A Long Night

Just after 2200 I decided that I was done for the night. I've been sick so an early bed time sounded great. I hopped into bed and turned on the reading light. I read my book for about 30 minutes then decided to knock out. Less than 30 minutes later the tones were going off.

We responded to a town house where we found a 52 year old woman with asthma complaining that she had been sick and now she couldn't breathe. She was coughing quite a bit but her oxygen saturation was 100% and her lungs were clear. She said that this had been going on for about two weeks. When I asked her why she called now instead of some other time in the last two weeks, she didn't have an answer. Thankfully AMR was right on our heels. We loaded her up and sent her on her way.

I got back to sleep around midnight. Not too bad. Then about 20 minutes later the tones went off again. This time it was for a structure fire. We hurried down to the apparatus bay and donned our gear. We went tearing out into the night with the siren blaring, the red lights reflecting off all the different surfaces around us.

I wish this is what I found when arriving at the warehouse.

Dispatch informed us that it was a small cardboard fire in the back of a warehouse. We knew that this building had sprinklers (something I highly recommend getting in your home if you can) so we weren't expecting much of a fire. When the first due engine arrived on scene they reported finding the warehouse full of smoke. they eventually found the source of the smoke. A small fire had started in the bailing portion of a cardboard bailer. They were able to extinguish the fire with the bumper line and tank water. The second in engine staged by the hydrant in case more water was needed. We stayed available for ventilation operations. We were called in a little after the fire was extinguished to assist the interior crew with opening warehouse doors to try and get out some of the smoke. By about 0130 we were loaded up and headed back to quarters. This time however, I knew there would be no going back to sleep right away. I was too hot and awake. So I had a bowl of ice cream.

As I settled back into bed I decided to text message my wife and let her know how my night was going. I figured with our youngest not sleeping well there was a good chance that she was awake. I was right.
She sent me a text saying that she was just going to ask me if I was awake. #2, our oldest son, was now sick and was having a hard time breathing. She was worried. I immediately called her and talked to her. I could hear my son in the background obviously having a hard time breathing. I had my wife go and get my stethoscope and try to get some lung sounds. Let me tell you, a lot of medical professionals struggle with lung sounds. Trying to get a lay person to listen and accurately describe to you what they hear is close to impossible. My wife had given him some Motrin and with some TLC #2 was starting to calm down and breathe easier. I told my wife to hold off on calling 911 or going to the ER. And I instructed her if he did get worse to call me back. I was worried about the little guy all night.

It's good to be home where I can take care of things if I need to. I know my wife is happy about that too.

I Could Have Done That

I'm sure that most of you reading my blog that deal with the public in emergency situations will be able to relate to this story.

We were called to assist a citizen that found a confused old man standing on the corner of the street with blood coming from the mouth. By the time we got there the old man had wandered back home to his family with the concerned citizen in tow. We asked the family, who were from the Philippines if we could check out their father/grandfather. They readily agreed. Our patient spoke very little English. Since we had family members that appeared to speak English I asked if they could translate. Here's more or less how it went.

"Ask him where he fell."

"I don't know where he fell."

"Ask him."

(in English) "Hey. Where did you fall?"

"No. Ask him in Tagalog.".....

"Ask him how long ago he fell."

"I don't know, I wasn't there."

"Ask him."

(again, in English) "Hey, when did you fall?"

"No! Ask him in Tagalog."

We tried with several different family members translating with the same results. Eventually we used AT&T's phone translating hot-line. I didn't know AT&T had that service. PD called for us. The patient signed out AMA.

Really, Really Old People

I was talking with my family the other night and I remembered a call I had when I was working as an EMT at a private ambulance company. We went and picked up this old lady in Inglewood and took her to her annual physical. She had one leg amputated below the knee (I don't remember why) but other than that was in great health. The amazing part was her age. She was 106 years old. On our paperwork we skipped an entire century. Her D.O.B. was in 1898 and the call was in 2004. It was strange to be transporting an adult that was not born in the 1900's.

The best part of the entire call was when we were dropping her off at her house. This sweet old lady that had chatted our ears off the entire time asked me to come closer. As I knelt next to her wheelchair she said she had something to tell me. She said, "My caretaker," with whom I did not get along, "she's a bitch." I'm glad I was already kneeling on the ground. I was laughing so hard that I would have fallen over.

I love really old people. They don't hold things back. I think more people should be that way.

Makes Me Feel Good

I love interactions with kids (when I'm not on a call). Yesterday we went shopping and as we were climbing back into the engine a little girl, probably 6 years old, ran up and said hi. Her mom told me that her husband didn't want to interrupt us while we were shopping so they waited in the parking lot until we came out. All the girl wanted to do was to say hi. She got a big smile and a sticker for her time.

Shake Up At IHOP

Just before 2100 hours we received a call for a child having a seizure at IHOP. We jumped into our bunker pants and started responding. Even today, the sound of the growler and the lights reflecting off everything make me smile. Even when it's cold I keep my window down.

