SCENE SECURITY? WE DON’T NEED NO STINKING SCENE SECURITY!

Well, it has been a busy time of year here, and I have not kept up my end of things on the blog.  Fittingly, DTXMatt, the Fire Captain on my crew is once again picking up my slack.  While he was kind, and said we were off on important business, we were in fact watching the local football team beat up on the division leaders, and all but secure a playoff berth.  Back at the home front, Matt was saving lives, and he ran the call, he can tell the story.  I’ll post my own as soon as I dig out from some year-end duties.  

Let me begin by saying that it is my pleasure to be the first “Guest Contributor” on this blog. Our crew was on duty on Christmas Eve last week, but MedicChris and MedicCat were detained elsewhere on important business. Pity. We had a call where we really could have used them. If you have read this blog at all, you will see many interesting parallels between this call, the one recounted in “A Bird on the table…”, and a few others. This call was interesting because of patient care issues, but was more interesting because of the incomplete or decaying scene security issues that we saw.

The poker game started late, but then again, at least it started. (See the parallels?) In the absence of Chris and Cat, Wayne was driving for me on the engine. In the back I had a rookie (total unknown quantity), Ernie (solid fireman, solid crew member), “Rookie” Dan (who is not so much the rookie anymore- we just call him Rookie Dan to distinguish him from another guy named Dan), and “other” Matt (firefighter, a graduate of our junior department, not called “Mini-Matt” because that name was taken). I hit a high straight on fourth street, second to act, and was getting ready to move a great number of chips when our temporary accommodations (you know, our trailer) erupted with the sound of alerting devices. The dispatch was for an “unknown situation” on “Mare- a – silly” street. Fortunately for everyone, I speak dispatch. The street was Marseille (pronounced Mar-SAY), but butchered by the same school of phonetic dispatch-speak that has previously given us treats like “oh-ACK Street” for the little lane marked “Oak St.”

As you might guess, an “unknown situation” can be anything. On Christmas Eve, it could really be anything. As I walked from the trailer to our gutted firehouse to get on the engine, I was thinking about melted Santa Claus lawn ornaments or malfunctioning inflatable snow globes, but then my pager started to buzz, and the information was for a child at a neighbor’s house screaming about blood or something, and a subsequent 911 hang-up at the actual address. Shit.

We loaded up on the pumper and I marked up on the radio. We were immediately advised that the call would be for a stabbing and that we should stage pending the arrival of the police. I think to myself, “No shit”. I acknowledge on the radio in a tone of voice that conveys “No shit”.

The location of this call is very interesting. It is about 700’ from the location of the shooting in “A Bird on the Table”. That shooting was in the toughest and worst neighborhood in our area; so tough, in fact, that until about three years ago, the police were having trouble safely going in there. When one travels the 700’ between these homes, one travels about a million socio-economic miles. The home in this call is across some railroad tracks (literally- the “right” side of the tracks) and is tucked into a little enclave of about 20 McMansions (beautiful, luxurious, and tricked-out 4000-6000 sq. ft. homes on .15 acres each) which either front or have a view of our local river. The homes are easily worth a million bucks a pop, and I have forever thought that it was hilarious that the residents there have to drive through an industrial park and a ghetto to get to and from their houses. Funny thing, though, nothing ever happens back there. I haven’t been into this neighborhood on a call since a hurricane came through two or three years ago.

As we turned onto the main street leading to the call, we were passed by some number of police cars, running code, running FAST. You know, that late-at-night, no traffic, real-deal call sort of fast. Again, not good. We staged on the far side of the railroad tracks with the thought in mind that we didn’t want to get caught waiting for a train to pass if the police called us in. We had a basic unit and a medic unit coming in from different neighboring stations, but they didn’t arrive in time to stage, as the police called for us to come in to the scene within a minute of our arrival.

The house was easy to identify. It was the one with all of the cop cars parked in a halo around it with the front door open. Bad news. We pulled up as close as we could. I directed the men to bring our EMS equipment up and I walked up to the door. Through the open door, I saw more bad news. Blood dripping off of a kitchen island and smeared down the side of the cabinets. The soles of some dude’s shoes, toes up. A woman frantically mopping blood from the floor next to the dude. Cops looking upset. Once I got into the house and crossed the foyer, I saw what all the fuss was about.

