"You Looked Like an Ass..."

We arrived on scene at one of the local shopping centers to find our patient ion the custody of the police. The 36 year old man had been driving erratically and was being held on suspicion of driving under the influence.  After having been in custody for 20 minutes, with his hands handcuffed behind his back, and with a crowd watching from the local restaurant, this genius decided to make a break for it. I don't know where he was planning on running but he ran straight for the closed grocery store. He got about 30 feet before the cops caught up to him. Most people realize that if the fuzz is chasing you they are going to tackle you. This really sucks when your hands are not available, being cuffed, to cushion the blow of the asphalt on your face. My patient had bruising and abrasions to his face and knee. It was hard to feel bad for the guy. After checking the guy out and bandaging his wounds we sent him to the hospital. Before the patient was transported  the police officer that had apprehended him told him, "You looked like an ass to the general public."

Stupid people = Job security

Down at the 45 Yard Line

Every Saturday during the fall the local Jr High school football field is covered by kids of varying ages playing football. Every year we end up responding to at least one call for an injured player. It could be for a twisted ankle, a concussion or a broken bone. It's a little more interesting than your average call because it's a kid.



A couple of Saturdays back we were toned out to the Jr High for a kid with injuries. When we arrived we found our patient on the 45 yard line surrounded by various adults. As I approached there was one guy that was kneeling at my patients side that gave me adecent report on the kid. Turns out he used to be a paramedic for AMR. The 10 year old would be football star had been blindsided and felt some pain in his neck. By te time that we arrived the patient denied any pain or discomfort at all. We ended up giving him a thorough head to toe exam and found nothing. The dad was there and decided that he would take his son in to get checked out instead of going by ambulance. The kid got a nice ovation as he walked off the field.

Dumpster Fire With Spectators

For some odd reason there are people out there that haven't figured out that if you throw away a hot item (match, cigarette...) without putting it out you can start a fire. We were toned out for a dumpster fire the other day in the parking lot of a shopping center. These are really easy to control because they are in a container and all we have to do is fill that container.

The only real concern is that if the dumpster is next to a building, it can catch the building on fire. Like this:

















Luckily for the local store owners the dumpster was not up against the building. We pulled the bumper line and filled the dumpster about half full of water. While doing this, as you can imagine, we drew a crowd. Why not. I big red engine with flashing lights, smoke, flames, firefighters in turnouts, hoses...it looks interesting. After we had put everything away a couple of kids came walking by the engine with their parents. We quickly grabbed a couple of Jr Firefighter stickers (with our departments name on them) and passed them out.


No sooner had we done this than a minivan pulls up and the older sister helps 4 younger siblings out of the vehicle to come see us and get stickers too. It was more fun passing out stickers than putting out that dumpster fire.

My Streak is Ruined

I have been in EMS for years and managed to avoid something until just recently.

As I walked up the driveway I was met by a middle aged woman that asked me if I was a doctor. I refrained for telling her that she needed a paramedic, not a doctor and just said no. She then informed me that she didn't need the fire department, she needed a doctor. That's why she called 911.

Turns out her neighbor, an 82 year old woman that only speaks Russian, passed out while she was at home. When she came to she threw up. She then felt better and walked over to he neighbors house to seek some help. Luckily for us the neighbor spoke Russian too. While working through the translator I was able to determine that something like this had never happened before. She also said that she had high blood pressure and was taking some over the counter Russian medication. Good luck figuring out what those are. I'm pretty good at puzzles so when the neighbor explained that she was allergic to a red fluid that you put on the skin to clean it I understood that she was talking about Iodine. She denied any medical complaint and was thinking about not going to the hospital. This was about the time that she passed out again. Her head flopped forward and to one side. I was worried about her airway so I quickly jumped in there to hold her head in a neutral position.

When she came around she blew chunks. Despite her earlier mention of this I forgot. She managed to throw up all over my left arm, my watch and into my glove. We're not just talking normal looking vomit. This stuff was stringy like snot. I went years without getting vomit on me in any way shape or form but she got me royally. Not much I could do. I continued to reassess my patient.

About this point AMR showed up. The AMR medic couldn't see my arm because it was behind the other firefighter. She took my report and then I asked if she would take care of the patient while I washed off my arm. Only then did she realize that I was dripping vomit.

As much as I don't like getting thrown up on I can't help but feel bad for my patient. How mortifying would that be throwing up on your firefighter paramedic as he is taking care of you.