 Since it's a pediatric call I talk with my engineer (he's a medic as well) during the ride about what we might encounter. We decided it was a 5 year old it was probably not a febrile seizure. There would more than likely be a preexisting seizure condition that the parents already knew about and that the staff had probably called. We figured that if the kid was of normal size he's be somewhere around 40 pounds which made the dose for Versed (in case he was still actively seizing when we got there) 1.8mg.

When we arrived we found the mother of the young boy holding his head while he rested on his right side on the floor. He was very hot to the touch. We tried out our new thermometer but it wouldn't work. Stupid new toy. The kid had a seizure that lasted about 10 seconds and the dad had helped his son to the floor. Since that time he had not been very responsive. The parents said that he was just starting to get sick today and that he had only had a fever for about an hour. He had no medical history, was taking no medications and had no known allergies. So far all of our assumptions in the rig (except for his weight which was dead on) were wrong. We quickly got him on some oxygen, got him out of his clothes and started cooling him and checked a sugar. AMR was on scene just a couple of minutes after we arrived.

The kid was a little old for your average febrile seizure but I guess no one had told him that. His parents did the right thing. They kept him from hurting himself by hitting anything and kept him on his side in case he threw up. The only other thing they could have done would have been to start cooling him off.

The Creation Of A Paramedic

When people call 911 (not your bull sh*t calls but your real emergencies) I'm quite positive that the caller never stops to think about the process, training, education and testing that goes into making a paramedic. All they care about is the fact that someone is coming that knows what to do and how to do it. I've been in a bad car accident where I was knocked unconscious. Luckily I came to after about 30 seconds. Hearing the sirens coming was a comforting thing. I knew help was almost there.

I can't speak about how to become a medic in other parts of the country but I know a bit about doing it here in California. There are some variances of course. First, you have to go to EMT school. Lengths vary but it's at least 110 hours for your national license. After passing your national EMT test you are now ready to work in most counties. Some may still have you pass another test. Then, after working for at least 6 months (this is the bare minimum but more time is preferred) you can apply to a paramedic program.

Paramedic programs have different prerequisites. All require experience as an EMT. Some require Anatomy and Physiology courses, Medical Terminology, letters of recommendation, a pre-course put on by the school, entrance exams, interviews and I'm sure a host of other things to make it difficult to get in. It's a competitive process. Some private programs can cost upwards of $15,000. Some programs at community colleges only cost about $1,500. Most are somewhere in between. Program length is anywhere from 12 weeks, where you're in class Monday through Friday from 8-5, to a couple of years where you're in class once or twice a week. There are pros and cons to each of these variables. When all is said and done the paramedic student must pass all the testing in the didactic portion of the program and be able to pass the national exam.

After the in class portion the student starts a hospital rotation. They spend roughly 240 hours in the hospital seeing patients and practicing skills (in some programs this can be done concurrently with the classroom portion). Then the student starts the field internship. This is probably the most terrifying part of becoming a medic. During this time (roughly 500 hours) you have to prove to an experienced paramedic, called a preceptor, that you have what it takes to do this job. They aren't there to teach you (but you do learn a lot). They are there to judge you. I can remember after one particularly stressful call (a 4 year old that had stopped breathing) my preceptor asked me what I had done on that call to make him fail me. My heart sank. I didn't think I had screwed up at all. I made some tough decisions and I stood by them. After letting me stress for about 5 seconds, which seemed like an eternity, he said, "Nothing. you did great. Relax and enjoy the job!" I could have killed him.

Now that I'm on the other side of the process (as an instructor at a local paramedic program) it's interesting to see the students thought process develop. You can see their minds working trying to put together the clinical findings and their knowledge of pathophysiology to determine the correct treatment for a patient. Normally, it's fairly simple. The problems occur when the patient has one or more underlying medical conditions which have their own set of signs and symptoms, but their current "emergency" is based off of something else entirely. An example. A patient may have CHF and emphysema as underlying medical problems. They will probably have some messed up lungs sounds (expiratory wheezing and rales in the bases) but that would be normal for them. They called 911 because they can't breath. While listening to lung sounds the student also hears rhonchi on the right side (in addition to those already mentioned). The patient has a fever and has been coughing up green phlegm. So does the medic treat the CHF, the emphysema or the possible pneumonia? These are the calls where medics earn their paychecks. Hopefully, by the end of their training, my medic students will all know what to do.

So next time you see a paramedic (preferably when they're not responding to a call) take a second and thank him or her for the countless hours he or she has put in to be able to know what to do when you need them most.

BLS Before ALS

In the December 2009 issue if JEMS there was an interesting article about how we are now inundated with paramedics in EMS. On the surface most people would think this is a good thing. If one is good, two are better, right? The numbers are not backing this up. Basically we medics need to make sure that we cover the BLS stuff.

