Category Archives: Medical Aid

From the Archives…for the heart attack…

With the Chronicles of EMS premiere racing towards me I find myself distracted in my writings of late, so I wanted to share some of my favorite posts with some of you newer readers.

This one comes from the very early days of my writings and still is a bit edgy, but I see the partner I had on this run a lot now and we still laugh about it.

Originally published August 3rd, 2008

You called 911…for the heart attack…?

blog medic

Another run in the middle of the night to a local residence hotel. You know the kind of place. Seedy part of town, lobby looks like a garbage sorting station, complete with dirty employees. We rarely carry equipment without a plan on never putting it down and cringe about having to clean our boots afterwords. We’re met in the lobby by a rather clean gentleman wearing headphones who waves us over like he knew we were coming. I can tell by his almost new shoes he is not a resident, nor has he been in town long.

THE EMERGENCY
“My heart is just beating away.”Usually a comment from a citizen like this elicits my compassionate response of, “Can you be more specific?”but on this morning at 3:30 and on our 20th run of the 24 hour shift, I had lost my cheerful disposition. In response to the comment, “My heart is beating away”I responded, “Mine too. Do you have an emergency?”"I can’t sleep,”he responded after a slight pause.”Me neither,”I shoot back getting annoyed. Not annoyed so much at the fellow who called us, but that this conversation is occurring in the lobby of the garbage station like residence hotel. But be careful, if you get these folks outside, they think they automatically get a ride, so keep them on defense. After his, “I can’t sleep”complaint crashed on take-off, he asked why I was so mean. I explained that there could be a baby choking or someone being shot who needs us but if he can tell me what the emergency is I can let him know how I can help. “I need some food, man, I’m broke.”"I have a job,”I reply, “You need to come up with something better. Maybe this line works where you’re from but not here.”"How did you know I’m not from here?”He wondered out loud while I moved towards the door. “Wait, can you give me a ride to the bus station or a shelter or something?”I moved towards the heavily fortified Manager’s window in the lobby of the residence hotel we were in and knocked on the window. A sleepy man who may have been speaking a form of English I’m not aware of became visible.”This guy needs a room, how much?”I ask. “Him stay 1 hour? or more to day? $10.”I look over to the fellow who called us and motion towards the window. “You can get a room for the rest of the morning or keep that money in your pocket and call whoever you left behind wherever it is you’re from and beg forgiveness and go home.”

THE ACTION

The gentleman considered my words, put his headphones back on and stopped talking to us, just standing amongst the trash, waiting for something to happen. I asked if he wanted an ambulance to take him to the hospital and he gave me the universal one finger signal for “Go away.”

What do you know?

blog medicWell, Ma’am, a great deal more than you.  Especially when it comes to emergency response protocols, anatomy and physiology, the effects of alcohol on the clotting factor of blood and what my job is.

THE EMERGENCY

A woman in a wheel chair has rolled herself into a hotel lobby, bleeding from the nose, asking for an ambulance.

THE ACTION

The engine has advised us to slow to a code 2 response and we are happy to do so.  As we arrive on scene I see the engine crew on the sidewalk having an animated discussion with a very alert and oriented woman with cotton balls stuffed up her nose.

As the door to the ambulance opens I now have the audio to match the pointing and head shaking.

Engine Medic: “Have you called your doctor, any doctor, about your nose bleed?”

Hell on Wheels (Could have been Helen, I can’t recall): “I’m not saying anything to you.  You are not a doctor.”

HM: “He sure isn’t.  Anything remarkable?” Is my question and the head shake my answer.

HM: “Then thank you Sir, we can take it from here.”

I introduce myself to our client and ask her to define a chief complaint.  Most times the person who called us has a singular issue they wish our assistance with.  My dad can’t breathe, for example, or I cut off my foot.  But this client goes into a laundry list of complaints ranging from before I was alive finally ending with what got us involved today.

“My nose is bleedin’.”

And it was.  At least it had been.  Hard to tell with her constantly moving around telling me to get her to St Farthest before she dies from it.

HM: “How long has it been like this?’

HOW: “Since 1 AM, I haven’t slept! Why all the stupid questions, let’s just go.”

A quick glance at the time, 6 PM.

HM: “Have you made any attempt to seek an evaluation without calling 911?  A clinic or an urgent care?”

HOW: “Honey I just got here and don’t have time for all your 20 questions.  I need a doctor, I need my pills.”

As my partner is confirming the vitals we got from the engine, I begin my social worker intake interview.

HM: “You mean you need a pharmacy.  The doctors don’t dispense medicine, they write prescriptions.  Is your prescription empty?”

