Monkey See, Monkey Do

1423 hours

Truck 51, respond with engine 57 for a motorcyclist down....

The truck was canceled by engine 57 while en route to the call, but they were already committed to the canyon. They passed the accident and saw that the rider had laid his bike down but had not gone over the edge.

1712 hours.

Engine 51, rescue 42, battalion 5, respond for a motorcycle down, possibly over the side....

As we started up the canyon we verified with dispatch that an engine and ambulance were responding from the city on the far side of the canyon, just in case they were closer.

As we wound our way up the narrow road a CHP unit came up behind us. Since he was able to take the road at a lot faster pace, we let him go by. A couple of minutes later we came up on him again. He was stopped behind a group of motorcycles and cars where one guy lay out on the ground. We immediately reported what we had and the responding BC canceled the balance of the assignment.

My patient had been traveling up the canyon when he hit some gravel and spilled. He didn't lose consciousness but was experiencing neck and back pain and also pain to his left scapula. We quickly did a "strip and flip" (a quick trauma assessment where we cut the clothes off the patient and check head to toe for injuries) then strapped him to a backboard.

It was about this time that we started to wonder about our ambulance. My captain called dispatch and found out that when all of the responding units were canceled, the ambulance was inadvertently canceled as well. Dispatch then informed us that there was still an AMR unit coming from the far side of the hill. We then asked for an ETA only to find out that that unit had gotten lost and was 30 minutes out. We had another unit sent from our side of the hill.

Meanwhile, we had time to do everything we needed with our patient. We had a complete history and physical. I started an IV and offered some medication for pain management, which was refused. We still had time to kill. We started making small talk. That's when we found out that he had traveled down to our trauma center to visit a friend in the ER. His friend had been in a motorcycle accident several hours ago, about 100 yards from where he was now strapped to a backboard. He had been unable to see his friend (because he didn't know his friend's last name) and had been on his way back home.

Almost an hour after he hit the asphalt my patient was loaded into the back of an ambulance. He was headed back to the trauma center where he had tried to get in to see his friend. Maybe they shared a room.

"Stupid Is As Stupid Does"

It wasn't even a holiday weekend which made the presence of a DUI checkpoint down the street a surprise. I'm sure it was more of a surprise to the drunk drivers trying to make it home. But this post is not about them. It's about another driver that made some very poor choices both before and after encountering the DUI checkpoint.

This man had chosen, earlier in the day, to steal a Land Rover. Stupid move #1.

As he rounded the corner and the flashing red and blue lights came into view I'm sure his adrenaline started to kick in. He then decided to do what a lot of people trying to avoid the law do when presented with a checkpoint, turn into a parking lot and go another direction. Unfortunately for him the police know this too. So when they see someone turning last minute it guarantees that a motorcycle unit will quickly follow to investigate.

When the officer tried to pull him over the driver hit the accelerator. Stupid move #2.

A short chase later (about 2 blocks) the thief wrecked and then tried to flee on foot. Stupid move #3.

The perpetrator, who happened to not be in great running condition, then decided that his chances of escape were better if he used his physical prowess to climb a fence. Stupid move #4.

The officers (now there were a lot of them....I have to assume that a chase is to a cop what a structure fire is to a firefighter) caught up to the bad guy at this point and pulled him off the fence. Now seeing as he was only outnumbered by guys with batons and guns and since our delinquent was obviously in great physical shape  I can understand why he decided to attempt to fight off said officers. Stupid move #5

This is about the time that we were toned out. As we approached the scene we could see that several PD units had half of the major street blocked and the entire side street was cordoned off with yellow police tape. An officer led me to the back of one of the patrol cars while explaining the situation to me.

My patient was very upset and was yelling quite a bit. Mostly he was cussing out and cursing the deputies that caught him. He was mostly cooperative but every couple of minutes he would go back on a tirade about police brutality. His face was bruised and sore but his biggest complaint was a sharp pain in his ribs. It's possible that he could have had a fractured rib. Every time he would start screaming about the "f***ing cops" I would just reassess his painful ribs (does it still hurt when I push here?). It shut him up fairly well.

Trying to get sympathy from me for getting beat by PD when you deserved it. Stupid move #6.

The arresting officer asked if he needed to go to the hospital and I informed that I thought so. He then asked if he was going to die if he went in the patrol car. Nope! Cancel AMR.

His only good choice was the type of vehicle he chose to steal, which I'm sure happened quite by accident. This is a pursuit of a Land Rover in LA several years ago.

Calling For The Bird

 

No, not that bird.

The tones went off for a traffic accident. We had the report of a motorcycle down on one of the canyon roads. This call started out like a lot of calls. We arrived at the reported location to find nothing. So we kept going. A couple miles down the road we found the accident.

The 25 year old rider said that he was being tailgated so he tried to go a little faster. That's evidently when he lost it. We found him laying on the side of the road in the dirt. Several bystanders had stopped to help. My patient had removed his helmet (even though he said he knew better from the combat corpsman training he had received while in the Navy). He said he didn't lose consciousness. His helmet was intact without much damage. His only real complaint was pain to his left hip. I quickly did an assessment to determine if we need a helicopter or if he was stable enough for the long transport to the hospital. Everything was looking like ground transport until I got to his pelvis. The patient was complaining of left hip pain and when I rocked his hips it really hurt. The decision was immediately made to land a helicopter. A patient could easily lose enough blood from a fractured pelvis to be life threatening.

