Sunday, May 8, 2011

A Touching Call.

Author's Note:  For those that took serious issue to this blog, I appreciate your feedback, and the reprimand.  Please keep in mind that a blog of this nature is 95% fiction, and 5% fact.  Not only would I never abuse a patient, I always go way overboard the other way to "not go there."  In fictionalized accounts, however, and having a very creative and inventive mind, sometimes you can allow yourself to fantasize what it would be like in some situations, for the sake of humor.  The instructor of my medic class was full of things like that, and I have no idea if he made them up to entertain us, or actually did them.  So, chalk it up to a poor attempt at humor on my part.  I do appreciate the chastisement... I probably did go a little overboard.

Cinco De Mayo and we had a full truck.  Myself, a driver, and 3 ride-alongs on a lazy Friday night in Spotsyltucky.  The ride-alongs were EMT's who have not been "released" to run a truck by themselves yet... they are still "precepting" under another EMT.  Tonight, they were running with me because my driver is an EMT preceptor.

We expectantly settled in, knowing that the career staff had run their butts off during the day... thinking that the volume was going to carry over into our shift from 6pm until 11pm.  We went out to eat, sure that that would spur some calls... we usually order our meals "to go" even though we stay and eat them there, and ask for our check in advance... just in case.  Can't tell you how many times we've had to rip out of a restaurant on a call, mid-bite.

Fortunately, this night was fairly quiet... no calls.  We ate in peace, then returned to the station.  Still no calls.  We sat and either worked on our laptops, watched bad TV, or congregated in the back of the truck and trained.  My driver for that night was a good friend... we love to teach... we dubbed our truck the "Learning Truck," and try to make it a place where newbies can feel comfortable asking questions and learning new skills.

We finally got toned out at about 9:45pm on an "Assist Law Enforcement" call.  I can't tell you how much I loathe those.. as I've discussed in other blogs.  We had to "stage" for a while until the deputies actually arrived on-scene, which means that we find a place to park some distance from the call until the police arrive and declare it "safe" for us to enter.  Po-Po arrived, and dispatch told us that it was safe to come in, so we proceeded to the scene.

It's not a great part of town.  In fact, it's pretty grungy.  Therefore, I wasn't surprised to arrive and find a 40-something male sitting on the curb, drunk off his proverbial butt, and looking like he had just crawled out of a dumpster.  No fewer than 5 officers were standing around the guy, who apparently was complaining of abdominal pain.  I wondered how someone could feel ANYTHING given how much alcoholic anesthetic was in his system.  

I tried to talk to him and check him out, but every time I tried to assess him, he became wild-eyed belligerent and obnoxious.  At one point, one of the deputies decided that this was definitely annoying, and immediately pounced on our patient, put his face in the dirt, and gave him a stern admonishment to behave better... as only a 300 lb, 6' 2" deputy can do.  After a few more minutes of questioning (I speak fluent Drunk), I managed to figure out that our patient had a kidney stone, a UTI, or some other sundry urinary tract problem.  I also found out that he had a serious drug problem involving popping pain-killers like cocktail peanuts.  Which he admitted to having been doing since that morning... and washing them down with his good buddy Jack Daniels.

At about the point where we were deciding where to take him, the patient suddenly went "unresponsive" (see previous blog).  He became red-faced like he was trying to initiate a "Code Brown" in his pants,and started drooling... and twitching slightly.  I called for the cot, and we all pitched in to lift him up on onto it.  When we got him on the cot, he decided that he was done being unresponsive, and that a new barrage of slurred insults were in order.  As well as grabbing one of the female EMT's ass.  Apparently he thought that he presented quite the alluring sex-machine package to our gals at that particular moment.  That promptly earned our friend the restraints.

We don't carry commercial restraints on our trucks, so we have to be rather creative.  A roll of roller gauze works in a pinch, though.  So we pulled one arm up above his head, and prepared to secure it to the cot.  Side Note:  We are taught to secure patients with one hand up above their head, and one hand below when we restrain them, so that they can't move around and get any leverage.  Apparently, our patient took serious umbrage with this, and decided that he would express his displeasure by grabbing the arm of the female EMT that he had previously groped, and squeezing so hard it make her scream.

My inebriated patient acknowledged the depth of his remorse and his intent to be more cooperative by then  grabbing the arm of the OTHER female EMT on my crew, who was trying to tie down his other hand.  She screamed, and I saw a blur out of the corner of my eye as a Herd of Deputy rushed the cot, and tried their own ad hoc science experiment: "Testing the weight limit of the cot."  Amidst a flurry of rather descriptive words about THEIR heritage and overall personal hygiene, the Herd of Deputy quickly ejected all pretense of being "nice," and handcuffed our patient to the cot via multiple elbows to the patient's throat and chest.  Of course, when this happens, one of the deputies has earned an all-expense-paid trip to Chez Hospital in the back of our humble ambulance. 

