The Storm...

A few posts back, I spoke of The Calm. A commenter warned me of the storm that always follows it. I should have listened...

On the way to work yesterday morning, I was wondering who I would be working with and if last shift was just a fluke. I speculated on the possibilities of working with the same New Partner (NP) again, or someone else. When I pulled up, her car was there and my suspicions were put to rest. She had made a point to get there before I did and was half-way through checking off the truck by the time I pulled in. With a big smile on her face she said hey and asked if I'd slept late. Smartass..Hmmm...I think this partnership will work out just fine.

Everything went as usual for an hour or two, then all hell broke loose. The entire county exploded and all 5 trucks got a call in less than 15 minutes. Ours was a routine transfer from a nursing home to Big City Hospital for a "routine medical", whatever that means.

Well it turned out to be not-so-routine. Out patient was an elderly lady with decreased level of consciousness (LOC) and no blood pressure to boot. We got underway and amazingly I got an 20 gauge IV in her arm. After a bucket-load of fluid, her pressure hadn't changed and her LOC hadn't improved. I couldn't find anything else wrong with her, 12-lead was good, her Foley catheter had urine in it and it was clear of junk, she wasn't running a fever, lungs were clear, pupils were reactive but sluggish. I was thinking maybe stroke, maybe an MI without ECG changes, hell I was grasping at straws by this point. I even gave some Narcan in case it was Opioid, even though her pupils weren't pinpoint.

No matter what was causing this, I knew I had to get her pressure up. So I started a dopamine drip and it worked! This action might seem very mundane to a lot of my readers and colleagues, but this was the first time I had done it, ever. Even in all the clinical's, I had never even seen one started. Needless to say I was nervous, but I couldn't help grinning as I watched her pressure rise to 96 by palpation and I stopped increasing the drip and it held. She even started moaning a little by the time we got her to the ED.

The next call was an allergic reaction, another bee sting. This time it was a 19 year old and she was having a full anaphalactic reaction. Luckily her parents knew all about it and stuck the patient with her Epi-Pen and it slowed the reaction till we could get there. But it wasn't enough. NP gave her another shot of Epi under the skin, and some Benadryl and Solu-Medrol through the IV I had started. She was still wheezing, so a couple of nebulized Albuterol treatments cleared her up on the way to the hospital.

We slowed down a bit after that, did another routine call for a guy with the flu and a three year old who had fallen off the back porch of his grandparents house. A few bumps and bruises, but otherwise he was OK.

We had just finished eating dinner and the tones went off. A possible Code Blue (Cardiac Arrest) at an assisted living facility. NP was almost jumping out of her skin with excitement. We get there and she practically drags me down the hall from the front of the stretcher. We see our patient, elderly male, laying on his back and he is purple from the nipple line up. Not a good sign.

The staff have no idea how long he has been down, the last time anyone has seen him alive was approximately 30 minutes before we got there. He is a full code, no DNR. I drag him to the floor, start bagging him and doing chest compressions while New Partner got the monitor out and attached the pads. Asystole, shit. The first responders show up and together we get him on a board and then to the cot. Once we get to the truck, NP goes for a line while I get out my intubation stuff and the squad members set up the IV lines and do CPR.

NP wasn't successful at the IV's so I told her to get the BIG gun out. It's a special device that puts a needle directly into the bone, that way we can give fluids and medications to the patient directly into the marrow and then it gets to the blood stream quickly. I dropped the tube on my first attempt and checked for breath sounds. I'm in! I look up and see NP grinning like a fool. She nailed the BIG gun on her first try as well.

The patient was still flat-line on the monitor and we started pushing the drugs and I told the squad to jump out and but I would need a driver. Me and NP worked the rest of the code by ourselves for the 15 minute ride to the local ED.

We didn't get him back, didn't even get any Epi-blips on the monitor. But I felt like we had gave it our all and done everything we could. Our supervisor was there when we arrived and he had heard everything on the radio. He was grinning from ear to ear. Later he took me aside and said that he was proud of me and that I was defiantly on my way. I imagine I turned about 8 different shades of red from this compliment. I thanked him and went to clean my truck. Running a code is a messy business, there were wrappers and equipment all over the place. About 45 minutes and 2 trash bags later we were all cleaned up and I checked us back in service.

That was the last call of the day, we actually got to sleep all night. Before I went off to bed, the phone rang at the station. It was my Training Officer. He was calling to tell me he had heard the call and had heard that we did exceptionally well. This man is the only one that could really intimidate me. I'm not sure exactly why, but he does. So a comment from him was a great thing to hear at the end of the day.