She shoots me a look I get often wen I bring reality into these conversations.  The head snaps around on the thick neck to me while leaning back slightly, eyes wide and a look of anger around the mouth.  Then it comes out.

HOW: “What do you know?  The paramedics where I’m from never disrespect me like this.”

HM: “What do you mean disrespect you?  I’m trying to establish if an ambulance ride to the hospital is the best option for you right now.”

I feel my tired arms leaning onto my knees as I stand bent over trying to stay in her line of sight as she realizes I’m not the pushover medics she left behind in whatever town she sailed in from.  A quick stretch and I ask her the magic question.

HM: “Do you want to do the right thing or would you like an ambulance ride to the hospital?”

HOW: “Do your job and take me to the hospital.  But somewhere where I can get seen fast, and get something to eat.”

My hands are back on my knees and I’m as in her face as I can be without losing my cheerful disposition.

HM: “Are you looking for a ride to food?  Because if you are we actually have that resource here.  You’ll have to wait a little while, but I can get you a free ride to a shelter and a warm meal.”

HOW: “I don’t have time for that, I need my pills now.  I have chest pain.”

Had I been a TV detective, this is the part where I bang on the interview table and go into a well prepared speech about the abuses of 911 and how the best thing she can do for everyone is go back where she came from.  Where she came from easily has a lower cost of living, but that has not entered into her equation.

But I am not a TV detective so she steered the power wheel chair over to the ambulance and told us how she has so many leg problems she is on disability.  Then she stands, climbs in the ambulance and sits on the cot with a familiarity some folks on the job don’t show.

We sigh.

HM: “Chest pain you say?”

HOW Now with arms and legs crossed: “Yup, let’s go.”

HM: “That means an IV, and I’m not all that good at them.”

HOW: “Oh no you don’t, you ain’t touchin’ me with no needles.” Her head is shaking almost to a point I think she’s going to hit it on the cabinet doors and then need an ambulance.

HM: “Yup, let’s go.”

On our short trip to St Closest she wanted to discuss the finer points of how I don’t know what I’m talking about and only Doctors understand what she is going through.  My lips were sealed, only asking my billing and pertinent negative questions and completing my report.  She refused a line, a trace and everything else except another BP.

When we made it inside she commented that the ER had an odd odor to it and she wanted to know the name of the hospital.

HM: “St Closest, why?”

HOW: “Tomorrow they’ll take me somewhere better.”

Report finished I left, smile on my face, almost wanting to work the next day just to see if she does it.

Oh No. Not Again

In The Hitchhiker’s Guide to the Galaxy by Douglas Adams, two missiles are improbably transformed into a suprised whale and a bowl of petunias. The whale embraces his new identity, while the bowl of petunias, while falling to the ground from space says, “Oh, no. Not again.” Adams then tells us that had we understood what the bowl of petunias meant we may have a better understanding of the nature of the universe.

I recently discovered that just saying that phrase, “Oh no. Not again” means your night is about to get interesting.

THE FIRST EMERGENCY

Automatic fire alarm activation

THE FIRST ACTION

The engine arrives on the scene just before 3 AM to find no alarm bell ringing and no strobes flashing. The building is secure and we prepare to pack up as a small man dragging a shopping cart makes a mad dash across four lanes of decently busy road to reach us.
He waves and waves and I lean out the window to ask him his trouble.
“I am out of medication.” he tells me, not even a hint of a wheeze or shortness of breath. There he is, no distress whatsoever, apparently he thinks we have a pharmacist behind the hydrant jumper lead in the hose bed.
“We don’t have medication refills here, do you have an emergency Sir?” I ask wondering if I;m really having this conversation.
“I need more medicine, I need 911.” He tells me, refusing to get onto the sidewalk, preferring to stand in the street.
“Do you want an ambulance, Sir, you seem OK.”
“No ambulance, no hospital, I need medication from 911.” He tells us, looking from my jump seat to the ladders on the side of the engine, still waiting for the pharmacist to pop out.
“We have no medicine refills on the fire engine, so if you don’t have an emergency and don’t want an ambulance, we’re going to go, OK?”
“OK, but where is 911?” And he grabs the dirty cart and scurries (Yes, he altered route and speed at random) back across the street and around the corner.
“We’re going to see him again, I can feel it” I said into the headset as we pulled away and back to the house.

Just as I got my turnout pants unbuttoned, the lights are on and the bells are ringing.

Oh no. Not again.

THE SECOND EMERGENCY

A cell phone caller reports a man short of breath at the doughnut shop.

THE SECOND ACTION

The doughnut shop in question is not the high quality place mentioned in other posts, but the 24 hour place on the other end of town.

