I think every agency has them... patients who, for all intents and purposes, should be eating their salads from the roots up, but are still trudging the aisles of WalMart.
We had one such patient some time ago... a 62 year old woman who had suffered 8 heart attacks previously... was a Type I diabetic, and a multiple amputee. If I'm not mistaken, she had also had several strokes and chronic high blood pressure. And she weighed about 350 sans faded moo-moo and bunny slippers. She was what we affectionately call the "Walking Dead." There is simply no way that this woman should still be sucking air. But she was. And unfortunately, that usually complicates things considerably for us.
When we arrived, I did a thorough assessment (even though I had seen her about half-a-dozen times before and knew her medical history probably better than she did), and put her on our cardiac monitor to see what was going on "under the covers." This little box is an invaluable tool for us... it helps us to spot immediate life-threatening conditions for which we have some very powerful drugs on board that can make the difference between life and death. I can also deliver a jolt that will literally lift you off the cot (or the floor), resetting your heart's spasms and hopefully settling it back into a nice little rhythm that is compatible with life.
In order to administer said life-saving drugs, we have to start an IV on our patients, which consists of inserting a needle/catheter into a vein in order to be able to get medications directly into their bloodstream. This assumes, of course, that our patients have what we call "patent veins." The opposite of this, of course, is "crap veins" or "S#$% for veins." This patient had the latter variety. I knew this from my previous experiences in trying to start an IV on this woman.
That presents a problem. How do you deliver potentially life-saving medications when you can't get an IV?
The answer today is much simpler than it used to be... although many will find it cringe-worthy. We have a very valuable tool on our trucks called a "EZIO," for "Easy Intra-osseous Infusion." Basically it's a battery-powered hand drill with a very long stainless-steel needle/catheter... it drills right into the bone, and when the needle is withdrawn (leaving the stainless-steel catheter in the bone), an IV can be attached to the hub. Since the needle is drilled right into the marrow of the bone, fluids can be administered almost as easily as they can with an IV.
This was the treatment of choice for this patient... much to her surprise and horror. The good news is that it isn't as painful as you would think... either going in or coming out. The painful part involves a "flush" of salt-water into the bone marrow to create a small "cavity" in which fluid can be pushed into... and THAT'S freakin' "lift-your-patient-right-off-the-cot-screaming" painful of the "you may feel some discomfort" variety.
Our patient survived a 9th heart attack, and will live to see a 10th, probably. Don't know how, though. She just is. Ya gotta love the Walking Dead.