You are here: Home / Archives for Emergency

First things first

May 1, 2013 by 2 Comments

I’m responding to assist on what was dispatched as a “possible overdose.” Really, I’m just bored, and this sounds like it might be slightly amusing.

I arrive shortly after the ambulance, and make my way into the decrepit house. I overhear the medic talking with someone in the house. This seems to be a regular occurrence at this home.

Around the corner I find the other medic fiddling on the ground next to an unconscious person. The monitor is on the floor, and off. The jump bag is on the floor, not open.

The medic on the floor has a tourniquet around the patient’s arm, patting the antecubital.

The patient is an interesting shade of blue. And I don’t see chest rise.

“Hey, maybe we should grab that airway first, and bag this dude or something” I suggest.

“Thanks, man. We got this.”

Yet somehow, I’m the asshole.

Filed Under: Case studies, Co-workers, Emergency

Who is the customer/You make the call

February 12, 2013 by 18 Comments

So; a scenario:

You respond to a local urgent care center where a Nurse Practitioner (there is no physician on staff) shows you to a middle-aged male who came in complaining of chest pain. The NP informs you that she performed a 12-lead, but didn’t see anything “really too wrong.” She also informs you that she has already called report to Roundthecorner Medical Center, and they are awaiting your arrival.

Roundthecorner Medical Center is one mile away.

After loading the patient in your ambulance, you perform your own 12-lead and almost fall over when you notice the humongous ST-segment depressions in the anterior, lateral, and septal leads.

Roundthecorner Medical Center does not perform interventional catheterization. They can perform caths, but can’t place stents. (Don’t get me started on that one.)

St. Elsewhere is 18 miles away, and they have the whole host of cardiology services.

For the sake of argument, your patient is stable enough to make the trip to St. Elsewhere. I’m not too interested in treatments, just the next decision to be made.

Your company policy says you must transport the patient to the hospital that the customer (in this case the NP) selected, and you are not supposed to even attempt to persuade the patient to choose another hospital.

Do you:

A: Take the patient to Roundthecorner Medical Center

B: Inform the patient that he is having “the big one” and transport him to Roundthecorner Medical Center

C: Inform the patient that he is having “the big one” and suggest he goes to St. Elsewhere

D: Suggest to the patient that he go to St. Elsewhere as opposed to Roundthecorner Medical Center, without telling him why.

 

I’m interested in reading your choice, and why you made that choice.

I’ve always held that the patient is the true customer, and the one we should be most focused on. I’ll let you all know what I would choose some time in the next few days.

Filed Under: Case studies, Customer Service, Emergency, Hospital, Patients, Politics

Shift change

February 2, 2013 by 4 Comments

Slimm says we are going to the local nursing home, and points to the MDT. “80Y/O M LOW-BP” it says.

Fair enough. Sounds interesting.

We arrive to see another one of our ambulances on scene, with the crew going inside. “What are you guys doing here?” a crewmember asks.

“Picking up somebody on the North Wing” is Slimm’s reply.

“Cool, so are we.”

Hmmm.

Our patient is about as distress-free as possible. I think he is taking an afternoon nap, when his nurse walks in.

“He isn’t normally my patient. I normally work on another wing. His blood pressure was eighty-over-fifty-two when we checked it just a little while ago. His doctor says he needs to go to the hospital.”

“Great, thanks for the info” Slimm says as he takes the packet from the nurse.

After moving the nice octogenarian to the stretcher and walking outside, we see that the previous ambulance has now been replaced by yet another ambulance from our service.

“You guys picking up, too?” I ask.

“Yeah, someone on the North Wing. I think the call is for nausea.”

Now that is interesting. Three calls from the same wing (which have about 15 rooms per wing) in less than 10 minutes.

It’s interesting until I take a glance at my watch: 3:17.

Shift change.

Filed Under: Customer Service, Emergency, Patients

Not really a stabbing

January 30, 2013 by 3 Comments

The “stabbing” that we sent 12 people to, blaring their sirens and flashing their lights, turns out to be a goofball who poked himself in the top of the hand with a steak knife.

Some college-aged moron was playing the “knife game” while drunk.

I have seen the future, and we are doomed.

Nevertheless, he actually bled a good amount. One of his roommates was kind enough to bandage everything up before the fire department got there, and he did a darned good job of it, too. Like, 4×4 dressing and kling wrapped, and tied in a knot.

The bleeding is controlled, and not a single spot show through the bandage.

I think the roommate said something about being a boy scout, but he was slurring his words pretty hard. Regardless, I’m not one to remove a bandage just to look at a wound, when the bleeding is already controlled.

Laziness, maybe. Maybe not.