Off the engine I can see only two customers in the shop. One on the phone and drinking coffee, the other remarkably familiar and scurrying again, this time out the door towards me, not away.
“No, no” He’s waving, “I no need firemans, I need 911 for medications,”
“What medicine do you need Sir? I have medicines for sick people…are you…sick?” I ask trying to chase him through the parking lot.
“My brain pills are gone. GONE! I am needing more.” he tells me over his shoulder, zig-zagging through the lot. There’s no way I’m letting him get away just to call us back all night long, so I’m in pursuit.

The only thing that slows him down is the sound of the approaching ambulance from at least 5 blocks away.
“My medicine is coming!” He tells me.

Good Grief.

The ambulance crew gets my “Don’t kill the messenger speech” to which they sigh and wave us off. I pay careful attention to the radio traffic when I hear the ambulance report that their patient has disappeared down an alley and they are going back in service.

Not ten minutes later, we’re backing into the barn when the bells ring.

Oh no. Not again.

112

One Hundred and Twelve degrees farenheit. 112. Last I checked cell walls break down around 107, but our caller swears her son’s temperature has broken the land heat record. At 1 AM, of course.

THE EMERGENCY

A mother states her son is lethargic with a temperature of 112.

THE ACTION

The bells are loud at this station and I seem to have chosen a bunk directly under the speaker. I wander into my turnout pants and down the slide pole before I completely comprehend the dispatch information.

“Did they say 112?” the Officer asks as we climb in the $450,000 fire engine staffed by 1 highly trained firefighter, 1 highly trained driver, 1 new Officer and yours truly.

“Impossible,” I say clicking my seat belt, “107 is as high as you go while alive. Maybe she’s reading it upside down?”

Enroute dispatch advises the child is unconscious and they add a Paramedic Supervisor to the run. This town panics when kids are involved. As we arrive at the address we see the standard teenage girl flailing her arms in the street as if the houses weren’t numbered in ascending order. Off the engine and bags in hand we’re led to the third floor, past a woman screaming a foreign language into the phone and into a back bedroom where I see our young fire child.

Awake. And dressed, shoes and all.

“Is this the boy with the fever?” I asked as the firefighter checked the boy’s skin.
“His fever is 112, I had to call you, I don’t know what else to do!” Mom is crying to us as young “Danny” is curled up at the edge of the bed asking why my pants look funny.
“These are my fire pants. We brought our fire engine, want to see it?” simply wanting to see if he comprehends the facts in front of him, kind of a level of consciousness test.

“YEAH!” He shouts and is off to the races and down the stairs nearly knocking down the ambulance crew running up the stairs, Pedi bags in hand.
“How much Tylenol have you given him?” was the last question I heard as the ambulance crew pushed us out the door and back in service.
“None” was mom’s response.

Danny was excited to see the engine, lights flashing in the early morning hours, even though he should have been fast asleep, tylenol doing its thing on his mild fever.

A HIPPA Friendly Post

I was joking with a friend that instead of changing facts in these posts to make them safe and legal and such, I could just omit the information. I joked it would look like a horrible MAD LIBS. Sounded like a challenge. So here is a HIPPA approved EMS Blogger Post:

THE EMERGENCY

[There is no way to confirm or deny the existence of a medical emergency]

THE ACTION

We arrived at [a location] for a reported [medical condition]. The reporting party said their [possible relative] was [partaking in a household task] when [he and/or she] lost their balance, resulting in a [mechanism of injury] that caused [an injury and/or illness].

The [municipal service] moved quickly to apply [a/an approved medical device] and extricated the patient to the awaiting [conveyance]. In the back I started a [patient care procedure] and rapidly shifted gears to the [medical device]. I charged the [medical device] to [an approved setting] and pressed [the appropriate button]. The smell was intense. [a body part] had caught fire, literally, as a result of the [patient care procedure] despite my use of [approved pharmacological interventions].

Needless to say the accepting [Physician and/or Physician's Group] at [a secular receiving medical facility] was not at all amused at our predicament and immediately started [an approved pharmacological intervention].

Losing Independence

Not a political post, I assure you. This is about a section of the population that needs to come to terms with their limited abilities. And to remind PAs that I am in charge of patient care at a scene.

THE EMERGENCY

Caller states there has been a car accident and one person appears shaken up.

THE ACTION

Shaken up. OK. Out the doors and a few blocks down we see a large SUV into a light pole, newspaper machines and trash cans in the sidewalk, 2 parking meters down for the count and a little old lady seated behind the wheel of a little hatchback behind the SUV.

Blink. Blink.

