Shutting Us Up

Someone did something that caused three firefighters to be speechless. That's quite a feet.

We got a call for a citizen assist the other night. Usually this means that someone fell down and the family members are unable to get them back into their chair or bed. Imagine our surprise when we were informed that we were going to help someone that didn't know how to clean up the broken wine bottle and spilled wine from under their car in the garage.

I'll wait a second while you re-read that and shake your head. Yes, you read it right.

When we arrived we were met by a woman in her late 30's. She appeared to be a well dressed business woman, and judging by the BMW in the garage, a successful one. She started by saying she only called 911 to get some advice. You see, she was afraid of the flammability of the alcohol in the wine. She said she, "didn't want to blow up in the morning."

We assured her that the small amount of alcohol would not ignite even if she were to start her car now and that by morning the alcohol would all have been evaporated.

After the call, we drove back to the station in almost total silence. The only thing said was, "I don't know what to say."

On a more positive note her 13 year old daughter squealed in delight and told anybody listening that that was the closest she'd ever been to a firefighter. We showed her the truck too. I think we made her night.

Oh! The Irony

So while I was at work I received a negative comment on my post 50mg Of Benadryl And Some Morphine. So I took the time to respond with a blog post instead of a lengthy comment (and I decided that getting negative comments is kinda fun). My original post was about a "frequent flyer" that just wants narcotics. She's well known to every firefighter in the area.

Fast forward about an hour after we went to bed. The tones went off and the dispatcher rattled off a familiar address. As we approach we notice that the front door is open and our favorite patient is waiting for us. She's learned not to ask for Morphine directly. This time she said that the medics before had given her a shot of Benadryl for her anxiety and another shot. She danced around the subject of MS for quite a while. In the mean time we grabbed a set of vitals (which we all well within the normal range).  She wasn't showing any of the signs of being in pain.

She then spent the next few minutes complaining about nausea. She explained that she had been vomiting all day. And that because of the vomiting she was experiencing abdominal pain. That, according to her, was the reason she needed the 'other shot.' Instead, we attacked the root of the problem. We gave her something for the nausea. She wasn't too happy that we weren't playing the game by her rules.

When AMR arrived I gave them a quick rundown on the patient. We then helped her onto the gurney and loaded her up. What was the last thing I heard her asking for as I shut the back door of the ambulance? You guessed it, a shot of Morphine.

Hate Mail

I feel like I've hit a mile stone with my blog. My first hate mail, er, comment anyways. And when I tried to answer it and explain my position a little better, I got another one. So instead of trying to explain things in the comment section I decided to do a post about it.

The original post, 50mg of Benadryl And Some Morphine, was about a drug seeker and my refusal to give them Morphine. In it, I mentioned that we have to ask a patient to rate their pain on a 1-10 scale. I think this is a waste of time because there's no real way for a health care professional to know what the patient's worst pain is. If your worst pain is a stubbed toe than a sprained finger is a   10. If you have had cholecystitis, then a sprained finger is a 2. So if the number rating is arbitrary then I have to go by my assessment to determine how much pan management is needed. 


Evidently Mr. (assumed from the typos and un-lady like language at the end of the first comment) Anonymous didn't like this. He said, 


""We always ask the patient to rate the pain. I generally don't care what they say their pain level is, their body language always tells me what I need to know. So why do we ask? I digress."

how woudl ur boss feel if they saw that? cunt"


I tried to understand where they were coming from. I reread my post and tried to explain where I was coming from. I replied, 


"My Chief is a medic as well and I think he would back me up 100%. I think you may have misunderstood what I was saying. I don't care what number they assign to their pain. My 4 may be your 10. The number is a waste of time but is used for paperwork. I treat my patient instead."


He really didn't like that. Mr. Anonymous commented,


"You have a God complex. It's not up to you to "decide" what a person's pain level is. "My 4 may be your 10". You're not the one in pain so you have no clue how bad their level is. You're what's wrong with the medical field nowadays-you don't listen to the patients and make assumptions based on how YOU judge a persons body language."


So I am going to make a couple of assumptions based on these comments. First, I think Mr. Anonymous has had a bad experience with someone in the medical field that did not his pain or pain management seriously. Having been in severe pain I can imagine the anger of someone that wasn't properly treated for pain. Second, I don't think that Mr. Anonymous is in the health care field. More specifically, in the pre-hospital setting. If I'm wrong, I'm sure he'll let me know.


