Assignment Evaluation

Boracho

2005-10-10T16:08:00.000-04:00

Had an out-of-the-ordinary experience last night...

Most of the time we medics are called to deal with the aftermath of drunk driving, but last night we applied the proverbial ounce of prevention. Cruising down a local highway around 3am, my partner and I noticed an SUV weaving all over the road. The driver then proceeded to jump the concrete median (throwing sparks) and speed toward us. My partner stomped on the gas, veered out of the way, and looped around so we ended up behind our very drunk friend, who was still weaving his way toward an intersection.

We grabbed the radio and called for some help on police mutual aid, flipped on the lights, and sped after him. We overtook him without much trouble, and cut him off at the median. Luckily, he didn't try to ram our truck, but just came to a stop. The guy hopped out, came to our window, and asked (very drunkenly and with much alcohol on the breath), "What wrong with my truck? What wrong?" We had the guy sit down and took his keys while we waited on the police. A state trooper happened to be at the intersection, and he joined us within a few seconds. We explained what we thought was happening, and smelling the man's breath, he performed a breathalyzer test. The driver blew a .20.

Needless to say, he was cuffed & stuffed for DUI as well as no license & expired registration. The police were very complimentary, and we left the scene feeling that we'd actually made a difference. Not that hauling nursing home patients to and from various and sundry destinations isn't important, but...

Paroxysm

2005-09-30T10:36:00.000-04:00

The body count:

+ female in her 40s with hx of SVT & pulse rate of 200 (terminated with adenosine; priority 2)

+ male in his 50s with altered LOC secondary to ingestion of unknown psych meds (priority 1)

+ minor car wreck in which several hundred pounds of turf were spilled on the roadway (priority 3)

+ male in his 60s with chest pain & cardiac hx (priority 2)

+ male in his 30s with epigastric & abdominal pain (priority 3)

All in all, a decent day. Cheers to my partner, who got a service commendation for his role in helping victims of Hurricane Katrina who were airlifted to Our Fair City.

Have a great weekend, all...

Asystole

2005-09-28T18:39:00.000-04:00

It would seem strange not to mention my very first pediatric cardiac arrest, though it didn't really stick with me like I thought it might.

We're dispatched at about 6am on a Saturday for a "signal 9" in an apartment in the 'hood. My partner and I (along with our ride-along, a precepting paramedic) get rolling. Ahead of us, we see Engine 15 blast through a red light without so much as a tap on the brakes. Typical fire department. We proceed through slightly more cautiously. Dispatch informs us that our patient is a ten year old and that CPR instructions are being attempted. I don't give this a whole lot of credence, since we're quite often dispatched on cardiac arrests that turn out to be seizures or people sleeping, and I'm even more skeptical given the area of town we're responding to.

We arrive a split-second behind the engine company, locate the apartment, and walk inside. A low-lit room cluttered with toys and other junk. A woman screaming and crying. A young black girl lying motionless on the floor. Mom is screaming over and over, "Please don't hurt my baby!" Beyond looking dead, this girl looks sick. She's got some minor deformities along with several ports and catheters.

The father is upset, but able to speak clearly, and he tells us that the girl suffered from Sanfilippo syndrome, a genetic disorder in which the storage of mucopolysaccharides are disturbed and which results in a degeneration of cognitive abilities and eventually death (see Medline for more). While I'm prepping the heart monitor and checking for a pulse (there is none), the father hands the Do Not Resuscitate form to my partner. This changes the game entirely. With that order in hand, we are not allowed to begin resuscitative measures on a pulseless & apneic patient. I quickly attach our monitor's limb leads and print a strip. "Asystole," I say quietly.

Both the mother and father understand what has happened, and its apparent that her death had been coming for some time. This, of course, is no comfort to the mother, who rocks the dead child in her arms and cries. The fire department, feeling rather useless, bugs out, while my partner and I attempt to gather more information as well as do our best to comfort the family. The police arrive and start to do their thing. It's all very quiet and anticlimactic.

