Thursday, December 30, 2010

- For those of you under a rock...

....Confessions of an EMS Newbie, featuring my bloggy daddy Ambulance Driver, is a GREAT podcast that covers a rookie's journey through Basic and Paramedic Class. Check it out!

-MM

Tuesday, December 14, 2010

-Self Defense

We have been called out to a domestic dispute between a father and his 16 year old daughter, where the daughter apparently made some sort of threatening gesture after an argument with her dad. The deputy meets us outside.

"He took away her cellphone after an argument. She got pissed and went home, and when he walked by in the hallway she shook a bottle of Aleve at him, and he freaked out and thought she had taken them. The bottle is still full."

"What an idiot. Jesus."

We go inside and get the story, the daughter still simmering with anger and crying. She raises her voice at the dad and yells at him a couple of times. The dad refuses to send her to the hospital, saying he would take care of the matter himself. The daughter's vitals check out and Dad signs the refusal, even after I explain that it may be in her best interests to get checked out at the ER. He still says no, and I get my supervisor involved, but the supe tell me to let it slide.

Everyone is out of the house now except for me, the daughter, and the dad. Apparently their screen door sticks if it closes wrong and is now locked in to place. The dad gives it a solid kick, but it stays stuck in its frame.

The daughter steps out of the hallway at this point, looking at her father. Her frustration is evident on her face, and tears are still drying on her cheeks. She walks into the kitchen, opens a drawer, and pulls out a large steak knife.

Then she starts walking towards me and her father with a determined look on her face.

Her father is still facing the door, preoccupied with getting it unstuck. A quick look around shows no other exits. The girl is still walking towards us. I think I could break through the frame of the screen door but I have to get through the father, who is maddeningly still hemming and hawing at the stuck door. The daughter still advances, feet whisper soft on the carpet, knife in hand, staring at her father's back.

7 feet. Definitely no way out now. My butt sucks up about half my underwear. She's big for 16, rivaling Serena Williams in musculature. She can probably get some serious torque on that stabbing arm.

4 feet. She's almost in range. I plant my feet shoulder with apart.

3 feet. Go.

I grab her knife-wielding arm as she walks by me, twisting at the wrist and squeezing, stepping into her with my hip and pinning her upper arm between my arm and chest. The knife pops out and, still holding the girl's arm, I trip her down onto the carpet, where she lands on her back with a confused look on her face. I kick away the knife behind me, towards the wall and near the dad

'WHAT ARE YOU DOING?" I yell directly into her face. A sheriff's deputy had been on the other side of the door and saw the whole thing, his pistol out and pointing over the dad's hunched form, trained on the daughter.

"It's for the door!" She yells.

The dad, incredibly, finally notices all the commotion, and turns around and stares at me and the daughter, who is sitting up and rubbing her wrist.

"Oh," he says. "Thanks, babydoll." He then picks up the steak knife and uses it as a wedge along the interior side of the screen door, which pops open deftly after he slides the blade down the length.

"That thing always sticks. Sorry, sir, thanks for the help this evening."

The deputy on the other side of the door is bent over laughing.

"No problem at all, sir," I say to him. "Have a good night."

-MM

Wednesday, December 1, 2010

- Numb

The carnage is amazing for only having one vehicle involved. The car has flipped multiple times - that much is obvious, from the impact marks in the grass trail of car parts from the roadway. To top it off, the car, which was now skidding on it's driver's side, slid roof-first into a large, sturdy oak. The passenger compartment is like the inside rim of half a donut, with the trunk of the tree filling the donut hole.

The driver is sitting on the ground next to a cop car. He has a lac on his head but is awake and talking, so I downgrade him to "Can Wait a second" as I walk over the car. It's pretty rough.

"One inside," says the fire captain who is prepping his extrication gear. "He's hurt pretty bad."

"Breathing?" I ask.

"Yep. Twisted around in there pretty good though. We're going to take out the back window to see if we can slide him out."

"Sounds good."

I crouch down to the back window where a firefighter is reaching inside maintaining immobilization. This patient isn't going anywhere for the time being. A quick look in the back shows most of his body lying along the interior driver's side of the vehicle, along the roof. His right leg looks wrong, but I'm not sure why yet.

