My policy trumps your policy

Today we pick up where we left off with our previous call.

To recap; some chick doesn’t want to be at school, so she either a) is having a panic attack because she forgot her homework, or, b) just wants to go home. The fireputterouters have no idea that nothing is actually wrong with the patient, because instead of performing an assessment, they went straight for the IV attempt.

And blew up both of her ACs in the process. With 22 gauge catheters.

Seriously, a 22 in the AC? Knock it off, guys.

Slimm and I fixed the flag, and we are walking out of the classroom, ostensibly in a hurry to take care of our critical patient.

Some guy approaches. This guy looks official. He has grey hair and a lanyard, AND a whistle.

“This is Missus Whatsherface. She is going to ride with you.”

“She will have to follow us down to the hospital, we can’t take riders.”

“Well, it is the school policy that a staff member accompanies any student.”

“Okay. She can accompany the student at the hospital. Slimm and I will accompany her in the ambulance.”

Now, mind you, I’m not really against people riding in the ambulance with patients. Frankly, I don’t care. Except in cases like this. First, this guy is being a mega-douche, and second, we don’t take riders in the ambulance with fakers/anxiety attacks. We give them quiet rides, with vital signs monitored. And third, I don’t like the cut of this guy’s jib.

“Umm, one of our staff members has to ride in the ambulance with her. It is our policy.

“I am terribly sorry, but it is the policy of the ambulance service that will be transporting her that only immediate family members ride in the ambulance with any patient, and that is at the discretion of the ambulance crew.”

She followed in her car. With her flashers on the whole way. Later, I find out that Lanyardman called and complained. And lo and behold, my supervisor stood up for me.  “Yes, sir, I understand, but the paramedic made the right decision, and followed our company policy.”

Maybe the third time that has ever happened.

More assessment, less IV-ment

A call at one of the local high schools. “15YOF PASSED OUT” says the MDT.

“Yeah, sure” says Slimm.

Sure enough, there is a young female lying on the floor of a classroom. I’m looking around, figuring this is a World History class, with all the flags and stuff on the wall. One glance at the chick lying on the floor, and it’s pretty obvious: ain’t nothing wrong with her.

Anxiety attack 101 is being taught in this classroom today.

“Hey, your American flag is backwards.”

“Really, I thought the stars went on the right.”

“They go on the flag’s right, which is the viewer’s left.”

“Oh. Thanks.”

“No problem.”

Meanwhile, the fireputterouters are scrambling to get an IV on this chick. I don’t know why. Her eyelashes are fluttering, she is making obvious cringing faces when they poke her with the needles, and I watch her protect her face as our third rider does the arm drop thingie. (Is there a name for that?)

These guys are sweating up a storm, frantically hoping for flash in the chamber. Meanwhile, their blood pressure cuff, glucometer, stethoscope, and everything else needed to actually perform a patient assessment remains in their bags.

“Maybe we should just go ahead and get her out of here?”

“Umm, sure. That sounds like a good idea.” I’m not really in a hurry, but I am excited to get back to that grilled chicken salad I have in the ambulance.

The next thing I know, these guys pick this chick up, and rush to get the seat belts on her. Then they take off down the hallway with my patient, on my stretcher.

I look over at Slimm. “Maybe we should follow them?”

“Yeah, probably. I locked the ambulance, so they are going to have trouble loading her.”

I know who my real employer is

Even through all the complaints I have about my employer, and their petty bullshit, I take solace knowing that I don’t really work for them.

Sure, there is a guy who signs my paychecks every two weeks, and I graciously deposit them. He pays me well for what I do, and is very generous to his employees.

My supervisor can continually come to me with nitpicky complaints, about how Slimm and I didn’t wash the truck after we got off ninety minutes late. He can get upset at me because I don’t take all the equipment out of the truck to the side of the road where a lady sits, complaining of abdominal pain. He can whine to me about ‘policy’ when I had the middle-aged lady walk to the stretcher because she wanted to go to the hospital for her depression.

My employer tends to stay out of the day-to-day operations side at his company. He relies on his employees in management to make policies, and those management employees make policies that are absolutely ridiculous. And I am glad to break those policies when my safety (and common sense) dictate otherwise.

Like responding to every single call with lights and sirens. “No, I didn’t use lights and sirens to go to that last call, because the caller said he wanted his psych meds refilled, and I didn’t feel like that warranted putting my life, my partner’s life, and the lives of countless other people on the road in danger for some guy who apparently can’t find a CVS.”

