On the Way to Paramedic in Northern VA
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Monday, December 26 2005
History Channel

One of the big differences between the transport gig and the rescue side is in conversation.

Running rescue, we're concerned with Information - "When did this problem start?" "What makes it worse/better?", that sort of thing. Questions designed to elicit information we can pass on to the receiving facility to give the docs and nurses a better handle on treating the patient.

On the transport side, things are quite different. We're picking up the patient from a facility already, where each and every doc who's poked his head into the patient room has already asked the same questions over and over. Consequently you can tell when a patient is reciting the answers by rote. Oh, occasionally our Bambulance Guy questions are somewhat different from the script followed by the hospital personnel - for instance, I always ask if a patient is allergic to anything, whereas scrubs usually ask if they're allergic to any medicines. Once in a while this pans a useful nugget of info for the receiving facility.

I learned this from transporting a patient, who I saw again in passing later in the week. She looked as though she'd lost weight, so I asked her if she'd been eating well. "No!" she replied. "Most of my meals have onions in 'em." Turns out she was allergic to onions, but nobody ever asked.

With transports, we not only pick up the patient, but a complete set of medical records, labs, EKGs, x-rays, and so forth. The medical part is mostly done - we do it again, somewhat differently as I said, but in a cursory way - and the rest of the transport can, unlike with rescue transports, be spent in simple conversation.

Now, I've been with medics who speak with the patients a few moments, and then plop down in what is known as the "captain's chair" - I have no idea why - and fill out their reports during the ride. This chair is situated against the cab of the ambulance facing the rear of the vehicle. When you're sitting in this chair you have a good view of the patient, but they're lying in the cot facing the rear of the vehicle. In that position you are behind them - they can't see you and it discourages talking. The trip is a silent one.

I prefer the bench seat, meself. Next to the patient, face-to-face. They may converse if they wish, or remain silent - up to them, really. Most do wish to talk, though, and bambulance folk who avoid this are really, to my mind, missing out on something Keen.

An 80-something gentleman:

"So, sir, are you retired, or...?"

"Yeah. I retired from the Navy. I was a gunner's mate."

"Well! May I say, "Thank you", sir! We appreciate your service to the country. What was your job, then?"

His eyes twinkled and a big, "Whaddya think?" grin spread over his face.

"Sinking Nazis!" he said, and proceeded to tell some amazing stories.

A woman in her 90's, peering out the back windows:

"Look at all this road construction!"

"Yes, ma'am. We're passing near the shopping mall, and it's a mess!" The mall was built when I was starting grade school.

"It used to be a field. My children and I would pick blackberries..."

A gentleman in his late seventies, who winced at a pothole:

"Sorry about the bumpy ride, sir."

"That's all right. What road are we on?"

I peered out the back, across four lanes to read the street sign, and told him.

"Used to walk down this road to school. 'Course, it was a one-lane dirt road..."

I've heard some medics complain that they "have to listen to some old story". To me, the conversations seem more of a perk. You don't always luck into them, but when you do, it makes the job better.


Wednesday, December 14 2005
Tough... well, not love, but...

Not everyone who dials 911 does so in the spirit of receiving help.

We were toned out for "an adult male, thinks he might have broken his neck last night."

My partner and I exchanged "WTF?" looks, shrugged, and went blinkies and woo-woos. We were the first unit on-scene to the private residence. In the interests of saving time, and anticipating our needs, we tossed a backboard and the backboard kit, along with our usual baggage, onto the cot and proceeded inside.

Our patient was sitting at the kitchen table, elbows on the table, holding his head in his hands.

"Hi, what's going on?" I asked.

"My neck hurts, I think I broke it or something," he mumbled.

"Okay, well, I'm going to stand behind you and hold your head still in case there's a problem," says I, quickly checking for step-offs (finding none) and taking c-spine. My partner fished out a cervical collar, sized it and began to gently apply it.

The patient went ballistic - screaming, flailing arms, stamping his feet on the linoleum. "Don't put that on me! My neck hurts!"