"Can you hear me, sir?" I ask the the young man. "Are you hurting anywhere?"

"No, not really. My nose kind of itches."

"Ok. Do you remember what happened?"

"Uh.....no?"

"OK man."

I walk back over to the driver and do a quick assessment. He has a small lac on his head. My partner, who has been prepping immobilization equipment, takes over. I walk back over to the smashed car as the extra unit pulls up.

The car is actually leaning against the tree it hit, allowing me access in through the rear driver side window. When I wedge my hefty frame inside, I am a mere foot away from the entrapped patient. There is plenty of blood on the roof from what looks like a lip laceration, but nothing else seems to be actively bleeding. I ask the patient his name. Now that I am inside, I can see that his right leg is covered by jacket, obscuring my view. I pull it aside and find out why it didn't look right.

The femur obviously has at least two fractures - it's bent in the shape of a "C". There is a large lac below that. And there is an ominous bulge in the front of the patient's loose gym shorts.

Fuck.

I grab the patient's hand.

"Hey, bud, can you squeeze my hand?"

There is no squeeze.

"Bud, squeeze my hand"

No squeeze.

"Tell me when you feel my pinch." I pinch his fingernail. Hard. Hard enough to make someone
pull away and yelp.

There is no reaction. He just stares up at ceiling. I take my pen from my hip pocket and drive it into his palm.

There is no reaction.

His eyes dart over to me. "When are you gonna pinch, man? Don't leave me in suspense."

Well, that's why his leg isn't hurting. He's paralyzed.

I do a couple of tests. He's numb from the navel down, and shoulders out.

It takes 35 minutes to extricate him. When we get him out he's starting to get shocky. The bulge I saw earlier is priaprism, an indicator of spinal injury in this case - I don't think the kid has had time to pop a Viagra with all the commotion. The chopper is fogged in, and our limpdick dispatcher is waffling about sending me some more back up. Our third and fourth trucks in the service area have both gotten emergencies on their way to the wreck scene, he says, and he can't spare anyone. It's going to be at least a 30 minute drive to a real hospital.

Tired of his jabber on the main radio, I pick up the 800, and lean forward into the cab, so the patient can't hear me. "Listen B, I don't care who you send me or where they come from. We can do an intercept. But I'm going to need someone soon, or I'm not going to need anyone at all."

I get my back up about 6 minutes later.

We manage to get some large IVs started, and hurry the kid to the hospital. He's starting to go in and out on me, and I have my intubation equipment set up, but a gentle verbal command perks him up and gets him breathing again.

We transfer care.

At home, in the shower, I wash broken glass out of my elbows, and try to wash the exhaustion off of everything else

-MM

Thursday, September 23, 2010

- Medals

I am not in the line of fire, although most shifts I encounter life-ending contagious diseases. I am not a hero, but most shifts I help save a life. I'm not a rich man, but I help enrich lives. I'm not a counselor, but I've comforted more grieving family members then some psychiatrists.

I'm not much. I'm two years of crunch medical training inside a delicate fleshbag that's as susceptible to the trauma of everyday life as anyone else.

I don't have a gun or handcuffs.

I don't have flame retardant clothing or a breathing apparatus.

All I have is a stethoscope, a bag of salt water enhanced with chemistry, and my own assessment skills to keep me ahead of the game and to help save your ass.

I don't wear my medals. I don't take them. I'm doing my job.

I am a medic.

And I am proud.

-MM

Friday, August 6, 2010

- Ventilated

I step under the yellow police tape. The young man is lying there, bleeding, on a pile of towels the people who's threshold he had fallen across had grabbed from under a sink. The towel givers are all in the same room as him, but pressed up against the walls, present for the action and at the same time wanting to be as far away as possible. He is lying on his left side looking face to face with Snoopy. Woodstock, farther down the towel, is turning an ugly orange as blood seeps from the gunshot wound to the young man's chest.

He had tried to break into a home several blocks over from where we are standing (or laying, in his case). The old man in the house had already been robbed twice this month. As our hoodlum slid open a window the old man, sleeping on the floor, silently rose up. He fired at the shape as soon as a clear silhouette presented itself.

