You Make the Call – Hotel Rooms

Dispatch has rung you out for a reported sick/altered mental status at a local hotel.  No, not the one all the addicts live in when they cash their checks, the one where all the conferences are held.  Confidence is high that this might actually be a call for a sick person.

Halfway to the scene you hear another rig toned out for the same complaint at the same hotel, different room.  Double checking your screen you are going to a Mr Brown in Room 403, Medic 88 is responding for a Mrs Gutierrez in room 503.

Arriving at the scene you are met by the manager who asks you to park around back so as not to frighten the patrons.  Ignoring him you take the elevator up to 403 and find Mr Brown doubled over the toilet, vomiting.  It is then the door to room 405, the room next door, opens and a young woman asks you to take a look at her mother, who is dizzy and vomiting.

Something is bothering you about this, but you agree to stop in after checking on Mr Brown.  Mr Brown’s wife is also feeling dizzy and complaining of nausea.

From upstairs Medic 88 is asking radio for a full hazmat response and to shelter the hotel immediately, then goes off air.

What is your reaction?

You make the call.

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42 thoughts on “You Make the Call – Hotel Rooms”

  1. Evacuate the hotel by pulling the fire alarm and instructing (not asking) staff to get people out. Do the same with my patient. Try to get 88 to leave too. When FD arrives, they are to measure for CO (and other gases their detectors will find) immediately.

    We also need at least 2 more ambulances to the scene – for the neighbor of my original pt, and my original pt’s wife.

    In my particular situation, we have a 4-gas detector with us, so when we noticed that two trucks were en route to the same location for “sick person”, I would have taken it up with me, turned on. And once I got my patient outside into fresh air, I would have put the RAD57 on him to see if my suspicions are correct.

    In my area we have had 2 instances in the past 18 months of responders getting caught up in CO poisoning situations where they required at least initial treatment at the hospital. For me, it’s a serious enough issue that it screams out to me when situations like this pop up.

  2. Evacuate the hotel by pulling the fire alarm and instructing (not asking) staff to get people out. Do the same with my patient. Try to get 88 to leave too. When FD arrives, they are to measure for CO (and other gases their detectors will find) immediately.

    We also need at least 2 more ambulances to the scene – for the neighbor of my original pt, and my original pt’s wife.

    In my particular situation, we have a 4-gas detector with us, so when we noticed that two trucks were en route to the same location for “sick person”, I would have taken it up with me, turned on. And once I got my patient outside into fresh air, I would have put the RAD57 on him to see if my suspicions are correct.

    In my area we have had 2 instances in the past 18 months of responders getting caught up in CO poisoning situations where they required at least initial treatment at the hospital. For me, it’s a serious enough issue that it screams out to me when situations like this pop up.

  3. First instinct would be to activate a pull station and assist the people I’ve made contact with to evacuate, but a disorganized evacuation could result in people who could potentially need to be deconned slipping through the cracks before we’re ready.

    Alternate plan might be to evacuate those we’ve made contact with to the lobby and await more resources, while advising hotel management and the OIC of the hazmat assignment of the situation so far.

  4. First instinct would be to activate a pull station and assist the people I’ve made contact with to evacuate, but a disorganized evacuation could result in people who could potentially need to be deconned slipping through the cracks before we’re ready.

    Alternate plan might be to evacuate those we’ve made contact with to the lobby and await more resources, while advising hotel management and the OIC of the hazmat assignment of the situation so far.

  5. Evacutate the property. I’m a firefighter too. Scba up and take air samples. CO POISONING. Either that or it was the shrimp. Either way you have the public safety in mind.

  6. Evacutate the property. I’m a firefighter too. Scba up and take air samples. CO POISONING. Either that or it was the shrimp. Either way you have the public safety in mind.

  7. Wait. Haz mat team dispatched? Again Evac. Immediately. I would go too until hazmat arrives I may hit myself with the duodote kit if I need it. Start with a level A. And find out why hazmat was dispatched I medic is not available to respond as to y they called for that research.

  8. Wait. Haz mat team dispatched? Again Evac. Immediately. I would go too until hazmat arrives I may hit myself with the duodote kit if I need it. Start with a level A. And find out why hazmat was dispatched I medic is not available to respond as to y they called for that research.

  9. My local agency has small CO detectors on their airway bag, so when they bring it in for anything it will go off. Not the most accurate alarm, but better than nothing to have with you all the time.

  10. My local agency has small CO detectors on their airway bag, so when they bring it in for anything it will go off. Not the most accurate alarm, but better than nothing to have with you all the time.