Mr Anonymous, you obviously think that I'm in the wrong, at least as far as patient care is concerned. Let me explain my approach to pain management. If, through a thorough assessment and examining the signs and symptoms of my patient, I determine that they are in pain, I do everything in my power to relieve that pain.


In a perfect world all I would have to do is trust a person when they say the hurt. Unfortunately, we don't live in a perfect world. I have to deal with people that lie. One of the more common misrepresentations is that of being in pain. People addicted to narcotics have been known to call 911 with the intent of getting morphine. If we as medical professionals were to just give out MS to every patient regardless of our own assessment we would not only possibly be causing more harm to our patient by feeding their addiction but we would then have every addict in the country calling 911 to get their fix. So to keep from doling out medication unnecessarily we have to judge for ourselves how much "pain" a patient appears to be in.  

How do we check someone's pain level? There are actual, physiological changes to the body when someone is in pain. There's a great paper (do you still call it a paper if it's online?) on the subject on the NursingTimes website. I'll provide a quick overview but you can find better detail in the article.


We'll start with the patient's heart rate, it goes up. As does their respiratory rate and blood pressure. There can be impaired thinking if the pain is severe enough. Oxygen saturation may be low. Nausea and vomiting often accompany intense pain. Because of the sympathetic response the patient may appear pale and sweaty. There are many other things going on with the body as it reacts to pain but those are the most obvious and easiest to assess.

So Mr. Anonymous, when I'm dealing with a 30 year old patient, with a known history of seeking narcotics, what would you have me do? Should I listen to them as they calmly tell me that they are in the worst pain of their life? Should I immediately dive for my morphine and draw it up stat? Or should I look at her vitals and perform an assessment? If her heart rate is 62, she's breathing 12 times a minute with a pulse oxygenation of 100%, their skin tone is normal in coloration, temperature and moisture, no nausea or vomiting, and their BP is normal should I ignore all the clinical data that says the patient is probably not in severe pain? I think not. 





Somehow I get the feeling that you, Mr. Anonymous, are still going to say that I need to listen to my patient. So is that true in every case? When a woman is having a heart attack but she denies it should I just trust her? No. That's why I went through schooling to become a medical professional. Contrary to what you may think we medical professionals have to do more than just listen to you. We have to look at clinical data as well. I'm sure there are some people out there in the medical field that have taken things too far the other way and they rely solely on the signs that they can observe, never listening to their patient. I am not one of those people.


Have no fear, if I respond to your home and you or a loved one are in pain, I will treat you appropriately. 

Stop Being An....

The lights clicked on in my room for the third time that night, and it was only 0230. They were immediately followed by the familiar tones of a medical aid. We grumble and stumble out to the rig and slide into our bunker gear.

While watching the houses go by the rig as the were being pummeled by red lights dispatch said that we were responding for a fall victim. Pulling up on scene I recognized the house. We had been there before, often.

My citizen in distress was a 70 year old woman. She's obese. Shocker huh? She has had a heart attack in the past and now has CHF. She also smokes more than a structure fire. Enough that I always feel the need for a shower when I'm done with the call so that I can get the smell off of me. She has COPD, Emphysema and Asthma. She's supposed to be on home oxygen but every time we're there the cannula is tucked into the corner, unmoved, I'm sure, from the last time we were there. And she also wonders why she gets short of breath when she does the simplest of tasks. And to top everything off, she has an attitude.

We walk up to the door and find her husband waiting. She is sitting on the floor in between her recliner (the kind that stand up to help people get out) and her wheel chair. We ask if she is injured and she says no, just stuck. We help her back up into her chair. Usually this is all we do. This time they needed more help.

We then helped to move her to her portable commode. While she did her business we stepped outside. She took the opportunity to light up another cigarette. We then helped move her back into her wheelchair and then moved her once again into her recliner.

Now I don't mind "citizen assist" calls. I really don't. I don't mind helping people do things at their house that might prevent us from going back there in a few hours. I can even stand ending up smelling like stale cigarettes to help someone.

What pisses me off is when someone that needs my help, because they won't take proper care of themselves, has an attitude about it. Maybe, just maybe, you should try being nice to the people that are just there to help you.

Calling 911?