so I asked him if he was hurt. He held up his and and I could see a bit of dried blood. I've seen paper cuts that have bled more.

The assailant had managed to take a small slice of skin off of the security guards thumb. I asked the guy if he wanted to go to the hospital, which he thankfully refused. As I placed a band-aid on his wound I asked if had had a recent tetanus booster. He had no idea. So before signing him out AMA I made sure he understood that he needed to go to his MD or a free clinic or an urgent care to get that shot.

As we walked out we canceled AMR. Another life saved (this last statement is literally dripping with sarcasm).

What Goes Down Must Go Up?

It had been a quiet shift. We decided to head over to the off road park to check things out. They were having a 3 day professional event which is fun to watch and usually good for providing a few calls. They always have a private paramedic ambulance on standby but anything serious or requiring manpower and we get a call. I told my engineer that every time we go over for a tour we end up getting a call there. It's almost as if the riders know we are close so they try some of the riskier moves, and fail.

We started down on the West side and worked our way East, stopping to people watch and to chat to the rangers. While traveling down the dirt road a dirt bike came at us in a hurry. A young man pulled up and said that a young girl had gone into the stream up one of the canyons. We flipped on the lights, notified the rangers and dispatch and headed that way. We also requested a helicopter figuring it's better to have it on its way and not need it than vice versa.

When we arrived at the accident we found a 11 year old girl laying on the trail. Her dirt bike was at the bottom of a 10 foot deep ravine. One of the "helpful" bystanders and decided to pull her up to the trail and take off her helmet. One of the rangers immediately grabbed c-spine for me. I can't say enough positive things about those rangers. They make my job easy.

A witness said that she had accidentally left her bike in neutral when she started down the hill. She accelerated to a speed which made it impossible for her to make the curve sending her into the stream below.

As I started my exam I noticed that she had a laceration above her right eye. The bleeding was relatively minor so I wasn't too concerned. The young lady kept complaining about her right foot. After my physical exam and noting that there were no other apparent injuries other than her cut and her foot my captain asked if I still wanted the helo. As I was about to say no I noticed that my patient started asking the same questions again, indicating a possible brain injury. I decided to fly her.

While some of the guys finished strapping her to a backboard others splinted her leg. I started an IV and then administered some morphine. I was working with an overtime captain and he was impressed that I even considered pain medication. I ended up giving the little girl as much as I could and it took the edge off of the pain from a possible fractured foot. Once all this was done we loaded her into the stokes basked on the back of the rangers 6 wheel ATV and headed down the hill. Part of our crew had already headed that way to set up an LZ.

Just as we got the the landing zone the helicopter appeared over head. Once I made sure the patient was safe from the rotor wash I snapped a quick video.

Once Calstar was on the ground we met up with the crew. I gave a report to the flight nurse who did a quick second check of the patient. We then loaded the girl onto the waiting helicopter, the engine never having shut down. Her father was going to get the ride of his life in the front seat.

After clearing the bird I took another video of them lifting off. In ten minutes she would be at Children's Hospital, instead of the hour it would have taken by ground ambulance.

The Candy Man

Engine 51, respond to the Hungry Valley SVRA for a motorcyclist down. With that we were off again. This time we were responding for someone with a leg injury.

When we arrived on scene we found ourselves at the trail-head of one of the more popular rides. A man was there on the ground holding his 15 year old daughter. They had been riding all morning and she had been doing great. She had been handling some tough climbs like a pro. That is until the end of the ride.

When she pulled into the parking area she slowed down a little too much. Gravity took over and the bike landed on her left knee. The lower leg had a little inward rotation to it and she was in a lot of pain.

The rangers at the park had already placed an ice pack on her knee and were getting ready to splint her leg when we pulled up. I did a quick assessment before starting treatment. She didn't hit her head or lose consciousness. She had no history of medical problems, didn't take any medications and didn't take any medication.

I pulled out the IV start kit and assured her that she wanted me to start the IV more than some other medic or worse, a nurse in the ER. Once the IV was in I gave her some morphine. It took a couple of doses of MS to get rid of most of the pain. With that accomplished we finished splinting her leg and loaded her onto AMR's gurney.

That's almost 30 mg of morphine given out in the last couple of weeks. Just call me the Candy Man.

Man Up

I understand that kids whine and cry. Hey, I just went through a PALS course. That means I'm a trained professional, right?! Ok. Not quite. But I am really good with kids. And I have 3 of the little rug rats of my own. So that's where I'm coming from when I tell this next story.

We were dispatched to a child down in the street. We expected the kid to be gone by the time that we arrived on scene. When we pulled up we could see a small knot of people standing and kneeling by a kid in the street. There was an ER RN at the head of the patient holding c-spine. It really looked as if we had a critical kid.

As I walked up I noticed the 10 year old boy was laying prone with his left leg and arm slightly bent in a normal fashion. I also noted that the kid was screaming bloody murder.The story was that the victim had been racing hes scooter down the hill and lost control. Luckily he was wearing a helmet and he wasn't on a busy street.

He was complaining that he had severe pain to his left hip. We exposed his hip and found that he had road rash. During the head to toe assessment I found that he also had some road rash on his left elbow. When the kid discovered this he forgot all about the hip and started wailing like our siren. Keep in mind, there is no blood. It's a large scratch. Band aid worthy.

I know road rash can be painful. But it's not that painful. My six year old daughter wouldn't have cried that much if she had broken an arm along with the road rash. I really felt like saying 'man up' to the kid. I guess I wasn't feeling to sympathetic that day.

Faceplant

A 16 year old girl was riding her dirt bike when her friends saw her head into a ditch. The girl then hit a rock at the bottom and the bike came to a quick stop. Unfortunately, she did not come to a quick stop for about a half second more when her face hit another rock.

Thankfully she had been wearing her protective equipment. Although the force of the impact did crack her chest piece and her helmet. Her face took quite a pounding.

She had an inch and a half gash on the right side of her jaw. Her jaw had probably been fractured. She had knocked four of her teeth almost all the way out and had bit her tongue, all of which caused significant bleeding, not to mention pain.

We placed her in a cervical collar and checked the rest of her out. We decided, because of the amount of bleeding in her mouth, that placing her on a backboard would lead to a possible airway compromise so we decided to c-spine her on a KED. Not a common use but it served our purposes.

Once that was done I started a line on her and gave her some morphine. By the time that AMR was ready to load her up she was packaged and almost pain free.

Just imagine how bad it would have been without the helmet.