  11. We use STEP-123. Simply put, 1 patient, treat as normal, 2 patients with the same symptoms, approach with care, and 3 patients with the same symptoms, retreat and arrange for hazmat response. I would therefore be approaching with care from the outset, and would probably ask the manager whether he’s aware of anyone else complaining of similar symptoms before I even went in. If he had, I would just get the hotel evacuated, and treat people outside.

    If not, differential would be something either food, air, or water borne. I would ask the patients from the 2 rooms to come outside with me, and activate the alarm on the way out (as we now have more than 3 people with the same symptoms). I would then don apron, gloves, and respirator. Firstly I would find out how many people had these symptoms, then check that there is no-one time critical. I would then assess those patients I have for linking factors – how long have they been at the hotel for, what have they eaten, have they been in contact with one another etc.

    Assuming none are time critical, I would ring the A&E department, and warn them of the situation, then arrange for patients to be transported in as few ambulances as possible, which should then be thoroughly decontaminated before being used for anyone else.

  12. We use STEP-123. Simply put, 1 patient, treat as normal, 2 patients with the same symptoms, approach with care, and 3 patients with the same symptoms, retreat and arrange for hazmat response. I would therefore be approaching with care from the outset, and would probably ask the manager whether he’s aware of anyone else complaining of similar symptoms before I even went in. If he had, I would just get the hotel evacuated, and treat people outside.

    If not, differential would be something either food, air, or water borne. I would ask the patients from the 2 rooms to come outside with me, and activate the alarm on the way out (as we now have more than 3 people with the same symptoms). I would then don apron, gloves, and respirator. Firstly I would find out how many people had these symptoms, then check that there is no-one time critical. I would then assess those patients I have for linking factors – how long have they been at the hotel for, what have they eaten, have they been in contact with one another etc.

    Assuming none are time critical, I would ring the A&E department, and warn them of the situation, then arrange for patients to be transported in as few ambulances as possible, which should then be thoroughly decontaminated before being used for anyone else.

  13. I think the first thing would be to take a minute and try to find out if anything is linking all of the patients. For some reason this is reminding me of the incident in Wake County a year or two ago where a bunch of high school students at a conference came down with food poisoning. You’re still going to need a lot of resources and you might as well keep fire coming both for the man power and the gas detectors, but evacuating a hotel because of 3 people who could be sick from anything (is it CO or is it bad shrimp? Does the hotel really need to be evacuated for bad shrimp? If it’s airborne, why is it only 3 people so far?), even if it is the same source, seems a little drastic without additional information.

    1. Here are two write ups from the Wake County norovirus outbreak where around 150 high school students attending a convention were processed on scene with only 5 students actually being transported to the hospital.

      Now, granted, how many systems has the resources of Wake County?

      Second, question, how much worse would it have been if they had called a general evacuation because a few students popped up at first with nausea, vomiting, and diarrhea?

      http://www.emsworld.com/article/article.jsp?id=12497

      http://www.legeros.com/ralwake/photos/weblog/pivot/entry.php?id=3034

    2. Interesting that you mention the Wake County “GI MCI” as an example. It was initially dispatched as a HazMat alarm, with lots of fire AND EMS resoureces. First fire unit got the story and cancelled the HM response. The resource that made it work was the available physician response! Everything else was standard EMS work.

      My concern about this one is that perhaps the responders could have decided not to enter the scene themselves. This has “CO written all over it. We had a single fatal, multiple patient CO incident this year where (fortunately) the first-due EMS supervisor ordered everyone out. We had another CO incident a while back where there were some 50+ potential victims due to a hotel malfunctioning HVAC system. Don’t want to loose responders!

  14. I think the first thing would be to take a minute and try to find out if anything is linking all of the patients. For some reason this is reminding me of the incident in Wake County a year or two ago where a bunch of high school students at a conference came down with food poisoning. You’re still going to need a lot of resources and you might as well keep fire coming both for the man power and the gas detectors, but evacuating a hotel because of 3 people who could be sick from anything (is it CO or is it bad shrimp? Does the hotel really need to be evacuated for bad shrimp? If it’s airborne, why is it only 3 people so far?), even if it is the same source, seems a little drastic without additional information.

    1. Here are two write ups from the Wake County norovirus outbreak where around 150 high school students attending a convention were processed on scene with only 5 students actually being transported to the hospital.

      Now, granted, how many systems has the resources of Wake County?