Cleared....

My service told me that I would have at least six months before I was cleared to work as a solo medic. With the shortages, I had a feeling that it wouldn't take that long.

Yesterday I showed up for work and my regular partner wasn't there. I usually show up 15-20 minutes early so I can get things done and not be in a huge hurry. Drink a little coffee, talk to the crew that is going home, that kind of thing. At 2 minutes till 7, in walks this brand new medic. I know her, but I've never worked with or around her. I've not had my patch for even 3 months yet, she has had hers about a week.

"You lost?" I ask.

"Nope, I'm working with you." she replies. Oh Shit.

About this time the station phone rings and I go to answer it. It's my supervisor and he's telling me what I just found out. Apparently 2 other medics had called out sick at the last minute and he couldn't get it covered with anyone but her. My partner got moved to another truck to work with a Basic EMT. He goes into his "pep talk" saying that I will be fine and that I am a lot stronger medic than I give myself credit for. Sheepishly I say OK and hang up the phone.

We get all the station duties done and go to breakfast. No calls yet. Me and Partner For the Day make small talk and I take a little nap in the recliner. I wake up and get some lunch. Still no calls.

My first call as a cleared solo medic was the most mundane that comes. A routine transfer from a nursing home to a doctors office, then wait and return. The next call was for a possible suicide. We staged for about 2 hours and then got cancelled by the cops, I never found out what happened on that one. We then went and got supper and back to the station.

The tones went off again for an allergic reaction, bee sting. The first responders were giving us a short report while we were en route and it sounded like a decent call. We get there and found out differently. He was having a reaction, but nothing "life threatening". A little O2 and benadryl and he was fine, we transported him to the local ED anyway.

My supervisor was at the hospital and about 45 minutes later we finally left. He had to give us a big talk and tell us all about how it used to be "in the old days". Don't get me wrong, I was raised to respect my elders and I do respect him for his age, station and experience. But in the year and a half that I have worked for him, I have heard the same speech at least 20 times.

On the way back we get another call, a stroke. The first responders on that side of the county were also saying that it was going to be a "load and go". I respect these first responders a little more, as they have proved their credibility to me time and time again. I step a little harder on the go-pedal and we eventually get there.

They were right, again. The patient was having an active stroke with symptoms starting 30 minutes prior. Complete left sided weakness, facial drooping, unequal pupils, incontinence and a lot of confusion. That squad functions at the Intermediate level and already had an IV in place, so that was one thing less to do. This was Partner For the Day's call so I let her run it. We got him loaded and finished assessing him and I asked her what else she wanted. "To get to the hospital" she replied. I agreed and down the road we went.

Half-way there she steps up between the seats and tells me all she had done and asked me what else? I tell her a few little things and then hand her the phone to call the Big City ED and tell them what we are coming with. She looks a little skeptical but does a good job overall.

Afterwards we are talking over the last 2 calls and she is asking me all kinds of questions and I actually have the answers. It felt good to help someone else. Not sure if she will be back next shift or who will be there when I walk through the door. But I have new confidence that I can get the job done.

BRM

The Adventures of Monkey Boy...

I was sound asleep when the tones went off. I cracked open one eye and listened to the dispatcher give out the call. 24 year old male. Abdominal pain. Great.


I get up, put my uniform shirt on and make my way to the truck. My partner was right behind me. We drove out to the middle of nowhere to a single wide trailer with crap laying everywhere all around it. Up the rickety steps, inside the house and we see our patient. A rescue squad member that I knew was trying unsuccessfully to get a blood pressure on the guy, yelling at him to sit still.


It wasn't working. Our patient was rolling around on the couch yelling. At first I couldn't understand what he was saying, then it came clear.


"My belly button is gonna fall out!"


I tried to keep from snickering and took a look at my partner and saw that he was trying to do the same. I made my way through the trash heap that was the living room to the guy. Then started in on my assessment.


He was indeed a 24 year old male that said he was having abdominal pain. He had went to the local hospital earlier that day with the same complaint and was sent home. He had been having this pain for 2 months, non-stop, with no relief. I started to ask him the pain scale thing and didn't even get 2 words out of my mouth before he screamed 12! 12! it's a 12! I took it that he had heard that question before. Wonderful. No other medical problems and no medications. At least none that were prescribed by a physician. Although he did have some laying on the table next to the couch that must have been prescribed by the local ABC store and his trusty neighborhood chemist. There was a definite odor of alcohol around him and his beard, mustache, nose hairs and eyebrows were singed.