HOH

We were recently toned out for a person having trouble breathing. 911 was notified by the medical alarm company. This was the first time that I can remember responding to an actual emergency that had been called in by a medical alarm company. The company had all kinds of useful information like where the spare key was to the house, allergies to medications and her medical history that included COPD and HOH. Although I had never heard of HOH.

When we arrived on scene we found an 88 year old female laying flat in bed complaining of shortness of breath. She said that she awoke in this condition about 10 minutes ago. We sat her up, gave her some oxygen, and listened to her lung sounds. She was wheezing and tight so we gave her a breathing treatment. After a couple of minutes she started feeling and looking a lot better. My captain then asked her about HOH to which she responded, "What?" So he repeated himself a little louder and got a similar response. It was hard to stop from laughing when we realized HOH is Hard of Hearing. We still occasionally joke about that one.

Our Fortunes?

One evening we were at the dinner table eating Panda Express (it was too late to cook). After we were finished the other firefighter with whom I work opened his fortune cookie and read his fortune. He laughed and then said, "I sure hope not." He then handed me his fortune. It read, "The evening will bring romance." Knowing full well that it was just us at the station I quickly agreed with him.

I then opened mine. It read, "A thrilling time is in your immediate future." It took a while for us to regain our composure.

Funniest Firefighter Video

Hunter Hits His Last Shot

First thing in the morning we were having a conversation at the table when we were toned out for a suicide. Usually, even if the person is dead, it's a suicide attempt until we get there and determine that the person is deceased. While responding we were given some additional information. Evidently PD was on scene with the victim of a self inflicted GSW. When we arrived on scene we were escorted into the bedroom where a male in his early 70's had pointed a .22 rifle at the side of his head and pulled the trigger. The interesting thing about the .22 round is that a lot of the time it possesses enough velocity to enter the cranium but not enough to exit. I did have to ask the cops to remove the weapon so that I could approach the body.

My part was really easy. I checked to see if he had a pulse or was breathing (stranger things have happened). I then hooked him up on the monitor and confirmed that he was in asystole. Only after determining death did we look around the room. The deceased was evidently a hunter because he had stuffed (taxidermied) animals everywhere in his room.

After the call was done we went back to the station and back to our conversation. We briefly remarked that this is a strange profession where your conversation can be interrupted by someone shooting themselves in the head and then the conversation continues. Just as if the conversation had been interrupted by a telephone call.

Afterwards

We were recently toned out at 0520 for a person with heart problems. We were met by the fire of the patient at the front door. We followed her into the bedroom where she proceeded to shake her husband trying to wake him. One look and we could tell that he was dead. I quickly moved the wife out of the way and checked to see if my patient was breathing or if he had a pulse. Nothing. I then checked to see if rigor mortis or lividity had set in becuase if it has, there is nothing we can do. Not finding any "obvious signs of death" (this part always reminds me of the movie "The Princess Bride" where Miracle Max talks about someone being mostly dead or all dead) we pulled the patient onto the floor and began CPR. I jumped on compressions. For those of you that haven't had the opportunity to do chest compressions on a frail old person the first one or two compression are noisy and strange feeling. I was able to feel all of the ribs on the right side of my patient's chest and most of them on his left break. I quickly asked my Captain to check and see if there was a DNR on this patient. So with just two of us doing CPR we noticed that there was a lot of medical knowlegde between us (we're both experienced medics) that is not doing any good because wer're alone and doing CPR.

Finally the AMR crew shows up with three medics. They have a new guy so he takes the lead. We quickly move the patient to the front entry way where there is more room to work. While the other firefighter and I continue CPR the new medic puts on the defibrillation pads, turns on the heart monitor and says, "SHOCKING!" That got our attention real fast. We moved away from the patient and then looked at the FNG. Fortunately his trainer calmly informed him that there were some issues that needed to be addressed before shocking the patient. First, plug in the pads to the monitor. Second, determine if he has a shockable heart rhythm. Third, charge the defibrillator. Finally, shock the patient after you make sure that everyone else was clear. I hated being the new guy. After that we got the autopulse going, started an IO, got an airway, checked capnography and administered two rounds of meds. We also administered some sugar and sodium chloride. Everything that we did had no effect. Time of death was called at 0553.

After the code we were able to obtain some more information. The deceased had had a heart attack in April and was advised that he needed a pacemaker, but refused. He woke up that morning at 0300 not feeling well. At 0500 his wife woke up and checked on him. She said that he had a very slow pulse. 18 minutes later she called 911. We were able to wait until the coroner was contacted and it was determined that we would be allowed to remove everything that we had done (such as the IO and the airway) and to move the body back into the bed for the wife. All this was not easy to do since there was a major language barrier.