He wants to go to the hospital across the county to be near his mommy. If I were drunk and stabbed myself while playing the knife game on a dare, the last place I would want to be is near my mother. It’s a low-priority call, so Slimm jumps in the back and I drive.

I catch about 20 minutes of a Rush Limbaugh rerun on the way.

At the hospital, after dropping him off, my Slimm is approached by the doctor on staff.

“Hey, did you guys even look at the cut on his hand?”

“No, not really. The bleeding was controlled by the time we got there, and the bandage was already on. We didn’t want to remove the bandage just to look at it.”

I’m hiding around the corner, but within earshot, working on my first cup of coffee.

“Well, you guys should have looked at it. It’s only like, two centimeters long and not very deep. It will probably only take one stitch, but we might be able to glue it.”

“Oh, so you guys can handle it? Or do we need to run him down to the trauma center?”

I choked on that sip of coffee.

Filed Under: Customer Service, Emergency, Hospital, Patients, Trauma

So I wrote a letter

January 27, 2013 by 22 Comments

Three things about me:

  1. I live in this city, and pay taxes in this city. Not just sales taxes, I am a homeowner here, so I get to actually use the “I pay your salary” line for city workers.
  2. I am an emergency worker, and I know how to use due regard.
  3. I know what I am supposed to do when approached by an emergency vehicle while I am driving my personal vehicle. I also know how not to be an ass when I am driving an emergency vehicle.

I imagine all of my EMS readers would fit in that above description.

What happened:

I was running an errand to pick up a toilet paper roll, a corkscrew, and some tinfoil, when I had to make a left-hand turn. I deftly activated my signaling device and gently moved into the center turn lane to await clearance in the oncoming traffic.

While I was waiting for a clearing to turn, I heard the firetruck. I looked in my rearview mirror, while keeping my hands expertly on the wheel at the nine- and three o’clock position. The fire truck was approaching from behind me in the left-hand travel lane.

The cars in the oncoming lane stopped. The fire truck moved into the center turn lane and stopped behind me.

And blared it’s horn.

I did what I thought should have been done. I heard the truck and I held my position. If I had been driving straight, I would have pulled as far to the right as possible, and stopped completely until the truck passed. The other cars did what they should have done: they stopped as well.

After several seconds, and realizing the fire truck was not going to do the easy thing, and simply go around me, I made my turn, swinging my car onto the right-hand shoulder of the road. I turned my head slightly to watch the crew drive by, wondering which station they were from, and if I knew anyone in the truck. As I did, the front seat passenger showed me something.

Both of his middle fingers.

I was taken aback. I didn’t know what to do.

So I wrote a letter. Several letters, actually.

To the Chief of the Fire Department, the mayor, each member of the city council, and two newspapers.

Filed Under: Customer Service, Emergency, Politics, Things that bother me

False competence

January 23, 2013 by 6 Comments

Double-ALS-night-shift-overtime. Half good, half bad. I don’t know why I agreed to work a night shift.

It’s going easy enough until around 3 in the morning. Diabetic call at the local premortuary sepsis factory decubitus plant nursing home. Easy enough, right? Throw some dextrose up in there and be done with it, right?

Wrong.

The staff says he must go to the hospital to be evaluated because the doctor says so. To complicate matters, we can’t get a line on this guy, who I swear, must have served in the first World War, and he has a long history of dementia, so who is to say what his normal mental status is, anyway?

Fine. No biggie. Stab him with a bit of Glucagon, move him to the stretcher, and drive him to the hospital. No big deal, right?

Wrong.

It’s my turn to drive. It’s going just fine. I’m listening to George Noory talk about aliens over the Pacific Northwest. It’s an easy drive over two lane roads dappled with houses. When all of a sudden…

“Hey, C, light it up, okay?”

“Dowhatnow?”

“Turn on the lights and sirens.”

“Huh?”

“Let’s go emergency!”

“Why?”

“His mental status isn’t improving.”

Taking a glance at my watch and doing some quick calculations, I realize ten minutes isn’t necessarily enough for Glucagon to work, and this guy has dementia anyway.

“Umm, you want me to get back there and ride this call?” I ask.

“No, I’ve got it. We should just get there faster.”

“I have faith in you. And the next three traffic lights won’t hold us up too much.”

—–

I’ll stop the story here, because the conversation became fraught with animosity. Suffice it to say, I don’t believe in traveling emergency to the hospital, except in extreme circumstances. I won’t judge someone who chooses to use the lights and sirens during some calls, but during a hypoglycemic episode, when there hasn’t been enough time to allow the drug to work, and the vitals are better than mine? No way does that warrant lights and sirens.