We went on with our shift, and I didn't feel out of sorts or anything. I've gotten used to adult cardiac arrests, but this was my youngest by far, and I fully expected to be in an altered state for a few days (or at least a few hours) afterwards. But I did not. This may be because the child's death was the expected, rational outcome of her disease. I find that it's easy to distance oneself from a patient (or from a patient's death) if death is impending.

In any case, the call did not throw me for a loop, and perhaps I should be a bit disturbed that it didn't.

"Hey paramedic!"

2005-09-28T14:45:00.000-04:00

"...if I'd have known I was gonna end up here, I'd have jumped out the back of your ambulance!"

-- yelled by a nursing home resident to yours truly while working on another patient.

Hey, me too, man.

Back in Black

2005-09-13T13:20:00.000-04:00

Apologies for the long absence...I suppose I have proven myself to be less than the hardcore bloggiste than I thought I was.

Lotsa stuff these past few weeks, chief among them being the omnipresent Katrina and her omnipresent victims. We received just under 500 of said unfortunates in our fair city, and yours truly was on hand to help receive them in our own little Superdome. Well, it was never that bad, but it was cetainly unorganized. My partner and I were the first medics on the site, and it was (at least intially, along with a few volunteer docs & nurses) our job to provide both emergenct and non-emergent care to these folks. Needless to say, with limited equipment and manpower, what followed was an MCI in its' own right.

But after two or three days of flying by the seat of our pants and haggling with various administrative types, they finally figured out a system in which the two hospitals in our city would provide round-the-clock nurse & doctor staffing and we would go back to being emergency medical technicians. Thank God.

Not much else happening...

Got to see and elderly woman take her last breath just as we walked in the door. Ended as a cardiac arrest, though dispatched as a breathing problem. Yeah, a not breathing problem.

Medicare Vacation

2005-08-23T18:33:00.000-04:00

Not much energy for a post tonight, but I'll promote the cause of a fellow system-abusee. Read DT's latest post for a dose of everyone's favorite emergency call.

Keep those blinkies and woo-woos a-goin'!

Oh, and while you're at it, check out ResQEllie's pics of the London Ambulance Service. Great visuals for reading Tom's posts.

Daily body count:
- 60ish male with dizziness; otherwise asymptomatic; priority-3
- mid-20s pregnant female with asymptomatic pre-eclampsia; transfer across the street from clinic to hospital; priority-3
- mid-60s male with shattered left patella secondary to a fall; priority-3
- male in his 40s with severe LLQ pain; priority-2
- cancellation / water rescue
- cancellation / general illness at the airport

As if being a medic wasn't hard enough...

2005-08-17T10:06:00.000-04:00

...we're apparently attractive targets for terrorists and other urban combatants. Say what you'd like about the current state of affairs in Iraq (and I for one do not think the US presence there is right), but the slaughter of civilians and healthcare providers of any nationality is unconscionable. Check out the news stories here.

Gonna Be Some Changes Made

2005-08-11T09:07:00.000-04:00

Three more days till my shift changes! Wahoo! I'm moving from a 7:15 truck to a 5:15 truck, complete with a new (and good, by all accounts) partner. Can't wait.

Quoth the pager:
- pregnancy call (psychotic patient off her meds because she's pregnant...watcha gonna do? - refusal)
- unconscious person (agonal resps, pressure 50/palp, kicking, screaming, thrashing - priority 1)
- assault (6 ft blind man beat up by his 4 ft girlfriend - priority 3)
- chest pain (middle age female with minor chest pain, direct-admit to hospital across the county - priority 3)
- general illness (paraplegic pulled out his foley cath, copious bleeding - priority 3)
- stroke (elderly man with speech problems, all systems resolved upon our arrival - priority 3)
- breathing problems (young guy out of asthma medication - refusal)
- hemorrhage (middle age man throwing up coffee grounds - priority 3)

Plenty for one day, I'd say.

Oh, and the title refers to a Bruce Hornsby song that I've been looking for forever - it's the background music to the Lowe's radio commercials. Go figure.

2005-08-04T20:27:00.000-04:00

SHPOS

2005-08-04T19:50:00.000-04:00

Not going to get a Christmas card from this guy...