We were almost literally a stone's throw from our neighborhood band-aid stand... the "freestanding Emergency Department."  It's a place where people go who don't really need definitive care... it's like an institutional "Doc-In-A-Box" that is run by the local hospital.

We dropped off the patient, handed his care over to the overjoyed ER staff, who knew the patient by name.  As we made our way to the EMS room (near the ambulance entrance) to start writing up our reports, a nurse popped her head out of the exam room to ask if we had any ammonia inhalants.  Apparently great minds think alike.  I sent someone out to the truck to fetch one, and in the meantime, heard a commotion down the hall.  When I turned around to see what was going on, I was greeted by our patient being escorted down the hall in what HAD to be a very painful hold, followed by the same burly deputy that had ridden in with us.  Our patient was quickly relocated to Chez GrayBar.

We spent the next hour or so writing both normal run reports, and then hand-written statements about what had happened when the deputy who graced our presence on the transport stopped in and told us that the patient was being charged with 2 counts of Battery on a Rescue Provider, a Class 6 felony in the Great Commonwealth of the Old Dominion.  Guess I'll have to nag the Powers That Be to actually give me a Class A uniform shirt now for court.  Knowing that just this once... the bad guy was going to be held accountable for treating us like crap was very satisfying.

Ah, good times.  Good times. 

Sunday, May 1, 2011

A Tale Of Two Unresponsives...

Just to illustrate how much this job is "like a box 'o chocolates... ya never know what yer gonna git"... we had two different calls this week that were dispatched as the same condition... "unresponsive..." but which had vastly different outcomes.

The first call was for an "unresponsive" in the response area right next to ours.  Now... we don't usually get too excited about this call, even though it sounds ominous.  And it can be... but usually is something very different, so we take a "wait and see" attitude.

We happened to be in bed at the time trying to sleep (never happened that night), when I heard the call go out.  A fire engine arrived on scene first, and I felt my adrenaline kick in a little when the officer on the engine immediately requested ALS.

This generally means that whatever is going on is not pretty.  ALS stands for "Advanced Life Support," and it means that a medic or paramedic has been requested, which is moi... I was the only medic on that night in the entire county.  So, I got up and started pulling on clothes... as the tones dropped for the ALS Assist, the dispatcher put us on the call, and we started for the truck.

The other crew that had been dispatched was a BLS truck (BLS stands for "Basic Life Support," and is staffed by EMT's), and they arrived on-scene shortly after the engine.  At this point, we become glued to the radio, because that is our only source of information about what is going on.  The dispatcher gives us an update on the situation when we call in that we are on our way (we refer to it as "marking up"), and we received the following information:

"Medic 4-3, you're responding for a 33 year old male... caller advises that patient experienced a seizure and is now unresponsive.  CPR in progress."

Anytime you hear "CPR in progress," your nether-region's sphincter tightens up a little, because it means that this is no "eye-rolling" type of call... which we affectionately refer to as a "BS call."  The other crew arrived on-scene, packaged and loaded the patient, and started out for the hospital.  We met them en-route, about halfway in.  Typically, on ALS Assists, the medic unit meets the Basic unit en-route, stops somewhere (usually in the middle of the road), and the medic jumps off his truck, and gets on the other truck, which then proceeds to the hospital.  Medics can provide more advanced care than normal EMT's... we can start IV's, push life-saving drugs, use electrical therapy (defibrillation) and place advanced airways.

Sure enough, CPR was being performed by the very anxious, very overwhelmed EMT crew.  The patient was a 33 year old male that looked like he had been ridden hard and put away wet.  As I bustled about doing my thing, the story started to dribble out from the crew, inbetween gasps of air (CPR, by the way, is exhausting).  Turns out the guy was as coke head... habitual cocaine user... who was playing video games, talking to someone in his family, when he just fell over dead.  It's like his heart said, "Game over, man!"  He twitched a couple of times, and that's what they mistook as a "seizure"  It was most likely post-arrest neurological activity... kind of like when someone "twitches" after they die on some bad TV show.

We did everything right... good compressions, zapped him 3 times with enough electricity to drop an elephant, dropped an airway, started a line, pushed the right drugs... the ER was ready for us, and worked him for 15 more minutes... but there simply was too much damage to his heart or brain.  We never got him back.  His family was, understandably, devastated.  No one should die this young.

Contrast that with a call we had yesterday.  Same dispatch reason... "unresponsive."  Same concern.  Same adrenaline rush.  Yet, this time when we arrived (as is often the case), the "unresponsive" patient is sitting up, talking to us, and quite indignant that we are even there.  Usually they're just too drunk to stay conscious, and whoever is with them panics.  And we breathe a huge sigh of relief, as we tell the dispatcher that we're back in service and available for calls.

It's actually one of the reasons that I truly love this job... you really never know what you're gonna get... or who you're going to wind up helping.