Now that that decision was out of the way I continued my assessment. The young man also had decreased mobility and strength in the left leg.Other than that he was in fairly decent condition. After checking him for further injuries we packaged him up. As we were strapping him down to the backboard AMR showed up. We quickly loaded him into the back of the ambulance and headed up the canyon to the LZ. There, engine 52 and engine 97 (from a neighboring agency) had shut down the road and set up for the helicopter.

We were there waiting as the helicopter approached. The pilot circled around the valley once to gauge the winds and then settled into a landing pattern. We all had on our turnouts and helmets, with our goggles on. I flipped up the collar on my jacket as high as it would go and got ready to get pelted by debris. I'm sure that there were a lot of drivers that were stuck behind the big red road block that enjoyed the show.

This is the same type of aircraft that was on my call.

As the helicopter came in he was buffeted by some strong cross winds. When he finally did touch down it was only with 2 wheel. The road was a little too sloped in the spot that had been chosen and the pilot was reluctant to set the chopper all the way down. He tried 2 more attempts at the same spot. Each time he did I became more and more nervous. I kept getting visions of helicopter blades and fireballs flying into the air.

Statistically, flying on a medical helicopter is the most dangerous 

job in the country, It even trumps miners, loggers and fisherman. Read a 

couple articles from Popular Mechanics and  The Wall Street Journal 

that talk about the dangers.

After the third attempt the pilot told the CHP officer and the captain of engine 97 to move their vehicles. They were now in his landing zone. This time he was able to bring it in without much trouble. He did decide to shut the helicopter all the way down while loading the patient for some additional safety. A few minutes later the bird took to the air with our patient.

We cleared the call as soon as the helicopter was gone. We had ice cream back at the station that needed eating.

Similar To Reindeer Games?

You ever wonder what other games the reindeer play besides Monopoly?

I like to think they do practical jokes. Kind of like a bored firefighter.

The other day I was at the station just sitting down to eat lunch with my crew. My engineer offered to make tuna sandwiches for everyone. My captain was just getting a glass of water when I took my first bite. I quickly discovered that the reason he was getting water is that there was cayenne pepper in the tuna. I wasn't expecting it and it hit my throat just right where I started to cough a little. So I got up and went to get a drink of water like my captain.

While I was getting a drink my captain noticed my face was red. He turned to the engineer and asked him if he had put cayenne pepper into the tuna because I was allergic to cayenne pepper. When I heard this I immediately tightened up my abdomen turning my face beet red. My engineer, who was on the phone with a firefighter at another station, took one look at me and thought that I was headed into anaphylaxis.
My captain yelled for him to go and get the EMS gear. His cell phone went flying as he headed toward the truck. Once he was out of ear shot we started cracking up. As the engineer started to come back in my captain was shocked to see me take it a step further by dropping to the ground. Now my poor engineer comes around the kitchen to see his firefighter "near death" on the floor. All he can do is shout, "What should I do?! What should I do?!"

At this point I sit up. Needless to say he was a little upset. After a few minutes he could at least see the humor in our gag. Although, for the rest of the shift he kept referring to us as *ssess and was sure to let me know that payback is coming.

Okay, maybe firefighter games are more fun.

Remember

Truama Preceding A Medical Problem?

The call came in for a fall victim, unconscious but breathing. As we were pulling out of the station I told my crew that this was going to be a bad call.

As we pulled down the second to last street, family members could be seen frantically waving their arms trying to get our attention to direct us to the patient. Not a good sign.

As I jumped off the engine, I was greeted by a slightly hysterical woman who I assume was a daughter. She said that my patient had fallen about 15 minutes ago onto the concrete. As I came around the tailboard I saw an old man sitting in the driveway with his back towards me. He was sitting in a walker/chair. The son was leaning in trying to arouse his father. As I approached, the son told me that he didn't think the old man was breathing. One quick look at the face was enough to tell me what I needed to know. Out of habit I checked for breathing and a pulse. Nothing.

I quickly wrapped my arms around the patient from behind and started to pick him up. The son was trying to help but without knowing what I was doing all he managed to do was get in the way. After forcefully telling him to get out of the way, I lowered his dad to the ground and started chest compressions. As I was doing this, my crew kicked into high gear. My engineer grabbed the airway bag, popped in an OPA and started breathing for my patient with a BVM using pure oxygen. My captain grabbed the heart monitor and pulled out the defibrillation pads. In between compression sets he put them on the patient.

By this point I had been doing chest compressions for about 2 minutes and we checked the heart rhythm. My captain said that we had a rhythm. The monitor showed that he was in a sinus bradycardia but he still had no pulses. This means that he was in PEA (pulseless electrical activity). The electrical conduction system in the heart is working well but for some reason the heart does not respond to the electrical impulses. As I continued compressions my heart sank as I heard the family members, with hope in their voices, state that they had heard us say he had a rhythm. I wish I had had the time to stop and tell them what exactly was going on.

