In the midst of potty training our youngest I’ve found myself saying some interesting things that, taken out of context, would sound disgusting.  Then I went to work and found myself saying some of the exact same things to grown adults in the midst of an “emergency.”

So let’s have a little challenge here and see if you can correctly guess which of the following statements were uttered by me to my 2 and 4 year olds or to a grown adult, or which was said by a 2 or 4 year old or grown adult.  Results soon!

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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.

This situation happened to, yes you guessed it, me when I was in the Officer’s seat for a few hours and we went shopping. We were so close to this alarm that we were on scene and in pump before the dispatch was completed.

On the surface we have a 3 story type 5 (Balloon frame ordinary construction) with similar buildings on both sides, 1/8″ apart not allowing for the “hot lap” so sought after in classes.

Soon after my firefighter shut down the power to the buzzing elevator box, my immediate concern was for what was behind the wall the box was bolted to and where the elevator motor room was.

As the balance of the box alarm assignment began to arrive I updated the Battalion Chief that we had no fire so far, but were checking for extension of an electrical box to an elevator control. Our truck companies carry Thermal Imaging Cameras (TIC) and we certainly needed one since this box turned out to be mounted on an exterior wall, meaning the only access was through the interior wall of the building next door.

Until we could confirm there was no extension, this situation gets the bulk of the resources assigned to it.

Behind all the clothes and storage was the elevator motor room, which was indeed charged with smoke, almost hiding the burnt out motor and smoldering wires. The electrical conduit served as a tiny chimney for the small motor room and was the reason the garage smoke seemed so light. The motor had faulted, causing the electrical box to trip. It was warm, but not hot, but the conduit fastened to the outside of the wall was hotter and was a bright white on the TIC.

If you said continue the assignment until confirmation of conditions, you made the right call.

This scenario is a left over from my Captain test prep time, sent in by Richard663. Since I’m now doing the Crossover with Motorcop, I figured this might start a good cross discipline discussion.

You are the EMS Battalion Supervisor dispatched to a reported officer involved stabbing. Since Officers rarely carry knives you are ready to treat a stabbed officer and likely a shot or injured suspect.
Responding with you is a seasoned ambulance crew from across town and a rescue squad from the next town over, ETA 10-12 minutes.  Your ETA is 2-3 minutes.
As you arrive on scene, all 5 officers on duty are at the scene frantically searching for the suspect while the weapon, a large kitchen knife, is in the hands of one of the officers. It is clean.

The watch commander approaches you and tells you his officer is not stabbed, but the blade hit the vest. The officer is resting, but refusing care at this time. You agree to assess him and the watch commander agrees that is appropriate. You get on the radio to slow the ambulance to code 2 and cancel the squad.

The watch commander explodes in anger screaming that his people deserve a code 3 ambulance no matter what you think MIGHT be wrong.

How do you respond?

You make the call.

Ah, a day off! You’ve decided to head out for a few quick drinks with friends and meet at a little restaurant/bar in a quiet suburb. As you try to describe to your fire and PD buddies about the culture at an event such as EMSExpo, they ask if folks wander into area bars in uniform.

Replying in the negative, they laugh and ask if folks wander into bars in uniform wearing stethoscopes.
When you glare at them they laugh and point over your shoulder to the other side of the bar.

Seated at a stool and drinking a beer is a fellow in EMS pants, a blue shirt with a large “EMT” on the back and, sure enough, a stethoscope around his neck.  The shirt shows no company or department name and he is wearing no ID you can see.

While you try to make sure you are seeing what you are seeing, your PD buddy says, “Well, are you going to say something?”

You make the call.

Ah, you all have gotten used to not having a weekly challenge, so let’s get back to basics.  How about the different ways to describe skin?  Instead of being crazy like some of my lab proctors in college finding the most exotic and disgusting photos, I’ll send along one of my own.

I know I have already turned a few stomachs with the photos of my burns, but that was about pain control and had to be done to make a point.