Dispatched for an overdose on unknown meds, patient outside an apartment complex, possibly violent. Just before we're on scene, dispatch states that our man took 14-15 Klonopin yesterday and is not acting right. We (and the engine company) walk up to the 2nd floor apartment where this cat is supposed to be, and we find a young guy standing outside, walking around with an unsteady gait, with The Look on his face. The Look you see, is that half-crazed, half-baked stare most commonly found in the dain-bramaged and drug-addled who have a propensity for violence. This is gonna be fun!

After several attempts at speaking to him and trying to figure out what his deal is, we inform him that he needs to be checked out. At that point, he makes a move to take off, but is held back by my partner and I. "No, no," we say, "you're staying here till the police get here" (late, as usual). A couple of cops show up, and we explain the situation, along with further information from the person he was staying with: this guy is from outside the city, but stays here; has a long history of drug abuse; attempted to knife his brother yesterday and then stole a car. He's pretty clearly altered, and his medication use sounds like a suicide attempt. The whole time: "Y'all muthafuckas, I'm fine, fuck y'all, don't need to go to no damn hospital, blah, blah, blah."

Since we've got plenty of manpower at this point, I head downstairs to clear off the cot and get our soft restraints ready, since it looks like this guy wants to go the hard way. As I start heading back up the stairs, I hear a scuffle and a loud SMACK followed by copious cursing and yelling - our patient had tried to make an ill-advised break for it, and was now beneath my partner, the two cops, and the firefighters, fighting like a crazed chicken. A pair of handcuffs later, and he was far easier to handle, though no less friendly - he told us 'faggot-ass muthafuckas' that he was gonna kill us when he got out. OK, sure, buddy.

So we got him in the truck, cuffed, stuffed, and tied, but he refused to shut his mouth, going on and on about how he was gonna kill us, get his lawyer to sue us, and could we please loosen these cuffs? Ha ha...no, but here's 16-gauge in your hand! Luckily, he went into a drug-induced sleep soon thereafter, so we were able to get him transfered to the hospital with relative ease. Ah, how I love my patients!

Seizing in Stereo

2005-07-31T09:40:00.000-04:00

Th girlfriend's parents have been in town all weekend, so I haven't had much chance for blogging...

Had an interesting one yesterday. Dispatched at 10 in the morning for a cardiac arrest, possibly for a 1-year-old. Dispatch tells us there's a language barrier, and they're trying to get further information. Needless to say, neither my partner or I want to code an infant. We roll up at the check-cashing store to find a group of hysterical folks and a flaccid-looking child. My partner scoops up the kid and we get him into the truck (and out of the pouring rain) and immediately notice that while he doesn't look well, he has a pulse and is breathing (sigh of relief).

We start working on the kid, and he appears post-ictal. Parents are of little help, though I manage (through broken Spanglish) to figure out that the parents saw some tonic-clonic activity. No history, no meds, no allergies, but he's febrile for sure. We've got him on O2, monitor, getting ready to get an IV - when our ambulance door bursts open and in pops another hysterical woman and another flaccid infant. Both my partner and I start yelling and scrambling to figure out what the deal is. The second infant is still seizing, though he stops after a few seconds.

I start to call dispatch to get a second truck, but my partner decides that it'll be faster to strap both infants down, grab some firefighters for extra hands, and book it to the children's ED. More O2, monitor, attempted IV en route. Both kids are starting to perk up and cry, much to our relief. Through more difficult translation, we manage to figure out that the two kids are twins (with the same first names, to make life difficult), and they both have fevers, and they both seized within minutes of each other. That's a zebra for me folks - never heard of that.

Upon our arrival at the hospital, both kids (and mom, of course) are crying, s things are looking up. I'm not sure how they did, but maybe next time mom could give them simultaneous Tylenol and avoid the hassle. Just a thought.