"Okay, okay," I say. "You need to keep your head still. The collar keeps it from getting worse."

It took some time talking before the patient calmed down and allowed the collar to be placed, during which he reluctantly answered questions. He had "been drinking some" and fallen down the stairs in the wee hours. Lightening mental calculation concluded that the patient had waited some eight hours before calling 911.

"Did you, uh, try any medications for the pain before calling us?"

Why yes, he did, he related. Many Valium washed down with vodka - until that ran out - and then liberal quantities of beer.

As my partner turned to take the backboard from the cot, the patient again went crazy - clawing at the collar with one arm, flailing around with the other - attempting to hit me! - Profanity and Wailing, and a great Weeping and Gnashing of Teeth.

"Stop! Right now!" I was surprised to find it was I who shouted, in a voice an octave lower than my usual pleasant tenor. I was shocked. It was as if I was standing outside myself, watching Me - and I looked Pissed.

"I don't want this on," wailed the patient.

Still Deep-Voiced and Pissed-Sounding: "Okay - listen up. You may have a neck injury. If so, you can make it worse and be paralyzed. If we take you to the hospital, it will be with this collar on, and anything else we need to do to keep your injuries from getting worse. Or we can go. You now have two choices: You can let us do our job, or tell us to leave. Speak."

"I want to go to the hospital."

"You have spoken. And if you try to hit either of us again, I'm calling the cops." A glance out the window showed we were still the only unit on-scene. No engine, no medic. Hmmph.

I considered the KED, since the patient was sitting, but his stomping feet and denial of back pain - plus unpredictability - all pointed to The Faster The Better. We assisted the patient in standing and did a standing take-down onto the backboard. About the time we were strapping him in, the medic shows up. Except for the drugs and booze this was strictly BLS, so they assisted us in packaging and loading the patient and waved to us merrily as they departed.

In the unit I placed an NRB at 12lpm, more for me than the patient - the heady fumes of his medication regimen were filling the box. As I was placing a BP cuff he suddenly went limp, his free arm flopped down and with a small "uuuhhh" he stopped breathing.

Poor thing.

"Okay, I'm going to take your blood pressure now - this may get a little tight on your arm," said DTs in a cheery voice. Still not breathing.

BP finished, I began working on the paperwork. From time to time I glanced at the pulse oximeter on the patient's finger, still snug, and checked the reading on the Lifepak. O2 sats in the mid-nineties, heart rate steadily climbing.

I figured he'd have to take a breath pretty soon, and so he did.

"Sir," said DTs solicitously, "Don't pretend to be dead anymore, okay?"

Alas, his reply is unprintable.

My partner says I should have taken the event of my patient's "death" to say something like, "Oh my God! Maximum Shocking Power Engaged! Everybody Clear!" and, um, "bring him back" that way. Although it sounded like a fine idea, and I kicked myself at the time for not thinking of it, on further reflection it may not have been the best thing to do, seeing as he was strapped down and may have exacerbated his injuries. And so, I am glad I did not.

Professional. Yeah, baby, that's me. Right.


Wednesday, December 07 2005
Ay, Theres the Rub

There is something better than food.

There is a thing better than sex.

It is sleep.

DTs has just come off what may be considered a 72-hour duty: 24 with the transport gig, followed by a 24 with rescue, finishing with another 24 transport for dessert.

One learns things during extended up-time. Did you know it is possible to take a brief but refreshing nap between the systolic and the diastolic? Most people waste that time staring off into space with that "I'm listening..." look. Not me, baby. "BP is... 140 over... [ZZZzzzzzzz] 80." Refreshed!

Only one patient contact of note during this period, though.

Staffing is a little ka-ka on the rescue side, and DTs is without a driver. Lo, another station is short-handed as well. Very little head-scratching ensues and DTs is sent to the other station, centrally located for our areas. To the best of our knowledge we are the only bambulance on the East side this fine winter's day.

We're toned out to a call some fifteen minutes down the road - going lights and sirens - for an "injury from an assault", in the early afternoon.

