"Skilled" Nursing Facilities

Skilled Nursing Facilities (SNF pronounced sniff) are long term care facilities like live in rehab centers, convalescent homes and acute care centers. They are by reputation staffed with less than the most competent of RN's. I can understand this because if I were a competent nurse I would choose to work in a hospital instead. Now this is in no way a dig on those few nurses that are great and work for SNF's.

Yesterday we got a call to go to the local acute care center for a patient that was unconscious. As my partner and I were doing our assessment we were both asking questions of the nurse (lest this seem confusing I was asking questions about the patients past medical history, allergies and medications and my partner was asking about her current condition compared to what she is normally like). This is common since the paramedics that respond to these facilities do not know the patient and the nurses do. We can get a great deal of information from nurses that know their stuff. This RN, in the middle of our assessment of her patient, said that we ask too many questions and walked away. At that point we had to go off the information that an unconscious patient could give us and go. When we told one RN at the ER about our experience she said that she would've smacked the nurse up side the head. Laughing makes it all better.

LHHFD

Here is a link to the La Habra Heights Fire Department web page. http://www.la-habra-heights.org/index.php?option=com_content&task=view&id=38&Itemid=78

Put on clean underwear

I don't know how many of you have ever been told by your mother to put on clean underwear before going out just in case you have to go the the hospital but I have some advice that pertains to staying at home. Don't sleep in the nude. That way when you wake up having a major asthma attack (or some other emergency)you are not found naked on the floor by 8 firefighters and paramedics. That can be rather embarrassing as a woman in her 40's found out today. We ended up covering her up with a couple of our sheets and transporting to the ER while giving her a breathing treatment. I guess that her mother didn't quite prepare her for everything.

Choices

Today my partner and I had to transport a patient from a acute care facility to the county hospital for a check up. The patient was non-verbal and had a tracheotomy (a surgical opening in the neck allowing the patient to breath with a ventilator). Unfortunately he was a little sick and was coughing up large amounts of thick, discolored mucous (graphic description for Tom). We had to suction out his airway every 3 to 5 minutes the entire time he was under our care. While suctioning the patient my partner half said to himself, "why'd I go to medic school?" That question alone sums up how we felt about this call.

Tachycardic EMT

A couple of days ago my partner and I had a brand new EMT ride along with us. When this happens, during our down time we teach them how to help out with some of the paramedic skills like putting a patient on the ECG monitor. I happened to walk by the ambulance as my partner was hooking up the EMT to the 12 lead (this is where we take a look at your heart from 12 different location and we can see if you are having a heart attack and where it is located). As my partner prints the 12 lead he mentions to me in a concerned way that there is ST elevation. This can indicate a heart attack. My partner hands me the rhythm strip and asks the EMT if he has any chest pain. At this point I realize what my partner is doing (since the EMTs ECG was fine) and I asked the EMT if he was having any trouble breathing. Still assuming that we are joking he says no. At this point I ask if he has been more tired than normal lately. His eyes went a little wide and he went pale. He had been more tired than normal this week (which was due to starting a new job that was 12 hours a day...he never thought of this). I told the EMT that I was going to call the hospital and see what they thought that we should do. At this point my partner told him it was a joke. When we looked at the monitor again we realized that he had gone from a normal sinus rythm in the low 60's to sinus tachycardia at 130. I guess that we scared him a bit.

Choking

A call went out this morning for a patient choking. As we were responding to the call I was talking to a relatively new EMT about choking calls. I told her that very few "choking" calls actually end up with a choking patient. . By the time that we get there the patient has either coughed up what was choking them or has fallen unconscious and then we have an unresponsive person with an airway obstruction. No sooner had I said this when the Torrance Fire dispatcher said over the radio that the patient was now unconscious.

The mentally handicapped patient was choking on a piece of bread which was removed with ease and the patient came back around. I wish all patients were this easy to treat.