I’m okay with getting in trouble for doing, or not doing, all that little bullshit. Because at the end of the day, I don’t really work for my employer.

I work for the patient.

And as long as I do what is best for the patient, every single time, I will still have a job, and I will still do that job better than any other paramedic at my company.

English major

A call for a “person in pain” about two blocks from our local hospital.

I decide to go ahead and finish my game of Mahjong on the computer while we are driving to the call, while Slimm opines on the situation awaiting us.

“Man, twenty bucks says she just walked out of the hospital, and wants to go all the way downtown.”

Knowing that our bets never involve the actual exchange of money, I accept.

“What’s going on?”

“I’m hurting everywhere.”

“Okay.”

“I want to go to the hospital.”

“Good for you, there is one right over there,” as I point to the hospital, about 100 yards away.

“No, I don’t want to go there. I want to go downtown.”

Slimm wins. Again. “Why don’t you want to go to that hospital right there?”

“They are mean to me. I just left there. I don’t want to go back.”

“Okay, then. Hop up here on the stretcher.”

Downtown is at least a half an hour away, so I have plenty of time for more Mahjong on the way. I’ve also started listening to Handel on the Law podcasts, and enjoy a brief show while I match tiles on the computer screen.

The radio report is made, and it was one of the best ever.

I wish you could have been there to hear it. I felt like such a hero.

“Umm, did you have to tell them that?” asks the person on the stretcher.

“Tell them what?”

“That I just walked out of the other hospital?”

“Well, yeah. It is kinda pertinent to the current situation.”

“What does that mean?”

“It means it is relevant, or germane.”

“Who is Jermaine? I don’t know nobody named Jermaine.”

Bad decision

A middle-aged male calls 911 because he doesn’t feel well. We find him sitting in a chair in his bedroom, looking terrible. Pale, cool, diaphoretic, cyanotic, and in obvious distress.

What my father would call “looking like death eating a cracker.”

He had a CABG a few years ago, and has high blood pressure. His wife says he has never had a heart attack though, and only did the CABG after an abnormal stress test.

He’s having one today though.

The 12-lead shows a big anterior infarct, with lateral involvement, and with lots of ectopy on the continuous ECG. His blood pressure is low, too.

Lots of bad things are going on.

“Sir, let’s get you on to Local Hospital.”

“No, I want to go to Southside Hospital.”

Southside Hospital is thirty minutes and two counties away. And this guy doesn’t have thirty minutes.

“We really need to go to a closer hospital, and Local is only five minutes away.”

“I will not go to Local Hospital. Take me to Southside” he says between breaths.

“Sir, you are having a heart attack. Southside is half an hour away, and that is just too far. We need to go somewhere a lot closer.”

“I don’t care. I am NOT GOING to Local Hospital.”

Slimm was wise, as usual, and had the patient sign a refusal form on which Slimm wrote ‘Patient refused closest hospital.’

I hated to take a firefighter so far out of the county, but I really didn’t have a choice. We told the other guys on the engine that we would bring him back. I really don’t like to take riders, but I felt like something bad was going to happen, and I would need the help.

Something bad happened, and I needed the help.

About six minutes after passing Local Hospital, the patient went into v-fib. Even though my defibrillator pads were already on, and it took about 5 seconds to deliver the shock, it didn’t work. After Amiodarone and two more defibrillations, he was in asystole.

Slimm diverted us to Local Hospital, and the patient never came out of asystole.

If he would have gone to Local Hospital, the outcome would likely have been the same, but I can’t help to think that it might have been different. If he would have listened to the advice of the providers on scene, he might have survived. But he made a bad decision.

Someone once told me something very wise.

“People have the right to make bad decisions.”

No appointment needed

Today we visited the upper crust of society, and entered into a gated community filled with homes that cost several million dollars each. Full of manicured lawns, cobblestone driveways, and homes with more square footage than one can imagine.

For a lady who “feels sick.”

Imagine that; bullshit calls aren’t restricted to those who have less than two commas in their bank account balances.

We are shown to the patient by a butler.

Seriously, a butler.

Slimm called the butler Mr. Belvedere

We found the lady in what appeared to be a sitting room to the sitting room to her bedroom. She looked very unsick, and impeccably put together.

“Yes, I seem to have a slight cough, and may even have a fever, and thought perchance I might go to the hospital to have my symptoms evaluated.”*

I let Slimm handle this one, since he is on a roll with the butler already. “Sure thing, ma’am. Which hospital would you like to go to?” he asks.

“I would like to go to Saint Catholic’s Hospital, if that is possible.”