The SUV was empty and parked, our little friend is alert and oriented, sitting behind the wheel, clearly upset at what has happened. I think she would likely get out of the car and be fine if it weren’t for the half dozen samaritans encouraging her to go and get “checked out.”

I introduce myself to the group and they all start to tell the story, each pointing different directions and saying different things. Quickly, I duck down and make contact, she is not injured and has no complaints. She describes not having parallel parked in years, let alone on a hill like this, and hit the gas a little to hard backing up (she points over her shoulder to the uphill parking meter). Then she gunned the gas a little too much instead of letting the car roll forward. (She points forward towards the mess down the hill). When she realized what was happening, she tried to hit the brakes, but her foot was still on the gas. She pushed that SUV right up off the street and onto what is usually a crowded sidewalk.

As I completed my assessment and she blushingly refuses an ambulance, a man approaches to ask me if she had a TIA.
“I don’t think it appropriate to discuss her condition with strangers, do you know this man?” I asked her seeing her shaking her head.
“I’m a PA,” he advises, removing his sun glasses, “Are you OK Dear?” He asked her as if talking to a three year old.
“Sir, I have this scene under control, and she has a name if you’d care to ask.” Was my smart ass response that got his attention off of her and onto me, as planned.

“You guys sure have a lot of attitude,” he observed looking me up and down, perhaps looking for my Registry Certificate, State and County Licenses, 48 hours of continuing education, Bachelor’s Degree, instructor’s certificate and years of assessments. I keep them in my other pants.

“I would have her checked out if I was you.” And away he went, placing his sunglasses back on as if nothing was wrong.

“Who was that man?” my client asked looking up at me from the seat of the car, holding her insurance information and license.
It was then that all the BS around that man faded away and I saw what was going to happen to my friend. There is no way her insurance rates will stay affordable, likely resulting in her losing the car. The freedom she has known for close to 70 years of driving will be gone. Then she’ll have to walk to the market, that is until her knees give out. Then she’ll be stuck at home. And the PA so concerned for 80 seconds will never stop by to lend a hand.

No one wins

The dispatch is for an unknown medical aid.

I press the button for the rickety elevator, wondering how long the trip up to the fifth floor will be.

“Mid 40s female…overdose,” the Fireman says.

I pause

“Early 60s male, respiratory issues,” is my reply.

“Lunch and dinner?” He asks, hand outstretched.
“Lunch and dinner,” and we shake hands as the elevator opens and we pile in.
The ride is shorter than we expected, and we made it all the way up.

As the door rumbles open there is a distinct odor of urine and an open door just down the hall.
“In here!” a tired male voice calls. I turn to enter the little room and see, on the bed, a man in his 60s having trouble breathing, holding onto a woman in her 40s with an altered mental status.

“Well that was anti-climactic” the boss says and we go to work.

Later that night we bought each other’s meals just to keep the spirit of the game going.

My Healing Hands

I’m working a 48 at a decently busy house when, early on day two we start to notice something extraordinary. Everyone I’ve touched has been cured on the spot. Call them miracles, call it a practitioner’s energy, what have you, but don’t burst my bubble by saying they weren’t sick in the first place. That’s just cruel.

PATIENT 1

A middle aged man at the local gym. The staff heard him singing one minute, then passed out cold on the floor the next. We arrived and found him supine, the water off, his skin still warm. I reached down to check his pulse when his eyes opened and he came to life. “What happened?” he asked me, standing and covering himself with the towel nearby. “You tell me,” I tell him and he does. He’s been up for two days straight and just finished a basketball game with friends. He remembers the water being so warm and inviting…then found himself on the floor. He awoke to my touch. Miracle.

PATIENT 2

Activated to a street corner for the severe asthma attack. The address is well known for drug traffic and asthmatics who rarely refill THAT prescription. the Police officers at the corner are waving frantically as we turn the engine down the last block. They run to my door, not the lieutenant’s door, but mine. This must be serious. “She’s barely breathing, hurry!” I’m told so I grab the bag and hustle over to where they pointed. A woman is leaning over the bed of a pickup truck with her head down. I quickly reach for her chin to assess her breathing when she slaps my hand away. Effective motor control for someone in distress. “Can you breathe?” I ask. “No, I can’t. I have asthma real bad.” Is her response. the stethoscope is out and under her intentional grunting is clear air movement, even way down in the lower lobes.
I can hear a bit of the conversation in the background between my lieutenant and the police.
“She wants into the apartment, hubby won’t let her in, she told us she needs her asthma machine and to call you.”
“I don’t think this is asthma,” reaching down to check her pulse rate, “is there anything-”
“Fine, thank you.” She interrupted standing, straightening her shirt and walking over to the officers. “Will you let me in now or not?”
As the ambulance crew arrived I told them the situation and they agreed I had the magic touch. For sure.