After this call I had some time to reflect upon death and my intimate relationship with it. Recently there was a death in my extended family of a 3 month old baby, an apparent case of SIDS. Given that I deal with people dying on a fairly regular basis I was surprised at how much the death and funeral of this baby affected me. It really put me into a funk for days. I thought that my ability to be emotionally detached would work in this case but I was wrong. So sitting outside the residence of my deceased patient I realized that there were some major differences (other than the fact that it was a family member and a baby) between the patients that die and my family member. After the patient died I was able to go over everything that I did with the other firefighter and critique the situation making sure that we had done everything possible to give this person a chance. It may not seem like much but having the ability to do something and then reflect that you did actually do everything you could is comforting. Talking out and critiqing the call actually helps deal with it.

As soon as we cleared the call we went back to the station, then went home. What a strange job.

Crazy Is As Crazy Does

The other morning we were sitting around the table talking and I brought up an episode of Storm Chasers where the guys were getting pelted by baseball sized hail. I commented that they had to be crazy to chase tornadoes that way. The other firefighter replied, "Aren't you the one that runs into burning buildings?" That shut me up.

I still think the storm chasers are nuts.

Losing

In the fire service there are a few cliches that are often used. These reflect, in a joking manner, what we do such as "Just living the dream" or Saving lives." While said in a non chalant way most of us do believe that we are fortunate to do what we do and can, every once in a while, save a life. The thing that is not mentioned is that sometimes we lose that fight to save lives. Most of the time when we lose that battle it's with an elderly person, quite often with pre-existing medical problems, that has lived a long life and it's simply their time to go. Or the person that has made choices in their life that unfortunatley shortened it, such as the use of some drugs. Every so often we have to deal with someone that is otherwise healthy that dies becuase of some traumatic event, a car crash, a shooting, a fall. There rarest and most difficult with which to deal are the ones involving kids.

This last week a couple of friends that work at another department had to deal with this. There was a drunk driver on the highway that crossed the double yellow line and, despite the evasive driving of the other vehicle, hit an oncoming car head on. From what I understand the vehicles struck on the front drivers side of both vehicles causing severe damage. The vehicle that was hit had in it a young family, a father, driving, mother and two daughter ages 3 and 5. The injured parties had to be extricated from the vehicle. The father sustained critical injuries and was transported to the trauma center by ambulance. The daughter was in full arrest and had some airway complications. She was transported to the closeset hospital because of the airway comprimise and then flown to the trauma center. They were able to get a pulse and a blood pressure back in the child but as they were starting to fly her out she died again. She was pronounced dead at the trauma center.

I know most of the crews that were on this accident. Things that most prople will never know are what the paramedic felt like when she had to shut the ambulance doors on that mother. Or another medic that stayed behind giving the mother a shoulder on which to cry. The medic that transported the father to the trauma center told me that they were relieved that he wasn't able to ask about the condition of his daughter. These stories almost never make it to the public.



As a paramedic you learn to be emotionally detached at what you do so that you can still function in situations like this one. The hard part can come later while dealing with your suppressed emotions. A lot of times agencies and departments will hold CISD's to help their crew through this process. In my experience crews usually deal with these situations in their own unique way on a crew level. They will talk it out with each other and possibly with a few friends in the industry that can actually understand what they are feeling sine they have been there themselves. Eventually you move on. My heart goes out to the brave men and women that serve our communities and subject themselves (and to a limited extent their families) to things that no one should have to see, then go back for more. I consider myself lucky to work along side you.

The Stupid Are Lucky

While on duty at station 1 we were toned out for a fire in the backyard of a residence at about 9pm. When we got there we found two smoldering plastic gas cans and a melted 55 gallon trash can. Once we determined that the fire was out we tried to determine what had happened. The fire had occurred in the backyard of a residence where there was a back house. The owners in the front house were the ones to see the fire, call 911 and extinguish the flames. The renters in the back house said they didn't see anything. We checked the area for an ignition source, lighters, matches, cigarettes, etc. Finding none, my captain again turned his attention back to the residents of both homes.

Finally the son of the renters spoke up. He appeared to be about 17 years old. He said that he had been in the service porch trying to pour the contents of one fuel can into the other. He was doing so without any ventilation. The fumes trailed over to the pilot light of the hot water heater and ignited. He was just able to open the door and kick both fuel cans outside. We spent a couple minutes making sure that he realized how lucky he was not to be severely burned. Hopefully he learned his lesson. If you're going to be using fuel, do so in a well ventilated area. Now he can go on and do other stupid things.