      Second, question, how much worse would it have been if they had called a general evacuation because a few students popped up at first with nausea, vomiting, and diarrhea?

      http://www.emsworld.com/article/article.jsp?id=12497

      http://www.legeros.com/ralwake/photos/weblog/pivot/entry.php?id=3034

    2. Interesting that you mention the Wake County “GI MCI” as an example. It was initially dispatched as a HazMat alarm, with lots of fire AND EMS resoureces. First fire unit got the story and cancelled the HM response. The resource that made it work was the available physician response! Everything else was standard EMS work.

      My concern about this one is that perhaps the responders could have decided not to enter the scene themselves. This has “CO written all over it. We had a single fatal, multiple patient CO incident this year where (fortunately) the first-due EMS supervisor ordered everyone out. We had another CO incident a while back where there were some 50+ potential victims due to a hotel malfunctioning HVAC system. Don’t want to loose responders!

  15. I think that’s the catch 22. In any high capacity building, especially if anything communal is happening (conventions, banquets, etc), there’s a lot of things that can cause a lot of people to get sick and the decision needs to be made quickly on whether people’s lives are immediately at risk (such as CO poisoning) and an evacuation needs to be done, or something more benign.

    asternatively, there’s always the extreme whi

  16. I think that’s the catch 22. In any high capacity building, especially if anything communal is happening (conventions, banquets, etc), there’s a lot of things that can cause a lot of people to get sick and the decision needs to be made quickly on whether people’s lives are immediately at risk (such as CO poisoning) and an evacuation needs to be done, or something more benign.

    Alternatively, what if it was something worse? If it’s a biological or chemical weapon attack, do you want to be evacuating everyone out into the public, which could expose and spread the contaminant to people outside? What happens to that one guy who isn’t feeling sick yet and says, “Screw this, I’m gonna go down to the bar and wait it out over a few beers”?

    It’s not that I’m against the concept of evacuating since it could be CO, or could be a ton of other things, it’s just that that’s a bell that’s a lot harder to unring (in contrast to, say, canceling incoming units) and needs a little more info than a few people in a moderate to high class hotel with GI symptoms.

  17. Everyone is focusing on the symptoms of the patients in 403/405.
    Medic 88, one floor up, has called for Haz-Mat and gone off the air.
    It can be safely assumed they know something you don’t…yet.
    Un-ass the scene, with patients if possible, and get to the rig.
    The calvalry are on the gallop and you don’t want to be added to the victim list.

  18. Everyone is focusing on the symptoms of the patients in 403/405.
    Medic 88, one floor up, has called for Haz-Mat and gone off the air.
    It can be safely assumed they know something you don’t…yet.
    Un-ass the scene, with patients if possible, and get to the rig.
    The calvalry are on the gallop and you don’t want to be added to the victim list.

  19. For me, 88 calling for a full HazMat response worries me. A CO incident would not normally call for a HazMat assignment in most depts., as most well equipped engine, ladder and rescue companies could handle it. You really don’t have to decon CO off of somebody. I would suspect a meth lab maybe as a more likely scenario. Ironically we just had this kind of incident this week. I would call for extra medics and advise that M88 may have a mayday if they are not responding on the radio.

  20. For me, 88 calling for a full HazMat response worries me. A CO incident would not normally call for a HazMat assignment in most depts., as most well equipped engine, ladder and rescue companies could handle it. You really don’t have to decon CO off of somebody. I would suspect a meth lab maybe as a more likely scenario. Ironically we just had this kind of incident this week. I would call for extra medics and advise that M88 may have a mayday if they are not responding on the radio.

  21. This does not fit a CO call to me. It just isn’t right, CO takes a while to settle in UNLESS it really a high level. Something more sinister here is working. Get the patients at hand OUT of the building in all haste, hopefully under their own steam, then firgure out a way to check on Medic 88. As just me, I might consider throwing on a NRB my self and trying to get a peak on the next floor up for a quick assessment. Of course the Chief would have me on the carpet immediately after the incident was over, assuming I survived.
    UU

  22. This does not fit a CO call to me. It just isn’t right, CO takes a while to settle in UNLESS it really a high level. Something more sinister here is working. Get the patients at hand OUT of the building in all haste, hopefully under their own steam, then firgure out a way to check on Medic 88. As just me, I might consider throwing on a NRB my self and trying to get a peak on the next floor up for a quick assessment. Of course the Chief would have me on the carpet immediately after the incident was over, assuming I survived.
    UU

  23. If Medic 88 is already calling Hazmat for what is likely one patient in 503, I would think they might know something. A couple guesses/questions:
    1. Is there any connection between the two patients? Do they work together or did they eat something together at some point?
    2. Since this is a conference hotel, is there a chance they were on a flight together? It’s unlikely, but particularly if it were an overseas flight there could have been exposure to bird flu or something.