“Absolutely, we can take you there. Are you ready to go now?”

“Oh. Now? Do I have to go now?”

“Isn’t that why you called us? Because you wanted to go to the hospital?”

“Well, yes, but I did not realize that I needed to go right now.”

“That’s kind of what we do, ma’am.”

“Well, I thought that I might be able to make an appointment or something.”

“Sure, you don’t have to go to the hospital. You can call your doctor and make an appointment if you would like.”

“Well, no, I meant, could I make an appointment for the ambulance to come take me to the hospital?”

Slimm and I look at each other, just absolutely dumbfounded. And then he winks, a wink only slightly perceptible to the untrained eye, and then turns back to the patient.

“Yes, ma’am. You can make an appointment. Just pick up that phone right there and call nine-one-one when you are ready to go to the hospital.”

Easiest refusal ever

A fender bender in a gas station parking lot.

Has anyone ever run a legitimate motor vehicle collision in a gas station parking lot? Please tell me if you have.

Nothing is wrong with this lady, and nothing is wrong with her car. Well, she has terrible driving skills, and is kind of argumentative. Even though nothing is wrong with her, and everyone knows it, she complains of back pain and wants to go to the hospital by ambulance.

She pulled out in front of another vehicle and doesn’t believe it is her fault.

I hear her on the phone to her baby’s daddy’s brother’s girlfriend. “I ain’t fixin’ to go to no hospital if it is my fault and pay eight hunnit dollars!”

Just then Officer Niceguy hops in the back to hand the lady her citation.

Bad dreams

A female smells gas in her home. Dispatch tells us to stage with the engine. We don’t know why, but really don’t care.

A few minutes later, we find out. There was an alleged prowler walking around the trailer park. And now there is a ‘person down inside the home.’

According to the caller, at least.

Finally we make it on scene, after I lose a game of Mahjong, and Slimm finishes his coffee.

The fire lieutenant tells the caller that there is no natural gas hookup

“Maybe it is carbon monoxide?”

“There is nothing in your home that would put off carbon monoxide.”

“Oh.”

“Yeah.”

“Well, maybe I had a bad dream.”

“Maybe.”

Three

My blog turns three today.

Yay.

It has been pretty fun so far.

Thanks, Dave. I’ve enjoyed the ride.

Here’s to many more years.

It’s like a Hollywood script

Finally, Slimm and I are back together. This will be our first time back on a truck together in what feels like years, but has really only been about one year.

I have to wake up 5 hours earlier than I am used to, but I think it’s worth it.

We hugged in the parking lot. It was a brief hug, but it was a hug nonetheless.

Then we got breakfast.

And our breakfast was interrupted because some guy fell out of bed. Now my gravy is going to be cold, and nobody likes cold gravy on their biscuits.

“Radio Med One.”

“MmmmGohead” I reply sleepily.

“Caller is advising agonal respirations.”

“Mmmmkay.”

I turn to Slimm. “I hope the caller is just stupid.”

“Me too, bro. Me too.”

“Radio Med One”

WHAT?! “Gohead”

“Caller advises full arrest. They are starting CPR.”

Shit.

This sucks. The sun isn’t up yet, and neither am I.

Sure enough, it’s a full arrest. The fire guy recognizes me.

“What’s up, C?” he asks as he’s doing compressions. “You pick up an extra shift?”

“Naw, man, I’m back on the truck with Slimm again. Whatcha got?”

“Glad to hear you guys are back. Wife woke up and found him here about ten minutes ago. AED says ‘no shock,’ Bubba got the LMA in, and Chester is about to start the IO.”

I feel around this guy. I don’t see any obvious trauma, but his skin sure is cyanotic. And cold. I mean, remarkably cold. Most people I have felt this cold before have either had lividity or rigor, but he has neither. He is in asystole, and his pupils are dilated and fixed.

Basically, he’s dead. But not dead enough to stop working.

“C, you want us to stop, or keep going?”

“Nah, keep going, let’s move him out into the kitchen, and we’ll work him there. We have more room there.”

Somebody gets the IO, and I see Slimm putting together the bicarb and epi. He looks over at me. “We going to do the two rounds then call it?” he asks.

“Nah, buddy. We’re gonna get him back.”

I wink. Just joking, of course.

But we did.

Five minutes later he had a pulse, was breathing on his own about ten times a minute, and had a blood pressure of 130/90.

“We have to stop doing this.”

“What? Getting people back?”

“Not that. But doing it so easily.

“They should make a movie about us.”