Home Invasion (Changes in Perspective)

There is an assisted living facility in my district that generates a lot of calls. One type of call that we get often is the Lifealert alarm. I'm sure you remember the commercial, "Help! I've fallen and I can't get up."

I think that most EMS responders will tell you that the vast majority of these calls are false alarms. I can only think of one time when it wasn't.

We were toned out at a little after midnight to the third floor of the assisted living facility facility for a medical alarm. Once we arrived we were met by the manager (who has keys to the apartments so that we can get in without breaking things) and we walked upstairs. I knocked on the door rather forcefully and yelled "Fire Department." There was no answer. I knocked again and got the same result. At this point the manager opened the door for us. I went right as I entered the residence toward the bathroom. My engineer went straight with both of us shouting "Fire department!" The last thing I want is to scare someone and get shot. As my engineer entered the bedroom an elderly woman in bed opened her eyes and screamed. Her husband was a little slower and calmer in his reaction. After calming them down we made sure that there was no actual medical emergency (other than the heart attack we just gave that poor old woman). We then apologized and showed ourselves to the door, then bid the manager goodnight.

A few blinks later (about 3 hours) we were toned out for the victim of a home invasion robbery and assault. As we were responding we couldn't help but laugh at the irony that just a few short hours before we were the home invaders. Turns out our patient was a 48 year old Desert Storm vet that had been pistol whipped. He had been in his garage, drinking, when he heard his wife scream. He came into the house to find a man with a gun. He quickly attacked the intruder to protect his wife and 10 month old son and got beat in the head. The intruder then ran away. Our Vet was most fortunate that things didn't go further. Because he was a little altered (either from the blow to the head or the alcohol) we sent him to the hospital to get checked out.

PD had us stay on scene for the next 90 minutes just in case they found the guy that did this and things went ugly. Once they had done a thorough search of the area, including K9 units, we were released. So much for a good night sleep.

Complicated Call

While in paramedic school you participate in scenarios. It's a way for the new paramedics to practice their assessment and critical thinking abilities and how to put all of their new skills to the test. The interesting thing about them is that the scenarios usually aren't your run of the mill calls. The instructors are usually medics and they give you calls that they went on that were different or interesting in some way. Quite often they contain some pretty severe curve balls. This call was just like one of those scenarios.

We were toned out for an 83 year old woman that had fallen. This is a fairly common call but there are a lot of ways it could go. While we were responding I started thinking of how this could play out: Slip and fall, weak and dizzy then a fall, hip fracture and fall, CVA and fall, heart attack and fall, syncopal, low blood sugar and fall, attacked by a dog and a fall...I think you get the idea.

When we arrived on scene we were met by the daughter of our patient. She said that her mother was in the bedroom trying to get back to bed after using the bathroom when she fell down. She was able to get her mother back onto the bed but that was all. When we got back to the bedroom we found our patient laying on the bed. She was looking at us when we walked in (a good sign) but didn't say anything. At this point the daughter informed us that her mother was deaf (I guess that slipped her mind). So now I was trying my best to communicate with my deaf patient (the daughter was trying to help with translating) and it wasn't going well. The daughter was saying that her mom could answer our questions but something wasn't right. Out patient kept saying that she was weak. I decided to check a blood sugar. Bingo. Her sugar came back at 31. Seems the daughter forgot to tell us that she was diabetic too. I started a line on her and gave her some D50. That seemed to perk her right up. As soon as AMR showed up we sent her on her way to the hospital. Not your typical scenario.

Why We Wear What We Wear

(You like the nice alliteration in the title?) This is a news story from CBS 5 News in AZ about a firefighter getting burned. I hope he recovers quickly.

http://www.kpho.com/video/21300180/

Fast Food Frenzy

We were simultaneously toned out with station 1 for EMS calls at fast food restaurants. They went to Taco Bell while we headed to McDonald's (I found out later that both calls were for the same thing...funny how that happens).

We were dispatched for a man having a seizure. It's amazing to me how rarely we get to a call like this and find the patient actually having a seizure. This time was no exception. When we arrived on scene, PD already there (maybe for a late breakfast??), we found our patient laying on the bench seat of one of the tables. He was a 17 year old "kid" that was there having breakfast with his dad. The father noticed his son having a seizure so he quickly grabbed him and lay him down. Up till now I'm thinking so far so good...easy call. The dad then informs me that his son has Autism and doesn't speak. The son does however understand things fairly well. This proved to be overly optimistic. As I checked on my patient I found that he was acting normally (I had to check with the father about this). My patient was very skittish at first and didn't like us trying to check out his vitals. After talking to him for a little bit and with his dad's help we were able to check him out. He even let me prick his finger to check his blood sugar, which came back a little low (seizure activity can use up sugar stores in the blood leaving the person with low blood sugar levels). Once again with dad's help we had our patient suck down some glucose paste (no it doesn't taste as good as it sounds). The dad also informed us that this is the second time in as many weeks that his son has had siezures. His son is currently undergoing tests to try to figure out why they suddenly started. My patient has no other medical history, no allergies, and is taking no medications. When we have the AMR crew bring over the gurney to take him to the hospital my patient flips out and makes a break for it. He pushes right past me, swims past my Captain and tries to get by the other firefighter, where he was stopped. After about a minute the father was able to calm his son down. My patient would flip out at the first sign that we were trying to get him into the ambulance.