As we started to get him up and make our way to the stretcher he stated something that I hadn't heard before.


"I think I swallowed a monkey and he is trying to eat his way out of my stomach!"


What? I must have heard that wrong. Nope. I heard it right. He kept saying it all 18 minutes of the transport. He wasn't sure how he swallowed the monkey or even when this supposedly happened. But that was his story and he was sticking to it.


Now before you, dear reader, get your panties in a bunch, I did do a full assessment. As much as he would allow. I could find nothing else wrong with him. All his vitals were fine, ECG looked good and there was no pain when I palpated his abdomen. Further evaluation revealed...well...nothing.


Then I began with further questioning. Like, have you been to any foreign countries where monkeys are native? What about the zoo? Have you fed the monkey in your belly lately? What does he like to eat? Is it male or a female monkey? (I was worried that maybe the primate inside his abdomen could be pregnant). What type of monkey was it? I mean I had to know what we were dealing with. Was it a small cute one, or a big hairy orangutan? Important questions that a thorough Paramedic like myself needs to know.


Needless to say that he didn't know any of the answers to the important questions. He didn't know what type/size it was, how it got in there or what it liked to eat, since he hadn't eaten in 3 days. All he knew was that it was inside of him and wanted to get out. That is what was causing his pain and he wanted help.


For my part, I took him to the hospital to get him that help. Although I didn't think they had a veterinarian on call.


The nurses all groaned when they saw him. They remembered him. But I lifted their spirits when I told them of his new complaint.

That's one thing I love about this job, you never know who you're gonna meet and what they are gonna say. Till next time...


BRM

Thanks again.....

....to all those who left a comment on my last post. It humbles me to think that there are still people out there that care about another persons suffering and pain. This job tends to put you in the mindset of otherwise.

I will definitely have to try some of the things that were suggested. I guess the thing that bothers the the most is the fact that I will soon have a son of my own. The dream took on new form once my mind wrapped itself around this idea. It's like I was the father of the dead child. I don't know how if could handle loosing my son.

I appreciate all the comments and well wishes from everyone.

BRM

Never forget....

I woke the other night choking down a scream, sweating and trying not to wake my Wife. I couldn't really remember what the dream was about at first. I just knew that it seemed familiar, like I'd had it before.

I sat up and went to the bathroom and splashed the sweat from my brow with some chilly water. As I looked up into my face in the dim light of the small nightlight by the sink, the dream came back to me with a vengeance. For just a second, I wasn't looking into my own eyes, but that of another man. A man screaming with rage, terror and grief. I gripped the edge of the sink and stared back into the reflection that didn't seem like a reflection as I remembered something that I thought I had long forgotten. But we never forget do we? I don't think so, even though we try, we never forget.

Just about anyone who has spent time on the streets as a cop, firefighter, or paramedic can tell you stories of their nightmares, if you can get close enough to them to get it to come out that is, this is one of mine....

Awhile back I was riding around in my truck, not doing much of nothing when my fire department/ rescue squad got a dispatch: Pedestrian struck. I flipped on the blinkers and motored over that way.

I was the third person on scene. The first was a fireman who didn't have much in the way of medical training, but eager to help. The other was a classmate of mine from early medic school. The scene was thus: A large sedan parked at the end of 10-15 feet of black marks on a curvy residential street, 10-15 bystanders that had come from out of their homes to gawk and one 5 year old child laying in a spreading pool of his own blood.

At this point I went into my "EMT Mode"- no emotions, just get the job done. I walked up and asked the fellow classmate what he had. I'll never forget his answer, "It ain't good BRM". As I was walking up, surveying the scene, I couldn't see the child in his entirety. I trusted the classmate for the hands-on stuff for the moment, and I was the only one at the time with any supplies whatsoever. So I started pulling stuff out of my bag and asking questions at the same time.

"Is he conscious?" I ask.

"No" he replies.

"Airway, Breathing, Pulse?"

"No, no, maybe."

"Maybe?"

"I can't seem to feel one" he says shakily.

