Just a night with the stars

The poker game started late, but then again, at least it started. It had been a while since we’d all sat down together at the firehouse to play. The weather had just broken and the nights were finally cool and dry enough to keep some doors open. That was why we heard the sirens racing past the firehouse as we played. “We’ll hear about that one soon” someone said and folded. Every one chuckled, and turned back to the issue at hand. Not long thereafter the tones could be heard from upstairs through the cinderblock walls. “Medic” says a firefighter as the Plextron in the hall begins to sound. “You too” I say standing and heading for the door.

“Box 1201 for an injury from an assault – Stabbing …L’etoile – advise you stage” says the lady in the ceiling. “L’ETOILE” we all cheer down the halls. L’etoile (not the real name of course) is this little hole in the wall place not far from the firehouse. We know it well. The place is populated most weekend, and many weekend days by a clientele that often provides us with assaults, and pedestrian struck calls. The latter from drunk patrons trying to walk home, at night, across a major road that runs in front of the place.

As we pull out of the station, the callback information tells us that there are reports of a stabbing, the assailant’s location is unknown. I’m in the back of the unit tonight, letting Jen get some time upfront, working the radio and reading the maps as part of her training. “All company 12 units report to the pre-arranged, L’etoile staging area” I hear Matt, our fire capt say over the radio. I smile to myself, this crew is fun, and experienced enough to keep the concern under control. The ‘staging area’ is the McDonald’s parking lot basically across the street from the location. Now, that is a bit close for most calls that need staging perhaps, but the defensive screen of 4 lanes of traffic seems to be impenetrable by L’etoile patrons..hence all the ped struck calls. We only sit there for a moment when more radio traffic breaks out. There is a new call, for an unconscious pt, possibly our stabbing victim at a house a couple streets down from us. Following protocol, dispatch starts a full complement for that call (Another engine, a medic and a basic). So now the scene is on the move, and so are the patients…great, one of those nights.

I feel the unit starting to move, and look out front to see that we are following the engine towards the new location. The brush unit, who had been on the road returning from a previous call, marks up on the scene of the Unc. Moments later, they tell us PD is on the scene there, to continue my unit and engine to him, let the additional units from further out handle anything that comes out of L’etoile. Smart move, and away we go. A moment later, he calls for a helicopter. The firefighter there has quite a bit of medical experience, though he hides it, and I know this can’t be good.

Arriving on the scene, I see 4-6 cops in a loose semi-circle looking inward at a late 20’s, early 30’s male who is face-down, shirtless, unconscious and covered in blood from his head to his shoulders. The firefighter who made the radio call is with the pt. As I approach, he tells me that he IS breathing, good pulse, and unc since the firefighter has been there. He wants me to see a laceration about 1-2” long on the back/center area of the patient’s head before we roll him over. I give the pt a quick check to make sure there is no other trauma to his back and legs, and with the help of a third person to hold his head, we roll him over. This wakes the patient up, and he starts yelling. This is mixed news, he conscious which is good, but is trying to move, which can be a problem. He has blood on his chest, but it looks like it came from above, and there is nothing obviously wrong below his chest. At first he’s not making sense, but then starts yelling for his mom, and pointing at the door. It seems he may live here. The blood is considerable, and I spend some time trying to find the source. It takes a bit, but I convince myself that all of the blood is from the one laceration. All that time up close and personal with this guy tells me one thing for sure – He is AOB. That’s Alcohol On Breath, a nice euphemism for drunk off his butt. (See also ETOH positive).

About now, I have all sorts of help. My crew and the engine guys are here with the backboard and collar, and he gets secured quickly while he is still ‘loopy’. As we are starting to move to the unit, Mom comes out by the front gate and starts asking what is going on. She’s a bit panicked, as mom’s tend to be, and I’m still a bit worried about this head injury. I have to figure out if it is bad, and fast…the helo is on the way. I stop by mom and tell her that the guys will fill her in, but that right now I NEED to know if her son is on any medications, or is allergic to anything. She says no, and I leave her with the fireguys for more information.

In the back of the unit, the patient is being more combative. I try to introduce myself, explain that we are here to help, and try to calm him down. He’s not listening, and is insisting on seeing mom, and his girlfriend. We get the ECG on, somehow a B/P and I get set for a line. I’m about to tell him the benefits of holding still while I start the IV, when he “gorks”. He’s mid yell about something when he stops and goes out cold. Not one to look the gift horse in the mouth, I hit that IV immediately, while he’s down. There is nothing by way of reaction to the poke, or any attempts to rouse him. I get the line taped, and the crew gets some oxygen on him. He’s breathing ok, so that is a plus.

The next 10 minutes or so go something like this. Patient wakes up. Patient yells, insists that he wants his mom, strains against the straps, spits, yells more and goes unconscious, Repeat. All the while, we try to maintain our lines from coming out while he writhes, and try talking him down. His pupils are equal, that is good, but one is slower than the other, that’s not. The helo was a good call, his combativeness, unconscious spells and the pupil all say head injury. I hear the radio saying the medivac is close, and I get on the radio to advise them to bring the RSI kit. I tell them what is going on, and that they are going to want to knock this guy out good for the flight.

The nurse and medic from the helo come on, and we are engaged with the combative patient. We give them report, vitals okay, ecg ok, and bad signs for head injury was the jist. The patient grabs my arm, pulls me over and is insisting that I call someone. I say Ok, and give me the number. I get the area code, and then nothing….I hear the flight medic say, “He’s not gonna finish that.” I turn to see him finishing his med push into the IV, and our guy is out. Finally. It’s hard to explain how disruptive and draining it is to ‘fight’ a head injured patient. Clearly you can’t really “fight” but you cant let them cut loose either. Dancing that line is tough, and I was glad to see him out. We get him intubated, breath for him and off he goes in the helo. Just another night from l’etoile.
Someone later told me the wound was from an ASP. I sure hope not, if it was I’m sure we’ll hear more about it later…..