There is no point in this.  Unless of course, you have no idea how to describe this wound in writing.  Yes, that was a challenge.

You may ask questions as to specifics not clear in the photo, but having the wrist and hand in the picture gives all the info you need for size, color and location.

I have been known to add a little of my college education to a PCR narrative or two, but only when sure.  So when I awoke this morning with the following mark on my forearm and my daughter asked what it was I told her and she wrinkled her face.

So my question to you is, how would you document this mark on my forearm?You make the call.

We had a patient very similar to THIS not long ago, or I didn’t, depends on your interpretation of the legal nightmare that is HIPAA, but since we’re learning here, I claim the education exemption.

He fell down the granite stairs, as evidenced by the drops of blood as we came up.  Why is it folks refuse to stay put when they might actually be injured but are held down by bystanders when nothing is wrong?

Up the narrow stairs we find a man in his 80′s with a head injury and a flail section. Double whammy.  In real life we had room to get the board around him and lay him down for the journey.  It was not easy and the issue of placing the board uphill or downhill was a quick learning moment for our EMT student ride along.

But when we returned to the firehouse, I wondered aloud what we would have done if we had not been able to fit the board.

Some possible answers included:

• Walking him back to the point of injury with C-collar in place.  No, not a good idea.
• Using the stairchair and buckling him in. Could work, and quick.
• KED and carry, not much room there unless we include the stairchair. Could help the flail section as well.
• Load and go, don’t spend time packaging, he needs definitive care.

All certainly good options and faced with a unique presentation we need unique answers.

But let’s not spend too much time in the stairway throwing out suggestions.  Find a solution and go with it.

If you said take precautions any way you know how, you made the right call.

The call was simple when it came in, a man has fallen and is bleeding.

As you climb the granite steps, they are narrow and steep and so far each one is covered in spots of bright red blood.  As you step carefully around the spots and up to the third switch back you find your patient standing in the corner, head laceration over the right eye, slurred speech and a wicked flail chest.  He’s 83.

He’s grasping onto the railings at a turn in the stairs, barely enough room for you to pass by and survey from above.

Similar to this photo from a hotel somewhere, the fellow with the red spot on his face is your patient, just imagine him standing straight up in the corner.  The stairs down around the corner are just as steep and narrow as the stairs here.

How will you deal with C-Spine precautions, if at all?

You make the call.

It’s been a quite day at the big house in your Department.  You are assigned to the busy engine and were ready for one hell of a day.  Today it will be quality, not quantity that gets you.

The bells ring and you have been dispatched as a single engine resource to a reported man hole fire in the City Center.  This area has heavy commercial, light industrial and some high occupancy buildings.  You have smoke showing from the firehouse as you pull out.  Convinced there is no way a 60+ foot column of smoke is your job, you are silent on the air at first.

As you arrive on the scene the wind is still, temps in the mid 60s and it is the early afternoon.  Turning the corner what you see is similar to this photo.

Obviously since you are first on the scene the responders in the photo have yet to even be dispatched.  Your driver is uphill and upwind, mainly because he’s that good and your crew is still in their seats.

What is your initial report for this incident and what resources will you request, if any? You make the call.

You’re the boss on the ladder company today and have decided to run the troops through their paces.  The large extension ladder is raised in front of the firehouse.

You’ve sent the young guy up to practice working off the side and locking in when a woman with a clip board casually strolls up and begins to talk to you.

Even though all your member are in their PPE with helmets in place, she refuses to stand back as she makes notes on a sheet on her clip board.

“I notice your ladder is not secured at the top,” she tells you.

“Well No, Ma’am, it’s not, we’re practicing a situation where that doesn’t happen, that’s why this fellow here is holding the ladder,” you tell her while pointing to your foot man holding the ladder as he always does.

She presents credentials from the local occupational safety department and orders your member off the ladder.  She then demands to speak to your supervisor for a violation of safety laws.

What do you tell her?  You make the call.