Start the Bird

2005-07-21T22:06:00.000-04:00

Flew one out today...got called for a fall with injury WAY the heck out in the county. While en route dispatch advised that our patient had fallen 30 feet off a ladder, and that they were starting our local medical flight service. All of a sudden the pucker factor had increased significantly... When we got there, he was conscious & alert, lying on the ground, really not complaining of much of anything. No obvious injuries or neural deficits, though his fellow construction workers were trying to one-up each other in describing how high he had bounced when he hit the ground. We, with the help of some first responders, got him packaged, stripped, IV'd, monitored, and all that jazz in a few minutes, and then I moved the truck from the site to the LZ where a couple of engine companies were staged. Just like on TV, the bird touched down, and out popped the flight medical team, to whom we gave our report. Then we ducked under the whirling blades and got our guy locked and loaded. The bird took off without a hitch, leaving us in a cloud of dust, grit, and sweat. So we got to drive fast, work fast, land a chopper, and we didn't have to transport anybody...this one's in the running for best call of the year!

Bad Crack

2005-07-20T21:50:00.000-04:00

That's what the cops told us she got into. And I never knew how accurate Dave Chappelle's portrayal of a crackhead really was until I saw this lady. She had the whole enchilada: delusional, agitated, jumpy, itchy, wild-eyed. And because she technically had to be monitored for heart problems, my partner had to ride the call (ha ha!).

We had a busy day: 9 calls, 6 transports, 2 cancellations, and 1 refusal. Further broken down:

a diabetic who we had to fight to get an IV (BGL 28)

a lady who drank some Pepsi and felt her heart a-racin'

a guy who sawed through an electrical socket, got zapped, fell backwards, hit his head, and seized

a pancreatic cancer patient who'd run out of meds

a CHF transfer from a county hospital to downtown

a high-risk pregnancy with contractions 2-3 minutes apart

a girl with a "bug" in her ear

a possible ectopic pregnancy

the aforementioned crackhead

Another surreal day in the world of the bo-lance...

Entrapment Protocol

2005-07-17T23:29:00.000-04:00

The long work weekend is finally over! And somehow we managed to get late calls for all three shifts. It's amazing how so many of our patients have a sixth sense that tells them exactly when shift change is supposed to happen - and therefore when to call 9-1-1 so they can get MY truck just as we're trying to get off.

Lessee...we had: a long-distance transport to a regional medical center, several patients that in one way or another I managed to tick off, a pin-in with a Buick vs. a dump truck (77-year-old pinned by the dash with 10-min extrication), and some other stuff I can't quite remember. Had to fight some folks who were hypoglycemic - my aching muscles remember that.

Oh yeah - our shift-bid happened, and I managed to snag a 12-hour truck starting at 5:15am. A miracle, really, that I even stayed on day shift, given my lack of seniority. And I even managed to get a good partner, plus I'll be able to take some PA-school-prerequisite classes at night. Sweet!

Not much else to say - just happy I've got a couple of days off.

Working hard...hardly working

2005-07-12T19:08:00.000-04:00

Lots of lovely patients today. I think my favorite was the guy we picked up at the airport who met us with a giant grin on his face who told us he had a "ten and a half out of ten" headache. No chest pain, no dyspnea, no dizziness, no nothing...just a headache and a crazy grin. I intially sympathized, but we soon realized this was a want-to-get-out-of-work-itis call. He was negative for all our stroke criteria, or any other criteria for that matter. While he's having this awful headache, he's sitting up, smiling, talking, and asking questions about the ambulance and what we do. Why can't I have headaches like that?

Runner-up for Patient of the Day was the guy who told us he felt like there were "bugs" biting him beneath his skin. While he had many skin lesions, possibly caused by recent exposure to poison oak, none of us were able to locate said bugs. After the patient stated he had recently smoked marijuana and crack, we stopped looking.

But hey, it was a better day than Monday, when I had to stand on a freeway in pouring rain while attempting to do refusal paperwork on four MVA victims - none of whom spoke English. Of course, my Spanish is pretty limited too (no fumo espanol), so I can't really blame them. It's funny, though, how that call was easier than the one preceding it, despite the fact that it was a code. All we had to do was walk in the room, note the firefighters' attempts at compressing her cold and stiff chest, and learn that she was last seen alive two hours prior. CPR had been going on for 15-20 minutes, and she was very asystole on the monitor - no save here, folks. We pronounced her and were back in service within 20 minutes. The multi-vehicle accident took about 4 times that.