The .38 hits about two inches of the midclavicular line at the 3rd intracostal space. The young man sprints across two yards, jumping fences, before I imagine the fact that he had been shot made itself present to him. He crossed over another a fence and limped, then crawled to a door - I can see the drag marks and impressions in soft earth where he went to his knees. The residents opened the door, fetched their old and ragged washcloths.

He looks up at me feebly as I step over him, assessing the damage. The slug went all the way through, a slightly larger exit wound out of his scapula. His hands are cuffed behind his back. I give him the once over as I place a collar. He has no other injuries. As we load him up in the back, a large, bloody bubble pops from hole in his chest. In the good light I can now see the bullet has almost perfectly bulls eyed a large cross tattoo the young man has on his chest.

His pressure is 100/60, but his heart rate is relatively steady at 100 and he is breathing with only a slight extra amount of effort.. As my partner affixes an oxygen mask and opens the tank, I slap dressings on. We are only 6 minutes away from the hospital. His left lung sounds about a third full. This kid needs a chest tube. I quickly call the state response network and the hospital and sink a large bore IV. It's all I have time to do - we are only 16 minutes from going on scene to transfer to a trauma bed. The doctors remove my dressing, now soaked, and another large ruby bubble pops out of the hole on the chest.

They stick in the chest tube with barely any warning. A torrent of blood splaches onto the floor and the doctor steps away, cursing. In his haste to insert the tube he neglected to wear shoe covers. The young man yelps. Eventually they sedate him and in short order intubate and ship him up to surgery.

I walk out of the room and throw my bloody gloves in biohazard on my way out.

In the unit the young man, a boy really, weakly asked me:

"Am I gonna be OK?"

"Yes," I tell him. "Don't worry. You're going to be fine."

I read his obituary three days later.

-MM

Friday, April 16, 2010

- State Job

Well, I've been a paramedic with Louisiana DOC for about 2 months now, and I am not impressed. Although I find the expanded medical practice extremely satisfying and rewarding. Jumping through all the bureaucratic hoops is starting to drive me nuts. Add in the 1.5 hour commute? Eccchhh....

Pros:
Extended practice
POST certification
free certs/recerts
I can tell someone "NO"

Cons:
Shitty pay
micromanagement
Spend a lot of time cooped up in the ER



New Hotness:

www.emssaudiarabia.com


I put in my application. Let's see what happens.

PS - everyone still alive? Drop me a comment, folks.

-MM

Saturday, March 13, 2010

- Horizon

I'm having a conversation with the Office Czar.

"No, I didn't check."

"No. I just said I didn't check."

"Because I was off duty."

"Well, I work 60 miles away from where I live."

"No."

"No."

"Seriously?"

"Fine."

I hang up. Ink raises his eyebrows. As I finish my run report the pagers go off again.

"Another fucking BLS transfer. You've got to be KIDDING me. I swear to God, Ink, I'm going to kill someone."

My unit, a 24 hour truck, is running BLS transfers while one unit sits in our base town. Now, from our base town, we cover a large rural area. One ambulance is not enough to cover it - if they get a call, the next closest unit is at the least 15 minutes away, and more likely 20-25 minutes away. And if they're responding to the eastern part of our area, which is bordered by the America's largest swamp, it's a 45 minute response time. That's a long time to wait when you're seriously sick.

To add to this, XXXX EMS has also been becoming more corpratized. When I started 5 years ago, the company was very employee oriented, really taking care of us. Since then the benefits have started to fade, and the company has in my opinion put profits ahead of patient care. Moral has dipped severely and not a lot of the EMTs and paramedics are very motivated. The call load has increased because they've cut units to save money. It's not unusual to run 10 or 12 calls in a 12 hour shift. The pay for a paramedic in my area is laughable - one parish over, they pay 7 dollars more an hour for the same job.

My personal job satisfaction has plummeted.

So when a friend mentioned that a state prison was hiring paramedics for its fledgling EMS program, I took them up on their offer.

Stay tuned...

Thursday, March 4, 2010

- Walk Up

Dispatch has trapped us in Major Metropolitan Area and has us, a Specialty MICU ambulance, running a routine BLS transfer.

As Ink is unloading the stretcher, a silver sedan pulls up. A guy gets out and asks us where the nearest walgreens is. I give him directions and he thanks us, then he asks us for a piece of gauze.