Especially not at three in the morning.

Let’s not trick ourselves into thinking we are heroes by running people off the road to get to the hospital.

Maybe services could review the calls in which the medic decided to utilize lights and sirens during transport. I bet there is some interesting information out there.

Filed Under: Case studies, Co-workers, Emergency, Lame, Partners, Patients, Things that bother me

The Paraplegic Mathematician

January 14, 2013 by 4 Comments

Accident with possible injuries where a 6-lane road meets another 6-lane road. During rush hour. In the rain. Fantastic.

Minor damage to the car, with no airbag deployment. “You guys have one patient right there in that car. My guy is holding c-spine in the back seat” says the officer on the engine.

“Hi, sir. How are you? Are you hurting anywhere?” I ask the driver of the vehicle.

“I’m paralyzed from the chest down and my fingers aren’t getting any blood flow and my neck really hurts” replies the alleged patient, quite calmly, and while gesticulating wildly with his hands.

A quick look into the face of the fireman in the back seat, and seeing the eye roll confirms my suspicions.

“Okay, sir, you just hang tight for a second, and we will get you out of this car.”

“Oh, I can get out” he replies, as he picks up his paraplegic legs and begins to get out of the car.

“You don’t have to do that, sir” instructs the fireman. “We can get you out of the car. You just hold tight for a second.”

The patient complies and is extricated from the car. A quick survey reveals neuro function better than expected, with no deficits. Anywhere.

“On a scale of one to ten, ten being the worst pain ever, and zero being no pain at all, how bad is your neck hurting you, sir?” I ask once we are in the ambulance.

“A million.”

“Okay. I’ll mark down ‘ten,’ how does that sound?”

“NO! I said it hurts a MILLION!”

“Sir, I really don’t have room in this little box for that many zeroes. I’m just going to have to write ‘ten,’ okay?”

“Make sure the hospital knows it hurts a million!”

 

Nurses never believe me when I give these reports.

 

Filed Under: Emergency, Lame, Patients

Nice talk, bro.

December 28, 2012 by 12 Comments

Working with a new guy again. Slimm took the day off for his monthly mani/pedi can haircut. Call is for a late 50s man who dropped dead in a crowded restaurant. Fire reports asystole when they arrived, about 5 minutes after the 911 call. Bystander CPR was performed and the AED advised “no shock.” Patient is loaded and we are now enroute to the hospital, about 12 minutes away, when NG throws me against the wall with a violent turn out of the parking lot, and activates the siren.

CCC: Hey, you can turn off the lights and sirens. Just give us a nice, smooth ride to the hospital, okay?

Newguy: But this is a cardiac arrest, we have to go emergency!

CCC: No, we don’t ‘have to’ go emergency. Turn off the lights and siren, and give us a smooth ride to the hospital. We have everything under control back here.

Newguy: Uh, okay. If you say so. [keying up the radio] ‘Show us downgrading per the paramedic.’

Dispatch: Teenfoe, Medic Ateen

CCC: Thanks, buddy!

And later on, at the hospital, after the requisite patient transfer and pronouncement of death…

Newguy: So why did you make me turn off the lights and siren? Aren’t we supposed to go emergency to the hospital with cardiac arrest?

CCC: I didn’t make you turn off the lights and siren. I asked you to turn them off. And no, we aren’t supposed to go to the hospital in any certain fashion. We are supposed to get there safely.

NG: But why didn’t you want the lights on? Wasn’t that an emergency?

C: No, it wasn’t. Everything was completely under control.

NG: But the guy wasn’t breathing!

C: You are right. He wasn’t breathing. But he had a secured airway thanks to the fire department, he was receiving ventilations from the BVM, and he was getting fantastic chest compressions as shown by our capnography.

NG: I think we should have gone emergency. My regular partner goes emergency all the time.

C: Well, I’m not your regular partner, and I respectfully disagree.

NG: So do you ever go emergency to the hospital?

C: Rarely, but occasionally. When there is an unstable airway, or a complicated labor with an abnormal presentation, or when surgery would be needed really quick.

NG: Didn’t that patient need surgery?

C: Surgeons don’t operate on patients who are in asystole and are receiving chest compressions. Plus, we don’t know why he dropped dead. It could have been a PE, an MI, a stroke, or any other thing, and how would the hospital know which surgeon to call?

NG: I guess that makes sense.

C: The last thing we need in a cardiac arrest is to be thrown around by a fast-moving ambulance, or to have a difficult time focusing. Lights and sirens make things more stressful.

NG: But don’t the lights and sirens save time and get us there quicker?