  24. If Medic 88 is already calling Hazmat for what is likely one patient in 503, I would think they might know something. A couple guesses/questions:
    1. Is there any connection between the two patients? Do they work together or did they eat something together at some point?
    2. Since this is a conference hotel, is there a chance they were on a flight together? It’s unlikely, but particularly if it were an overseas flight there could have been exposure to bird flu or something.

  25. Establish command. Order an evacuation but designate a gathering area in an adjacent structure or open air parking garage (be creative). It’s tempting to “protect in place” until you know more but there’s too much risk that you’d be jeopardizing citizens who are not yet exposed or are sub-clinical and will remain so as long as you act immediately. Law enforcement should establish a permeter. No one in or out. Order up lots of resources and activate HAZMAT. Whether or not to begin decon will depend on how the incident develops from this point forward. Check on the other medic unit ASAP and call a PAR for all units on scene.

  26. Establish command. Order an evacuation but designate a gathering area in an adjacent structure or open air parking garage (be creative). It’s tempting to “protect in place” until you know more but there’s too much risk that you’d be jeopardizing citizens who are not yet exposed or are sub-clinical and will remain so as long as you act immediately. Law enforcement should establish a permeter. No one in or out. Order up lots of resources and activate HAZMAT. Whether or not to begin decon will depend on how the incident develops from this point forward. Check on the other medic unit ASAP and call a PAR for all units on scene.

  27. The fact that the room where 88 is located is directly above me immediately has me thinking evac, via the closest exit with my pt.. In my area CO is not a hazmat response, so I’m thinking something more sinister. On my way out notify Dispatch of a Level 1 response (immediate supervisor response along with additional medic units and gets LE and fire,with supervisors, on the way) and tell thm to poll 88. and setup a perimeter. As I exit the building hit the pullstation.

  28. The fact that the room where 88 is located is directly above me immediately has me thinking evac, via the closest exit with my pt.. In my area CO is not a hazmat response, so I’m thinking something more sinister. On my way out notify Dispatch of a Level 1 response (immediate supervisor response along with additional medic units and gets LE and fire,with supervisors, on the way) and tell thm to poll 88. and setup a perimeter. As I exit the building hit the pullstation.

  29. …We respond with fire on all calls anyway so as soon as they are able they can send someone up in an SCBA to check 88 as the others setup a hasty perimeter. As soon as I reach the outside air, either my partner or I will assume command along with the FD officer on the engine. Whichever of us is left will treat and triage the people we have come into contact with.

  30. …We respond with fire on all calls anyway so as soon as they are able they can send someone up in an SCBA to check 88 as the others setup a hasty perimeter. As soon as I reach the outside air, either my partner or I will assume command along with the FD officer on the engine. Whichever of us is left will treat and triage the people we have come into contact with.

  31. With the information provided, three scenarios come to mind. The 1st is a mobile Meth Lab, because who would suspect it in a “hotel where all the conferences are at” as opposed to “the one where all the addicts live in when they cash their checks.” A possible reason that the other medic crew is not responding is that they have become incapacitated by fumes/other people in the lab that don’t want the attention. The other, and less likely is it could be a detergent suicide via Hydrogen Sulfide (H2S). In this case, more than a few seconds of inhaling the fumes would be almost immediately fatal. Both instances’ response would play out basically the same. Evac the hotel to a point upwind, have LEOs set up a perimeter so the contaminants don’t spread. Full Hazmat response. Triage and decon/transport with as few ambulances as possible, due to cross contamination concern.

    Also possible is the food poisoning issue. I’d keep Hazmat coming, and evac both floors 3-6 as a precaution to either an open air parking garage, or if weather doesn’t allow it and there is one suitable, an interior conference room and protect in place. (4&5 have confirmed cases of the possible issue, 3&6 as a buffer). Here as well I’d have the LEOs set up a perimeter for containment

    1. would also keep trying to raise the other medic crew via radio. failing that, i’d send up a team of 2 responders with Level A Hazmat suits as soon as practicable to investigate.

      1. I think Medic 88 is one of the big unknowns.

        Possible scenarios for being “off the air”

        1. They’re a casualty of some sort.

        2. They made a transmission got confirmation that resources are in route, and have nothing else to say (unless I should be reading into “off the air” as “We’re calling them and they aren’t responding” instead of simply “not talking.”