Just then AMR pulled up. They grabbed a backboard and in between compressions we slid the patient onto the backboard. While continuing CPR the others strapped the old man to the board. We then took a moment to load him into the ambulance.

Once in the bus things really started to get going. My engineer and I switched places. The AMR medic obtained vascular access by starting an IO infusion on the patient's right leg. While this was going on I grabbed the medications that we were going to need and passed them over. Several Epi's, some atropine, some sodium bicarb and a calcium carbonate just in case. While the AMR medic handled the drugs and the monitor I bagged the patient and set up to intubate.

I had forgotten how hard it can be to try to intubate someone in the back of a small ambulance. I squeezed down in between some equipment in a weird contorted way that would have made me look like I was auditioning for Cirque de Soleil. I managed to get an okay look at the vocal chords and passed the tube. While the other medic popped on the capnography I listened to lung sounds. I had good lung sounds in both lungs AND in the stomach. The tube's cuff must not have been fully inflated so I grabbed the syringe to give it a little more air. Somewhere during all this I think the tube became dislodged so I pulled it out. Since we were only a minute from the hospital I just went with a BLS airway.

More or less what we see when we are trying to intubate someone. 

We want the ET tube to go right through the opening where the #2 is.

After getting to the ER I found out that the patient now had 3 rounds of epinephrine, 1 round of atropine and 1 amp of sodium bicarbonate all on board and was now in a sinus tachycardia PEA at a rate of 120. Somewhere in there the other medic had checked a sugar as well. It was 135.

We gave our report to the staff at the ER. It took the doctor 2 attempts and my help with some cricoid pressure to intubate the patient so I don't feel to bad. My engineer and I didn't stick around long enough to
see the outcome of the patient but we didn't have to. We've seen enough to know he wasn't going to make it.

So the question is did his fall cause the full arrest or did his full arrest cause the fall? It doesn't really matter. Dead is dead. If trauma had caused it there would be no bringing him back. If it was a medical problem, then we gave him the best chance at survival.

More Proof About Cops!

Yes, I'm back at that old joke, what do firemen and cops have in common....

Here's a story of a couple cops pretending to be firemen.

I Have An Idea

****WARNING****

Venting about to take place

Why is it that the patients that have the biggest bull Sh*t complaints are also the biggest, most self absorbed, self important, *ss holes?!!

So this is a story of one of our most recent adventures and is in no way isolated.

This patient had a headache. OK. To be fair, a migraine. Still, it's just a really bad headache. I've had one, my wife has them frequently, I understand what they are and how bad they can be. So the patient, I'll call him John, decides to go to the ER.

Here I could make the argument that he shouldn't be going to an ER but I won't. I understand that due to economic times and ignorance people believe that the local emergency department is their only recourse for any medical attention.

My issue begins with John's visit to the ER after he gets there. John signs in and tells the receptionist about his ailment. Then, in order of importance based on threats to life and limb, he is placed on a wait list to see the triage nurse. This nurse does a quick evaluation to determine how serious someone's injuries really are. John is then placed on an ever changing and updating waiting list for a bed in the ER where he can be seen by a doctor. Not only can he be bumped down the list by someone walking in with, say, a heart attack but he also gets bumped when an ambulance brings in a guy with an amputation.

After a short wait (to be honest I have no idea how long John had to wait in the ER waiting room but I know that he went in early in the morning when ER's are generally slowest) John decided that he had waited enough. John walked across the street to the first pay phone he could find and called 911 (at least he walked out of the hospital....I've been dispatched to the waiting room of the ER). He figured that he would be seen faster if the ambulance brought him in.

Somehow I doubt that any of my readers would do this but let me dispel this rumor right here, right now. If you are not a patient with a true emergency and you are brought into the ER by ambulance, you will still end up waiting just as long as you would have had you walked in. When I worked on a box (an ambulance) there were plenty of times where I would wheel the patient in on the gurney, through the ER, straight to the waiting room and tell them to have a seat.

Luckily for me AMR showed up to meet John before I did. They waived us off as we approached. I hope they put his *ss right back in the waiting room.

Eating Smoke For Breakfast

My alarm buzzed a little too early. I did what a lot of people do and hit the snooze. While laying in bed slowly waking up the tones went off. The structure fire tones (we have different tones for medical aids, vegetation fires, structure fires...). Structure fire tones this early in the morning usually are not false alarms. And most of the structure fires this early in the morning are blowing pretty good.

As we were responding dispatch informed us that we were en route to an outside fire that was up against a building. Engine 50 was already on scene requesting a first alarm assignment.

Once we arrived engine 50 cancelled everyone else. They had a fire that had started in a shed and spread to the wood fence. About 20 feet of fence line was charred. I took the chain saw and started cutting the fence and shrubs. After about 30 minutes what was left of the fence lay in an ashen pile soaked in foam.

The owner was very thankful that the fire was limited to the small area in their yard. We arrived back at the station with just enough time to tell our story to the other guys at the station and go home.