Smoke in a Bank

The other day a call went out for the Torrance Fire Department for smoke inside a bank. The smoke was reported by employees when they arrived to work. TFD had to stage outside the bank and wait for the Torrance police to show up in case it was a robbery. After the building was cleared of potential suspects TFD entered the to find that the smoke was caused by a botched robbery. The assailants had tried to blowtorch their way into the vault and the ATM machines but were unsuccessful at both. I don't know if anyone has been caught for the attempted robbery.

La Habra Heights Fire Department

I just had my chiefs interview with La Habra Heights Fire Department and I was offered the part time firefighter/paramedic position. I still have to go get a medical done and figure out what my schedule will be but soon my stories will include tales from the city of La Habra Heights.

Come check this out!

In certain professions there are things that should not be said such as "oops" at a dentist. As paramedics, when we find something out of the ordinary we want others to see it as well. Today our patient had some chest pain and in the process of checking him out it was discovered that he had very interesting lung sounds in the base of his left lung. Immediately the paramedic that discovered this said to my partner and me, "Hey, come check this out." I realize looking back that that is probably not what a patient would like to hear from their paramedic.

Closest Receiving Facility

In LA County EMS the closest receiving facility is the hospital that is closest to you (in time not distance) that can take care of your patients problem. We generally like to take our patients to the MAR since it means that they will get seen by a doctor sooner. Paramedics can take you to another facility for a couple of reasons, most often because the MAR is closed to paramedics (possible reasons to close include saturation of the ER and internal disaster such as a hazardous material leak or a power outage). The other major reason we do not take a to the MAR is they request to go somewhere else. This may be due to insurance or just because they like a certain hospital.

The call goes out for an altered patient right outside Little Company of Mary Hospital's ER lobby doors. My first thought is why isn't the ER staff walking the 15 feet through their lobby and treating the patient?!! Evidently our patient just found out that her dad has cancer. After she got the news she went outside that lobby of the ER to try and stave off a panic attack. In her agitated state of mind she thought that it would be a good idea to up the dosage on her Xanax. She was now not acting normal (for her) and her family was getting worried. Then, a helpful hospital volunteer happened to walk by and called 911 (instead of getting a wheel chair and walking to the ER). When we got there we found a woman in her 40's that was unable to tell us her name. She could answer everything else just fine. When asked which hospital she would like to be taken to she decided that it would be better to drive across the city to another area hospital than to be seen by the doctor that had just "given" her father cancer. All we could do was check to see if the hospital she wanted to go to was closed. We crossed our fingers but no luck. We had to drive away from the ER to go to the ER.

Photo!

This a shot of our new medic unit sitting in the bay of the fire station Hermosa Beach. We covered their city for a couple of hours while they fought a large structure fire.

Chest Pain at Gerber

My partner and I decided to go get something to drink. While we were out on the air our dispatcher came on the radio and said "MEDICS! Return to station for chest pain." Here a bit of back story is needed. Our dispatcher (that day) has heart issues. When we hook him up to the ECG monitor while he drinks a Monster energy drink it shows him having an MI (heart attack). Sometimes when he wants a Monster he tells us he needs his heart medication so when we got this call for chest pain we thought that he might just be thirsty. When he didn't ask us to phone in we realized was probably serious.

When we got to the station we were told that it was one of the billing ladies (we are a compartmentalized company can you tell?) and that she was upstairs in the conference room. We grab our stuff (drug box, ECG monitor...) and went up. Turns out she had had a chest cold with a non-productive cough for 7-10 days and is a smoker. The chest pain, which she described as a pressure, had been going on for a week and she was told to have us check her out by our office manager. Everything checked out normal and she did not want to go to the hospital so we made base contact (we are required to contact the hospital for patients with possible serious medical complaints to cover our butts) and signed her out AMA (against medical advice).

Job Security

While I was in our dispatch center this last week we had a person call us to find out how to get a hold of 411 to look up someones address. I'm willing to bet that this person drives and votes. Scary thought huh?