Isn't it odd how a person's passing can garner less time and necessitate less paperwork than a BS wreck?

EMS/Blogging reactions to the London attacks

2005-07-08T22:20:00.000-04:00

Please check out Tom Reynold's blog for some very interesting writing concerning the recent attacks in London.

Our prayers are with those in London and victims of terror everywhere.

Weekend (Off) Edition

2005-07-08T21:59:00.000-04:00

...well, almost off. I worked a PR/demo thing at a kids summer camp today. We talked about summertime safety, told the kids who we are and what we do, showed them the truck and some equipment (even put one in spinal and hung him upside down), general show-and-tell type stuff. The kids didn't fall asleep, so I think we accomplished our mission.

Thursday was slightly more interesting - didn't even make it out of the parking lot before we got dinged for a wreck on the interstate. Just as we were pulling up to the accident, however, our 240,000-mile old POS ambulance decided to blow a gasket and lose the power steering and brakes. Narrowly missing the already wrecked cars, we provided traffic cover till the highway patrol arrived, after which we gingerly limped our truck back to get looked at. Turns out the power-steering column (insert mechanical jargon here) failed...imagine that on a truck that should have been retired 40,000 miles ago. Whatever.

We switched trucks and got back in service - and a good thing too, because we were then dispatched to save the life of a 2-year-old...with a quarter-inch laceration(!) to her finger. The child wasn't even crying when we arrived, and yet the mother insisted she be taken to the hospital "because my car done broke." Okay, sure. Another one snatched from the gleaming jaws of death!

Oh, finally fulfilled my ice cream craving with a Reeses Blizzard from Dairy Queen! Wahoo!

And now a weekend off, without an ambulance in sight...

average day on the bo-lance

2005-07-06T20:35:00.000-04:00

Hidey-ho, neighbors...

Today's body count: an urban outdoorsman with CHF & pneumonia; a 24-year old who couldn't figure out why she felt so bad after smoking two blunts and snorting a gram of cocaine; a traffic accident/cancellation; Grandma with chest pain; a guy who didn't eat all day and wanted to know why his blood sugar was 48; and finally a non-emergency transfer for a PEG tube replacement.

All in all, an average day for us. We had a nursing student ride-along today, and she surprised my partner and I by gloving up and getting in the action on all of our calls. She helped take vitals, calm patients, and other good things that we'd never seen a ride-along do before - all unasked. Why can't all nurses be this cool?

Time to go sate my craving for ice cream. For all you bloggers out there, please read Medic!'s Blogstitution. Doin' my best to follow No. 6 as we speak...

EMS in the blogosphere

2005-07-05T14:52:00.000-04:00

I'm impressed!

A quick Google search turned up a ton of EMS blogs. One is even written by another anthropology major/EMT - what are the odds of that?

Just goes to show you that not ALL paramedics and EMTs are illiterate stretcher-fetchers. Just the ones I work with, ha ha ha...

My *lovely* EMS agency is getting ready for a shift-bid here in a week or two, so its anyone's guess when and with whom I'll be working for the next year or so. I desperately want to get back with my old partner - she and I had a good vibe going until she got moved to a 14-hour truck. So we'll see...and hopefully I'll stay on day shift, though I'll take a night truck if its a 14-hour. Updates to come.

Assignment Evaluation: 10-41

2005-07-05T13:57:00.000-04:00

Hello, world.

I suppose now that the media firestorm about blogs is nearly over, I'm a little late in creating my own.

A few words of explanation: the title of this blog refers to the dispatch software used by the EMS agency I work for. Each truck has a mobile status terminal that displays information on calls and provides recommended routes for getting to the scene. Assignment Evaluation is displayed on the MST miliseconds before a call is dispatched. When it comes up, my blood pressure rises, my pulse spikes, and off we go, lights and sirens.

This blog is probably going to be pretty heavy on the emergency medical services stuff, so all you Ricky Rescues and EMS Geeks can start salivating now.

Oh yeah, 10-41 is the ten-code for the beginning of a shift on the ambulance. Here we go...