Now here's my question to my readers. What would you do to get your patient to the hospital? You have all kinds of resources, drugs, cops, ambulance, fire engine, restraints and probably some that I never thought of. What would you do, for your patient, to make sure he got the evaluation at the hospital he needs (the father completely agrees that his son needs to be seen in the ER and, for the sake of this question, is willing to go along with whatever you come up with)?

On a side note, the crew from station 1 had transient that had a seizure and was very noncooperative. Funny how many similarities there were.

I'm Not a Drunk, I'm Just Stupid

We got toned out about 8 in the evening for a teen with ALOC. When we got there we were let in the house by the parents. The 14 year old came into the front room really amped up, pacing and talking fast. He said that he was walking on the park when a white guy came up and offered him a drink of something that looked like apple juice. He then changed the story subtly and said that he was offered a "shot" of something like apple juice. The story was then altered one more time. He said he was offered a "chunk" of what he thought was apple juice. My patient then quickly added that he didn't want his parents to know because he didn't want them to think he was a drunk (my thought, "Yeah, right. It's much better that your parents think your a blithering idiot for taking "chunks" from strangers in the park."). Everything checked out on my patient except his heart rate, which was cranking along at 145 beats a minute. at one point my patient startd talking in Spanish to his parents. The other firefighter I work with flash me a knowing look. I'm fluent in Spanish so I just eaves dropped on the conversation to see if his story stayed the same. It did. After calming him down we sent him to the hospital.

Since the was the second patient with similar presentation (a little amped up with a fast heart rate but no other medical complaint) in a month we followed up. We were informed that Kaiser diagnosed him with acute alcohol ingestion and nothing else. I think either the kid had something else in his "chunk" or Kaiser didn't want to test him for anything else and went with the simplest of explanations.

More Ambien Please

We were toned out for an auto accident with PD on scene. Upon our arrival we found an SUV in the parking lot of a strip mall. PD had the woman standing next to her vehicle. I asked what the story was and was informed that she had been driving erratically and was followed by a city employee while on the phone with 911. As my patient tried to turn into the parking lot she hit a small tree, knocking it over. My patient was clearly not operating on all cylinders so we did some checking. All her vitals were normal. Blood sugar levels were fine. Patient had no real medical complaint. She was able to answer all of our questions but very slowly. PD had grabbed her prescription medication out of her purse and handed them to me. She had filled a prescription for 30 Ambien the day before and was down to two. I wasn't sure what an overdose on Ambien would look like so I decided to call poison control. The MD on the phone said that it would just make her really out of it like having too much valium.

He also said that she did need to go to the ER. We finished up our asssessment and handed off patient care to AMR.

Twisted Ankles, Twisted Paramedics

We get toned out at about 2300 for an ankle injury. Thankfully I was not yet asleep. I'm embarrassed to admit that when we get a call like this my first response is usually to grumble that the person is calling 911 for a twisted ankle. It's hard when I know people that refuse to call 911 when they amputate a body part to think that the person with a broken ankle really needs me. Once we arrived on scene we were greeted by the husband who said that his wife had tripped and fallen down the two steps to the living room and they couldn't get her up. He was embarrassed to have to call us.

We quickly did an assessment and found that she had no other apparent injuries other than the ankle. While we worked on her ankle, the couple told us that they were watching "Nurse Jackie" and laughed that they now had to have their own encounter with emergency medicine. We joked around as we splinted her leg with a vacuum splint and put an ice pack on her ankle. I offered her some morphine but she declined. Our patient was one of the nicest patients I've ever run a call on. That's what makes the arrival of the AMR unit so bad. Some people in the EMS field are burnt out and should get out. They hate their job. the medic that showed up showed all the signs of being one of these people. So we had to load up our nice patient into the back of the ambulance with one of the grumpiest medics I've ever met. Afterward the husband made it a point to come shake all of our hands and thank us for being there.