C: I would rather perform better CPR and be able to focus on my patient, and know that everyone is going to get to the hospital safely than get there two minutes faster.

NG: So it’s not like, a rule that we have to drive emergency?

C: Not as far as I know. But your partner can do whatever she wants to.

NG: You ready to go in service?

C: Yeah. Let’s go get us a Coke or something.

 

Filed Under: Case studies, Co-workers, Education, Emergency, EMS 2.0

Toe to toe

August 11, 2012 by 18 Comments

“Local Hosspital, this is Medic 7, local hospital, come in please.”

“Medic seven, go ahead.”

“Local Hospital, I have an ETA of approximately 10 minutes. This is a 56 year old female STEMI alert. He chief complaint is general malaise for several days. We have 4 millimeters of elevation in V1, 5 millimeters in V2, and 3 millimeters in V3. The rhythm is a sinus, at a rate of 65, without ectopy. Her blood pressure is normotensive, she has had her aspirin, and is receiving nitro every 4 minutes. I am transmitting her 12-lead now. We will see you in 10.”

“Medic seven, we’ll see you in 10. Local Hospital clear.”

This whole activating the cath lab from the field sounds great and all, but it doesn’t work when you have a doctor who thinks your job is to deliver his paycheck.

Neither myself, or my paramedic partner-of-the-day expected to find a STEMI on this lady, but we did. An anteroseptal one at that. So we did what paramedics do: we treated the patient.

We gave her aspirin, and we administered nitroglycerin. We performed serial 12-leads. Every 4 minutes, about 2 minutes after each nitro, I pressed the ’12-Lead’ button on our Lifepak 15. And I set up the automatic transmit option, so that Local Hospital received each 12-lead about 30 seconds after I did.

And what do you know. Her ST-segment returned to baseline. And what else do you know? Hotshot new doctor wouldn’t activate the cath lab. Because the last 12-lead showed no elevation.

Well, duh. I put a chemical band-aid on her, but now she might need some PCI.

“She doesn’t have any ST elevation now, so let’s put her in room 9.”

“She did have elevation, but you are right, she doesn’t have any now.”

“It’s not a STEMI.”

“It was a STEMI.”

“I’m the doctor, I know what I’m doing.”

“Then you should know what I was doing in the ambulance.”

“You were giving nitroglycerin to a patient without chest pain.”

“Nitroglycerin causes vasodilation, and reduces myocardial oxygen demand, which can help return an ST segment to the baseline, just like it did on her ECG. Y’all do PCI in the ER now?”

“She doesn’t need a cath.”

“She needs a cardiologist.”

“I will make that call.”

I never did find out what happened with that patient. I hope the hotshot doctor called cardiology. I won’t pretend to be a doctor, but I can prove the lady was having a STEMI.

She’s hotshot’s patient now.

 

Filed Under: Case studies, Emergency, Hospital, Patients

Not really hurt.

April 9, 2012 by 2 Comments

A call for an accident with injuries in a gated neighborhood.

Yeah, right. Like that ever happens. Well, it did that one time, but that’s another story.

Enroute, things become a little more clear: “21/F IN MVC EARLIER/BACK PAIN/REQUESTS CHECK/” the MDT tells us while we are on the way. Slimm and I make eye contact, and reflexively turn off the lights and siren.

This call is going to be stupid.

Humongous house. Million dollars plus. A lawn manicured with a very small pair of scissors wielded by midgets with monocles. More than three German luxury automobiles in the driveway. All black. All big.

A butler (no shit, even wearing a uniform) directs us to the elevator (no kidding), and to the “lady’s wing.”

Some cute chick laying on a bed big enough for 8 with enough pillows to smother several gaggles of geese.

“My back, like, it like, totally hurts and stuff.”

Interesting. Once again, something I already knew. “What happened to your back?”

“Well, I was like, driving, and like, I totally got hit by another car, and I was all like spinning in circles and stuff, and I didn’t want to go to the hospital, because, you know, I felt okay at the time, but like, after I came home, my back started to hurt and stuff, and now I like, can’t move, you know?”

Blank stare.

“How long ago was the wreck?”

“I dunno, it was like lunchtime.”

A quick glance at my watch informs me that lunchtime was approximately 5 hours ago.

As I turn around to lower the stretcher, because this obviously traumatically injured female is not capable of ambulating, I notice it:

A large television on the wall, across from her bed.

It is paused.

On a commercial.

For a local ambulance-chasing lawyer. His number prominently displayed on the bottom.

“Make your WRECK into a CHECK!” “Call NOW! 1-800-SUE-THEM!”

I wonder if we were her first, or second call?

Filed Under: Emergency, Lame, Patients, Stupid
«Older Posts