PATIENT 3

An elderly man was seen being escorted from the commuter train, pale and sweating, by two adult males. In this time of increased security, the guard decided to give 911 a ring. When I arrive in the bathroom, the man turns out to have been escorted to the train by his two adult sons, who were concerned he wouldn’t make it to the toilet in time. They reluctantly open the stall door and there he is, pale, cool skin covered in sweat, and a look of embarrassed discomfort on his face. “I’ll be fine as soon as I can go.” I’m thinking the same thing you are so I reach for his pulse rate when he groans. Honestly, the moment I touched him, he pooped and instantly felt better. “My medication makes me constipated.” He says. And my supernatural powers do the opposite my friend.

PATIENT 4

Sometimes you really can talk sense into your regulars, especially when they try playing your game. This time our friend in the lobby of the motel tells us of an elaborate cardiac procedure performed earlier that day that should have meant a scar and a few more days of observation, but hey, at least he’s trying. I explain the details of the procedure and how long I spent in school to learn that as he fidgets with 3 of his 4 extremeties. As my EMT is taking vitals and holding one arm still, the other begins to fidget around. This man’s nervous system is clearly in massive overdrive and the blisters on his lips give me a good idea what’s happening. When I place my hand on his shoulder to get his attention he straightens up, looks at me and says, “If you think nothing is wrong then I don’t care, I’m going back to sleep.” And wandered back up the stairs.
The lieutenant walked up and asked if I’d be willing to touch his throat, he’s had a cough as of late. I told him he should wait until I wash my hands. My miracle hands.

PATIENT 5

Anxiety impacts a large portion of our population and our friend called today because he refilled his prescription for anti-anxiety pills, but sold them for heroin instead. We’ve all been there, right? He walks out of the hallway alert, oriented and breathing fine, all the while telling me he can’t breathe. I talk him through some breathing exercises, slowly calming him and he feels better. As the ambulance pulls up he waves them off. I haven’t touched him yet and am wondering if it’s a fluke. As the ambulance turns the corner he starts to breathe quickly again telling me he needs the pills or he won’t get better.
“Look at me,” I say taking his arm to focus him, “You don’t need those. We didn’t use them today, it’s all about controlling your breathing.” He smiled, turned around and walked away. I turned to the crew, each with a different variation of “WTF” on their face and thought to myself, “This is totally going in the blog.”

What is that smell?

Some folks, when given instructions by 911 dispatchers, follow those instructions. Others follow them to the extreme and have a negative impact.

THE EMERGENCY

Security is reporting an employee with burns from the fryer.

THE ACTION

Racing down the freeway towards the casino at the northernmost exit, ours is the ALS ambulance and my driver has decided he can’t let the BLS unit responding behind us to beat us to the scene. To anyone coming the other way, it must have looked like an ambulance race instead of an emergency response. All I could think of was the scene from Mother, Juggs and Speed.

We arrive at the casino and are led into the tiny security office off the main lobby to a most peculiar smell. In the corner is the cook (They make nachos and chicken wings so Chef doesn’t cut it) we always make a nod to when we pick up dinner on some nights. The look on his face is one I would later learn is true excruciating pain.

He was emptying the grease from the deep fryer when it spilled out and splashed on his lower leg, which is still smoking ever so slightly. As we made quick movements to do the first important thing when treating burns, removing the source of the burn, the security supervisor explained he was told by the dispatcher not to put anything on the burn.

Um…yeah…about that. That excludes removing the oil with a towel or perhaps cool water, right?

Soon after the 2% area was cleared and wrapped the Manager burst into the office asking why the kitchen (snack bar) was closed. She actually asked if he could finish the last 4 hours of his shift before getting treated. The guy could barely stand up the pain was so bad so there was not even a hint of a possibility of letting him stay.

Enroute to the hospital, a 40 minute haul, we talked about the Manager’s plans to expand the kitchen (snack bar) into a real restaurant and hire him a staff. Then he could make one of them empty the fryer.

Video from NBC about 911 abusers

I almost missed this thanks to the football game tonight, but was able to get it online. the previews for this story were completely different than the story they tell in the video.

Visit msnbc.com for Breaking News, World News, and News about the Economy

I think this is a foot in the door to address the abuses of the 911 system and possibly reach out to our communities about what an emergency is.

I think the most interesting part of this video was the dispatch in the beginning sending 2 engines and an ambulance to a trouble breathing call. 2 engines…10 people…1 patient…