"Sure Man, no problem. You OK?"

"Oh, yeah man. I'm fine I just got shot."

Ink and I look at each other.

"What, with a gun?" I ask.

"Yeah."

"You mean, like, just now?"

"Yeah." He points to his leg, where there is a through-and-through wound just above his ankle, oozing blood.

"Oh. Dude. You need to go to the hospital."

"Well, it really doesn't hurt that much. Are you sure?"

"Yeah man, let me call it in. Ink, help him into the back and get me some vitals. I'm going to call it in."

The silver car's driver asks what hospital we're taking him to, and I tell them the nearest, only 4 blocks away.

I call dispatch over the radio. "Papa Lima 2 to dispatch."

"Papa Lima 2, go."

"Put us out at this location for a walk up patient with a 58G" which is our code for GSW.

Dispatch doesn't respond immediately, and when they do, it's in a questioning tone "Uh, did you advise a 58G?"

"Yes ma'am."

"Uh....standby." I climb in the back and begin in assessment. Remarkably, the wound isn't bad, there's no vascular compromise. The bullet doesn't seem to have hit anything important.

About two minutes later she comes back.

"Uh, Papa Lima 2, police, fire , and City EMS units enroute.Supervisor wants to know if the shooter is in the area."

Shit. I don't know. "Uh, I don't think so. Pt is completely stable, one gsw left lower extrimity, GCS 15"

"Copy that....uh....I'm still going to need you to handle that transfer, so transfer care to City EMS."

Shit. I thought this might have been our ticket out.

About thirty seconds later 4 police cars come screaming up, as well as a fire truck, City EMS supervisor, and City EMS ambulance.

I shrug at patient. "Sorry bro, didn't think it was gonna be such a big deal.

Two City paramedics bust ass with 30 pounds of equipment leaping into my unit ,BSI'd to the teeth. "What you got?"

"GSW to the leg, no other complaints. I got it bandaged and an IV in."

"Oh." They look crestfallen.

We transfer care.

As we drop off our BLS patient, Ink looks over at me. "That was weird."

"Yeah. Yeah, it was."

-MM

Tuesday, January 19, 2010

- Scalped

I'm a city boy. I'll cop to it.

I work a rural area, however. This has its advantages - there's a slaughterhouse near our station that THE freshest meat I've ever had the privilege to eat. Ink pan-fried some burgers the other day and proofed them in the oven. I've never had a burger that satisfying. Ink and I sat, faces greasy, bloated on delicious cow flesh. AMAZING.

Disadvantages are present too. The area around our station is primarily agricultural - sugar cane fields. They just got done with the last harvest, leaving wide open plains with no wind-blocks. Sometimes the breeze feels like a low-grade hurricane. Plus, there's the dirt.

This isn't normal dirt, mind you. This is vitamin rich, well tilled, 100 percent pure-dee GROWING dirt. Which is great, if you're a farmer.

But if it's been raining for a week? All that dirt turns into the ickiest mud I've ever encountered. It's like cold, wet, napalm. It sticks to everything, it gets into equipment, and it tastes horrible.

And then someone runs their car into one of the ten foot ditches at the surround these mudflaps, and we have to rescue them.

The mud is most of the way up my boot ankles with each step. The patient slid off the road going about 60 and flipped into the ditch, up the other side, and then cartwheeled across the cane rows until coming to a rest on the driver's side. There's no chance we're getting the unit back here. We're either going to have to carry the patient out on the board or figure something else.

I've been working out in Backwater for quite some time and know the firefighters pretty well. They are clustered around to the left of the car, kneeling and standing adjacent to the roof. They wave me over. I shlosh to the front of the vehicle.

If you've never smelled it, large wounds have a smell all their own, which I call "The Gore Smell". I've never been able to smell it anywhere else. It's kind of flat, maybe a little coppery. I can smell it now even though I'm ten feet away. Once I reach the windshield, I pop a squat. Inside is an older man, maybe 50 or so, rotund, and bleeding, sitting on the drivers side window.

I introduce myself. "I'm March, with XXXX Ambulance. How are you feeling?"

His eyes flick up to me, and what he says next drops my internal temp by around 30 degrees.