I kind of nudge him aside to check for myself. This is my first, unobstructed view of the patient. It's a site I don't think I'll ever forget. His head is a mess of blood, hair and torn flesh. His shirt is torn in several places and blood is oozing out of many of them. One of his little arms is bent at an distorted angle back and behind him. His legs are mashed and bleeding and he has only socks on his small feet. This all took place in about 2 seconds, although it felt a lot longer at the time. I had the fireman hold what he could for c-spine while I inspected the child's airway and assessed for breathing. He wasn't, not good. His airway was full of blood and I asked for the hand-held suction in my bag. I got most of it suctioned and remarkably it stayed clear as far as I could tell.

In goes the tiny oral airway and I ask for the BVM to start breathing for him. Classmate hands me an adult one and I remember that is all we carry. Due to budget restraints we were never issued the pediatric or infant ones. I fit the mask to his face the best I can and give a squeeze feeling for compliance and watching for chest rise. It doesn't. I try to get a better seal and I am looking at his head this time when I squeeze. As I put pressure on the plastic bag I notice bubbles popping out of the top left side of the child's head where most of the damage seems to have occurred.

I can't believe what I am seeing. I try again and see the same results. I realize that the entire inner anatomy of the child's head is pretty much gone. The air I am trying to put into his lungs is coming out the side of his head. What the hell do I do now? I feel for a pulse and there is a weak one in his neck.

I can hear the sirens of the fast moving ambulance by now. It's almost here, but in my focused state of mind I didn't hear it. There are others on scene now, other EMT's and rescue personnel but they are just standing there looking at me. One asks me what I need and I say a surgeon. I'm thinking that is the only thing that can help at this point.

I continue bagging with the Classmate holding as good of a seal as he can with the over sized mask. Knowing that the effort is pretty much futile with all the bubbling coming out of the skull, but hoping that at least some of it is getting where it's supposed to go. I had also applied all the gauze pads I had to try to staunch the blood coming from his head, also futile, but I didn't know what else to do.

The ambulance arrived and 2 medics that I knew jumped out. You could smell the brakes cooking. We loaded him up and by that time the weak pulse I had earlier felt was gone. CPR and down the road we go. They tried to intubate, then tried to cric him. Neither worked, there was just too much trauma. They worked him for a long time at the ED, being a kid and all, no one wanted to give up. Eventually they did and we made our way back to the truck. Other fireman/ first responders from my department had followed us and cleaned up the truck so I rode with them back to the scene.

They had moved my truck down the road a little, to make room for the yellow tape the state cops had put up for their investigation. That's when I got the story. That's when I found out the rest of the horror.

The child was playing in and around the road. Neighbors said that he lived about a quarter mile away in a trailer park. He was always playing near the road. Most thought of him as a nuisance. He would throw rocks and such at cars and other devious things. A few had spoken to his mother, but being the alcoholic that she was, she just got defensive and cursed the neighbor out.

The child also had an older sister, 11 years old. She saw it all happen from the side of the road, about 6 feet away and was the one to run and ask someone to call 911. I can't imagine the thoughts of that little girl as she tries to grow up and find her place in the world.

The driver of the car was cleared from all charges. It was determined that he was driving within the posted limit and that he would not have been able to see the child in the road because of the curves. I never even saw the man. I don't know if he even got out of his car, I'm sure he did, but I didn't know it. Even though he has no criminal charges, I can imagine that if he ever got behind the wheel again, he would see that little boy crashing into the front of his car. If it were me, I'm not sure I could ever turn the key to another vehicle again.

He is a grandfather. He had his 2 young grandchildren in the car with him, ages 6 and 8. No one but God knows what kind of emotional scaring occurred to them that day.

After the investigation was over, we had to do the clean-up. We poured sand on the blood and tried to wash it off the road. It had poured from under the boy and ran all the way to the other side of the road and pooled in the dirt shoulder. I've drove through there many times since and I don't think it ever washed away completely, but that could be just my imagination.

We found the child's shoes. One was right behind the spray-painted marks where the car had been sitting, the other was about 15 feet farther up the road where the initial contact was made. This was the first and only time I had ever seen anyone actually knocked out of their shoes.

About this time we heard an engine growling its way toward us. A small pick-up came over the hill and several fireman had to jump out of its way. It skidded to a stop in the grass just beyond the yellow tape that was still up. The vehicle had barely come to a halt when a young man wearing mechanic's overalls jumped out. He was screaming before the door was open. He was screaming his son's name.

Someone had eventually called him at work and he came here instead of the hospital. He and the boy's mother were separated and initially no one knew how to reach him. One of the EMS supervisors was still on scene and apparently knew the guy but had not made the connection between him and the child. I was about 5 feet away when they stopped him. I could see the strain of the tendons in his neck as he pulled against those that had ahold of him.