        3. Finished transmission, bumped volume button by accident , and are just not hearing the radio while involved with patient care.

  32. With the information provided, three scenarios come to mind. The 1st is a mobile Meth Lab, because who would suspect it in a “hotel where all the conferences are at” as opposed to “the one where all the addicts live in when they cash their checks.” A possible reason that the other medic crew is not responding is that they have become incapacitated by fumes/other people in the lab that don’t want the attention. The other, and less likely is it could be a detergent suicide via Hydrogen Sulfide (H2S). In this case, more than a few seconds of inhaling the fumes would be almost immediately fatal. Both instances’ response would play out basically the same. Evac the hotel to a point upwind, have LEOs set up a perimeter so the contaminants don’t spread. Full Hazmat response. Triage and decon/transport with as few ambulances as possible, due to cross contamination concern.

    Also possible is the food poisoning issue. I’d keep Hazmat coming, and evac both floors 3-6 as a precaution to either an open air parking garage, or if weather doesn’t allow it and there is one suitable, an interior conference room and protect in place. (4&5 have confirmed cases of the possible issue, 3&6 as a buffer). Here as well I’d have the LEOs set up a perimeter for containment

    1. would also keep trying to raise the other medic crew via radio. failing that, i’d send up a team of 2 responders with Level A Hazmat suits as soon as practicable to investigate.

      1. I think Medic 88 is one of the big unknowns.

        Possible scenarios for being “off the air”

        1. They’re a casualty of some sort.

        2. They made a transmission got confirmation that resources are in route, and have nothing else to say (unless I should be reading into “off the air” as “We’re calling them and they aren’t responding” instead of simply “not talking.”

        3. Finished transmission, bumped volume button by accident , and are just not hearing the radio while involved with patient care.

  33. Alright. I’m worried about Medic 88. If they’ve truly dropped off the air, this is bad. They obviously have seen something that concerns them, and may be incapacitated.

    I’m going to grab my partner, any patients I can reasonably assist out, pull a fire alarm, and the the He!! out of the building.

    Outside, i’m going to enlist hotel staff to assist in controlling the evacuating masses. Likely also triaging as folks come out. Perhaps get the patient into a nearby area that can be secured (parking garage, perhaps?) and off the street.

    Assuming I had SCBA, I’m torn about trying to go in after my co-workers in 88. Not sure what, or how much, we’ve been exposed to, and if we go down somewhere in the building, now we are creating more problems for HAZMAT.

    That being said, unless Hazmat is really fast, it would likely be appropriate for the first-due engine to pack up in full PPE (fire PPE should be adequate to protect for some time against a lot), and go and try to grab the Medic 88 crew.

    Depending on number of patients, this is also going to be escalated to a MCI. Work on coordinating treatment areas, as well as remote staging for incoming units until HAZMAT tells us WTF They might be exposed to.

    Until I know what we’ve been exposed to – my crew, as well as the hotel staff need to be isolated with the evacuees, at least until we know what level of Decon is needed.

    I’m also going to be doing everything I can to help – but also want to be careful to not do anything that’s going to make the responding units do more work.

  34. Alright. I’m worried about Medic 88. If they’ve truly dropped off the air, this is bad. They obviously have seen something that concerns them, and may be incapacitated.

    I’m going to grab my partner, any patients I can reasonably assist out, pull a fire alarm, and the the He!! out of the building.

    Outside, i’m going to enlist hotel staff to assist in controlling the evacuating masses. Likely also triaging as folks come out. Perhaps get the patient into a nearby area that can be secured (parking garage, perhaps?) and off the street.

    Assuming I had SCBA, I’m torn about trying to go in after my co-workers in 88. Not sure what, or how much, we’ve been exposed to, and if we go down somewhere in the building, now we are creating more problems for HAZMAT.

    That being said, unless Hazmat is really fast, it would likely be appropriate for the first-due engine to pack up in full PPE (fire PPE should be adequate to protect for some time against a lot), and go and try to grab the Medic 88 crew.

    Depending on number of patients, this is also going to be escalated to a MCI. Work on coordinating treatment areas, as well as remote staging for incoming units until HAZMAT tells us WTF They might be exposed to.

    Until I know what we’ve been exposed to – my crew, as well as the hotel staff need to be isolated with the evacuees, at least until we know what level of Decon is needed.

    I’m also going to be doing everything I can to help – but also want to be careful to not do anything that’s going to make the responding units do more work.

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