"Man...I feel like I'm gonna die." His face is so pale, he looks like a black and white photo come to life. He coughs a clot up and spits it at the console, which is level with his head now that the car is on its side. I can see that he's missing three teeth on the bottom. The seat behind him is simply painted with dark crimson. The firefighter holding c-spine is pale. He looks pointedly at me and then down at the back of the guys head, then back at me. Message received. Big boo boo.

"Well, I'm gonna do my best so that you don't. We're going to get you out of here. Let me take a look at your head real quick." I lean over and look.

There's a chunk of flesh and hair the size of my hand on the back of the man's head, flapped over like an open book. I can clearly see skull. I gingerly reach over, and flap it back, and adjust the firefighter's thumbs to hold it in place. I wink at him, and step back.

"Sit tight. We're going to have cut you out of the car. I'll be right back. Someones right behind you, keeping your neck still as a precaution, OK?" I hate to leave the guy, but I need to get things rolling on the medical side.

I stand back up and start giving orders, politely but firmly, with my paramedic face on. My preceptor, Spiderman, once told me that as the paramedic, you need to be cool, even when you're scared shitless. If you stay cool, it helps everyone else stay cool, and things will for the most part run smoothly. Stay in control, but don't get bossy. Take care of your first responders and they take care of you.

"Genetleman, we need him out, ASAP. Maintain c-spine, O2 on him at 15, and keep him warm. If you please, can you send one of the fellows out to the Ag center to set up a night landing zone for the chopper." I get on the radio and request the chopper. They will arrive in 15 minutes.

At this point, an off duty deputy runs up to me through the mud. "March, my truck has 4 wheel drive. I can back it up over to the access road, and you can put the spine board on it."

I look at the mud on the ground. Even with 6 people carrying this is going to be incredibly rough terrain to get across.

"OK, sounds good." He scampers off to get in and pull around.

I go back to the front of the car with a c-collar from the bag I left near the car, and call for the KED. The man, however, has so little neck that not even the shortest setting on the collar will fit him. Fuck it, I think, I'll just do a really good tape job.

A blanket covers all of us as I assess more injuries and the firefighters take out the posts at the top of the roof. A ton of sensitivity on both ribs, and when he breaths, I feel a large section just below his nipple moving out of sync with the rest. I've never actually gotten to feel paradoxical motion. His lungs sounds are slightly diminished just underneath that area, as I expected. The right side is OK. In addition, his left shoulder is dislocated or fracture. I start to sweat a little bit but manage to keep my cool.

His BP (136/84) and pulse (104 and regular) are ok, but he's breathing around 24 times a minute and his room air sat is 90%. I put the oxygen back on. I here a wrenching of metal and the blanket is pulled off. The whole roof of the car has been pulled down from the side of the car, an eerie mirror of the man's head injury. They lay a board down, and we grab the handles on the KED, easing him over.

Quicker then quick we get him into the truck bed and drive out of the field. We load him in the unit and drive the short half a mile to the Ag center. I expose him completely but find no more injures. As the chopper's landing I attach a bulky dressing and make a little bastardized sling/swathe for his shoulder. His lung sounds aren't getting any worse, and his color has returned with the O2. As the flight medic pops the doors open, I'm the phone with the Trauma Hot-line, who gives me a destination. We get him loaded up.

I look down as I walk back to my unit. My boots and cuffs of my pants look like someone rubbed chocolate covered cherries over them - mud and congealed blood all over. Damn.

Ink does a great job getting everything cleaned up as I phone in a report to hospital - the Trauma Hot-line should've let them know, but I want to make sure the hospital knows he's coming.

It takes us over an hour to get the mud off of everything. My boots simply will not get clean. One of the firefighters, Slim, stops by and laughs at me. "Jesus, how long have you been out here, March? Don't you know how to clean cane mud off of something?"

He takes a bottle ofIvory out of his truck and sets to work. Within ten minutes my boots, although damp, are mudfree.

I take them back from him. "You know, you're not too bad for a fucking country bumpkin, Slim."

"Ahhhh...go fuck yourself. I'm gonna tell Mom not to sell you any more ground beef at the slaugherhouse." He walks off laughing.

"Slim, I was only joking. Slim? Buddy?"

Shit.

-MM