I could see into his eyes as they told him that his only son was gone. I stood, unable to move, frozen by that mask of terror, grief and rage as I realized that the eyes that I was looking into were my own.

At this point I woke up.

At this point I always wake up.

It had been a long time since I'd had this dream. Up until now, it wasn't my own eyes that I was looking into as I awoke. But my wife is pregnant with our first child and now the dream has taken on a new form. I couldn't sleep afterwards. Instead I lay awake, cradling my wife, my arm protectively around her pregnant belly.

My wife also works in EMS as a Paramedic. But she doesn't have any of the experiences that I have had. So she can't really understand, even though my best attempts at trying to articulate my thoughts to her. She is my rock, but this time it seems that I break my waves around her, instead of on her. Even though she wants to help and understand, she is unable to stop the torrent that floods my mind.

So I am trying this, other than my wife, no one has heard this story in its entirety. I guess that I am hoping that by writing this out, I can somehow free the rat that is trapped in my mind.

BRM

My service....

I said in one of my last posts that I would get back to the topic of to go or stay with an EMS service. I got several great comments and I thank all those who did. I am gonna take a minute to talk about my service and you can tell me if you would leave...

We are a smaller, rural service. About 60 total employees. We run 5 trucks at 4 different stations. The shortest transport time to the Big City is about 20 minutes, the longest is 1 1/2 hours, and that is going emergency traffic.

We do have a small in-county hospital, but they only have about 130 beds and the ER has 5, only one of which is behind actual walls and not a curtain. We also have an urgent care/emergency room/ lab/CT scanner facility. Not much goes there except a cardiac arrest and very minor stuff. It's most beneficial to the local doctors office's for the use of the lab facilities, X-Ray and CT scanner. Neither of the in-county facilities have an actual MD on scene 24 hours a day. Most times you get a PA or NP with a doc on call. Sometimes you only get a nurse if the doc-in-the-box was out of rolling MD's when they needed one. Not sure how they get away with this, but it happens.

We work a 24-on, 48-off schedule like most other services in the area. There are a couple that work 24-on and 72-off, but only one is within driving distance. The pay here is on par with the area as well. Of course the Big City service pays a little more, but we are at the top of the average for the state. Benefits are decent. For employee's the insurance is free, and that includes medical, dental and vision. There is a few other plans for employee and spouse, employee and dependant (for a child), and a family plan. They are all decently priced. We also have the option of secondary insurance if the employee chooses. The only thing that is not covered under the county policy is life insurance, but you can get that through the secondary company or own your own. We also have one million in malpractice insurance provided by the county for each employee.

Con-Ed is also provided for all the employees and is of course mandatory for all the full time people. The training officer is very good about sending out emails for upcoming classes and conferences in the area. He usually finds a way to get you off work to go if you want to and he's always, so far, found a way for the county to pay for those classes/conferences. Not many people go to the specialty ones like Advanced Burn Life Support, Rope-Rescue, Dive-Rescue and the like. The reason is that they don't get any extra money for it. To me that's just a bad attitude, but in a way I can understand.

The call volume is fairly low in my opinion. At the busiest station you could run between 6-10 calls per 24 hour shift. The slowest has gone 2-3 weeks without running anything, but that rarely happens. Most of the time they run 2-3 calls, but they are also the farthest out from anything resembling society, much less paved roads. Up there you hear banjo music every night. Its where the men are men and the sheep are nervous if you get my meaning.

Now for the bad stuff.... There is no room for advancement. We have a director, assistant director, training officer and 3 supervisors. That is all the management that we have. With the turnover, anyone who has at least about 3 years in as a full-time Medic is considered a senior medic and those are who the students and trainees are put with. None of the management is going anywhere anytime soon, in so far as retirement goes.

There are also no raises. Well, you get one at 6, 12 and 18 months after you get hired, but they are so small I never even noticed them on my check. After that, nothing. It's been 6 1/2 years since the last cost-of-living raise came down the pipes and it ain't looking good for this year either.

So that's pretty much my service. I know this sounds like a recruitment speech, trust me it's not. I'd just like to hear what other people think the service that I work for and whether or not they would leave or stay. I am happy with it for now. I don't see myself going anywhere anytime soon, if ever. But you never know what the future may bring.

BRM

Been away....

Been awhile since I last posted. Sorry to those readers that come looking. The Wife and I went on a little pre-baby vacation, which was very much needed. I will post in the next day or so.

BRM