EMS and the Fellowship of The 911 System is certainly representing. We have an engine on scene; we have some police on scene. There's an ambulance... wait a minute. Why, then, we wonder, are we here?

"Prince William, what units were dispatched to this call?"

"You and the Engine, DTs."

"Uh, okay. Thanks."

A member of the engine crew trots over. "You guys can go in service, this other unit came for the call."

Okay, not a problem. Turn around. Look left, look right, begin to pull away.

Another member of the engine crew trots over. "You guys can't go in service, this other unit has a one-person crew."

One-person crew? What the hell is that? Turns out the fellow was in the unit, heard the call, and came along. Ten out of ten for style and helpfulness, not so hot on the usefulness side if the patient needs transport.

Grab stuff, wander over.

The patient is an adult male, glazed of eye, sitting on his front stoop surrounded by cops and fire guys. One of the folks there is finishing wrapping a bandage around the patient's head. He looks like a homeless version of the fife-playing guy in The Spirit of '76 painting. Both ears are covered in blood.

A fire guy tells DTs, "He doesn't want to go to the hospital. Just get a signature for the refusal."

"What's going on with him?"

"Oh, he has a hole about the size of a quarter in the back of his head. He isn't sure how it got there. He was in the park. Somebody drove him home, drove away and called 911 on their cell phone."

Oh, the park. In this area, the park is notorious as a place to score drugs, guns, and hookers at all hours. Thursday is Ladies Night - you can score a drugged-up hooker waving a gun.

The patient says he doesn't know what happened, never saw it. He wants to go inside. Quarter-sized hole? The fire guys say no brain matter was falling out or visible. Still, this patient looks like shit. He gives me the option to go Authority on him when he fails his "oriented to time" test - thinks it's Saturday when it's not - and I tell him it's us or PD. Funny, they always choose us.

Back in the unit, take some vitals. His pulse is in the low sixties, his BP is 68/45 (!), breathing normal, sats in the 98-99% range, dexy 140, eyes constricted and unresponsive. He babbles, in a whisper. Uh huh. Let's check that wound, shall we?

We undo the bandage job to find, not a hole, but a steadily bleeding area in the occipital region, covered by skin with a star- or cross-shaped laceration. Keen! This is just the sort of avulsion created by a gunshot!

"Prince William, you have a medic for us? Cuz, if you do, that would be just really, really swell."

"Negative, DTs. They're all out."

Oh shit oh dear.

"Hey," says DTs to his driver, "Ask the fire guys-"

"Fire guys is all gone," says his driver, looking around. "Hey, so is the other ambulance. And the cops."

"Well, for gossakes! Is there anyone out there?"

"Why yes, there are about a dozen good citizens striding towards the ambulance."

"Perhaps we obstruct their flag-football game, here in this fine parking lot. Do let's move, then."

"Indeed we shall," says his driver, "With lights and sirens - they are so festive."

"'Tis the season," agrees DTs. "And let us listen to and be entertained by the Christmas-y thunk of door locks."

We call the hospital with our findings, make sure they know the patient is unaware of the mechanism of injury. We can have the patient there in seven minutes, versus twenty-plus for a chopper to meet us here. "Come on in," they tell us.

About the only thing we can do for this patient is O2, Trendelenburg, keep him warm and talkative - such as he may be. DTs' Medic Sense is tingling as well. Feels like.... patient has drugs on board.

The patient is now complaining of neck pain. Hooray! He gets a collar. The blood around the ear is disconcerting, but there is none in the ear canal, and no other fluids. Pupils aren't blown and the BP is so low I don't suspect a rising ICP, but we keep an eye on what we're allowed to, as BLS, just the same.

Patient hasn't deteriorated by the time we get to the hospital and turn him over. All in all, a strange but entertaining call.

Perhaps I'll ask Santa for one of those Saturday-morning cartoon character rings - you know, touch the two halves together and turn into Released Medic Man, able to do some IV and drug-box action before, at the hospital, returning to Mild Mannered DTs.

That or some NO-Doze.



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Posted Monday, January 09 2006 10:50  Site Meter