I work on an apparatus with 3 other paramedics. A complete ALS unit. As you can imagine it would be very easy to forget the "little" stuff (which are actually major things) such as patient positioning. At my station we've kind of sorted it out by making assignments. As the low man on the totem pole, I am patient man. I get to ask all the questions and run the call. The other firefighter is my BLS man. He gets me vitals and does everything a great EMT would (patient positioning, oxygen and such). My engineer just kind of stays out of the way unless I need him. For example, it's nice when giving medications, when I don't have to open the box and draw up the medication. I just do a quick once over to make sure that everything is good and administer it. My captain does the paperwork and deals with the family. So far this has worked out well. And, on calls where it's nice to have another medic (such as a full arrest or multiple patient calls) voila! We have more than enough.

Just don't forget the BLS. It's important.

Sad, But True

It's a sad commentary on today's EMS system when communities have to host website to teach people when to call 911. I thought it might be helpful to others. Please share it with your family, friends, neighbors....and anyone that calls 911 for a not so bright reason (here are a few stories from a fellow blogger).

50mg of Benadryl And Some Morphine

I just moved to a new station. My engineer bid out to the same station as me so we're still together. So while my captain, engineer and I were working out we talked about "frequent flyers" that are in the area. I've met a couple of them already from the overtime shifts that I've worked. My engineer mentions one that used to be in the area a while back but my captain says they haven't run on her in a long time.

Fast forward to lunch time. The tones go off and we are dispatched to a familiar address (at least to the rest of my crew). At my old station I would get dirty looks when I would say we hadn't had a certain type of call in a while. We would undoubtedly get on that shift. Full arrests, traffic accidents, wires down, fires...it didn't matter. Every once in a while it would strike me that we hadn't had a, fill in the nature of the call here, in a while. My crew would groan and say more or less, "SHUT UP." Well this time my engineer had done it. We were headed to the frequent flyer that my engineer had just told me about.

 When we arrived on scene we found a 28 year old female complaining of severe abdominal pain. When asked about her medical history she rattled off a list. She then informed me that she would like "50mg of Benadryl for her anxiety and some Morphine." Going into the call I was forewarned that she was a drug seeker. Even if I hadn't been, she asked for Morphine. Anyone that asks me for Morphine automatically is put into the category of drug seeker and I refuse. At that point my thorough assessment will determine if you really are in pain or just full of sh*t. I am very aggressive about pain management. This stems from me getting yelled at by my preceptor years ago when I wasn't going to give Morphine to a guy before I moved him.

I asked my patient to rate her pain on a scale of 1-10 if a 10 was the most pain she had ever been in. This is a funny thing that goes on in the medical profession. 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. My patient said it was a 10!" So I asked her if this was the single most painful event of her life. She looked at me as if I were stupid and said no. So I tried to explain further. Think of the most pain you have ever been in, that is a 10. How is this pain compared to that? "It's a 10" she said again still with that look of your an idiot plastered on her face. Really not the best tactic if you're trying to get some pain meds. At this point I gave up. She obviously isn't in much pain, if any at all. And she's been in the EMS world enough to know what we ask and how she can get drugs (at least from a new medic).

Needless to say, she got nothing from us, nothing from AMR and I'm willing to bet, nothing from the ER. I'm sure I'll be seeing her again.

The Glass Is Half Full?

Yesterday we ran a call at the Jr High for a 13 year old with chest pain. The kid had a condition where one leg was a different length than the other. This caused him to have poor posture and which every once in while would lead to have pain in the muscle in between his ribs. He had been seen several times by the local ED for the same problem. We contact his mom and after a brief conversation, she decided that she would pick him up at the school.

So what about this call had us talking and laughing around the kitchen table after the call. The simple fact that the mom had said that her son had one leg that was longer than the other. We all agreed that we would have described it as one leg shorter than the other. We decided it had something to do with viewing life from the perspective that the glass is always half full. We just couldn't figure out which side we were on. Yes, we talk about the most random things at the station.

There's A Reason Cops Are Not Firefighters

A couple of days ago a 26 year old man in Portland decided to torch himself. He poured gasoline all over himself and then ignited the fumes. Luckily, there was a Portland police officer just down the street. The officer saw the flames and smoke and quickly drove over to render assistance (furthering the idea that all cops want to be firefighters). The would be rescuer went to the trunk and grabbed the fire extinguisher. The officer then sprayed the human torch who tried to avoid the extinguisher. This might be why. The officer, instead of grabbing the fire extinguisher, grabbed the over sized bottle of pepper spray used for riot control. It is the same color and similar in size. It's water based so it didn't fan the flames but I'm sure it started a whole new type of burning. Unfortunately the man died later on in the hospital. I know I shouldn't find this funny but I really do. Here's the story as told by KGW news in Portland.

 

Here are pictures of both a 2 1/2 pound fire extinguisher and a large bottle of pepper spray (I don't know what types of either the police department uses.