In the middle of a Christmas party of about thirty people, I was presented with a late-20’s to early 30’s Hispanic male, shirtless, barely responsive, lying in a large pool of blood, with a wound in his chest (6cm) under his left arm (5th or 6th intercostal space I’d say). The wound wasn’t bleeding, but clearly had been. It was a nasty cut, and someone there said that he had been run through with a kitchen knife. The wound was consistent with the story. My first thought was “That’s a great way to get stabbed in the heart”.  I called for a helicopter by radio, told Wayne where I wanted the LZ, and he set about conveying the LZ coordinates. The guys took up patient care, and as they were getting set to apply O2, I told them to slap an occlusive dressing on the stab wound. Now, if I were hands-on with this patient, I would have used the wrapper from the O2 mask to make the dressing, but that’s just me. Timing and heat of battle being what they were, the piece of plastic that got used for this task was the plastic wrapper from a pack of soft tortillas. Whatever. Any port in a storm, I suppose. Ernie did the actual dressing, and did a fantastic job. Despite the fact that the patient was utterly covered with blood (like, his torso was reddened by drying blood, his hair was slicked back, etc.) Ernie got the tape to stick, and for the moment, I called that issue “managed”. I was relieved to have the immediate work dealt with in advance of the arrival of EMS units. My relief was to be short lived.

As my guys set about further evaluating the patient, there was a loud crash, a shaking of the house, and a bunch of yelling and boot-stomping from upstairs. As it turned out, our “secure” scene was somewhat less than secure. This house was big enough that the cops felt safe letting us into the kitchen to work on this guy, but didn’t tell us that the assailant was not accounted for and, oh yeah, was thought to be either upstairs or in the garage. A voice from upstairs- “Hey, we need help up here! There is someone else cut!” I leave my crew to check this out. There is a cop at the top of the open foyer, giving the “round third” sign at an upstairs bathroom. Other cops were kicking in closed bedroom doors and performing “tactical” entries and searches. All of this would have been really cool, except that those were real guns that they were using and there was a really dangerous somebody not accounted for.

Our second patient of the evening was sitting on the edge of a tub in the upstairs bathroom. Also shirtless, he had an obvious slice to his left bicep area, and was holding an abdominal wound that didn’t appear to be a full-on puncture of his gut. He was conscious and alert, had good color, and was complaining about how the party had been ruined. There had been some blood loss, but not enough to cause me any huge concern. I took a closer look at his abdomen, and categorized him as BLS in my mind. Assured that he was going to live for a few minutes, I turned my attention back to scene security. It seemed to be better in hand by this point.

I returned to the foyer and as I was coming downstairs, I met the Ambulance and Medic crews. I put the medic unit on the guy stabbed in the chest and guided the BLS unit to the guy in the upstairs bathroom. By now, the police were starting to question all of the bystanders. Many of these people were getting in the way. Some of the people were seated in the dining room eyeing a big tray of chicken. Most of the people were upset, and it was generally a weird vibe. The basic unit asked for one of the medics to come upstairs, as they disagreed with my assessment. I thought to myself, “That’s cool, they got a better look than I did”. One of the providers from the medic unit went upstairs to look at the second patient.

Back to the kitchen, where I watched the assembled fire/EMS people put the first guy onto a backboard and hustle him outside. Most of my guys went out with them, including Wayne, who was by then directly helping out with patient care. The rookie and I were by the front door. THUD!

Patient number three was a 18-24 year-old female who decided that she had seen enough and fell out right there on the dining room floor. The thud had been her head hitting the floor. This same girl had previously been running around trying to tell people what happened, checking on things, and generally making a pain of herself. The police asked someone to come back and take a look at her, and I realized that with the exception of the rookie, I was the only person not hands-on with someone, so I went to take a look. She was lying on the floor with her eyes closed, breathing, and looking upset. My EMT-B initial impression was “bullshit”. She didn’t respond to verbal inquiry, so I did a sternal rub on her, and miracle of miracles, she came around. I left the rookie with her, and left to go outside to find someone else to take care of her. On my way out, the basic unit lead told me that the new plan was to fly patient two. Great. I called for a second helicopter by radio. As I am standing there, one of the older men in the house pulled me aside and told me that patient three had some cardiac history, and had passed out like this before. Great. I called for a second medic unit. Patient two was on his way down from upstairs in a stair chair. The medic caring for him is a top-notch provider, and I stopped thinking about him.

I went outside and found the bulk of my engine crew aboard the medic unit. They were busy assisting the ALS provider with holding things and starting lines, etc. I remember someone saying that the guy’s blood pressure was bad news/lousy, and it was decided that Wayne would go in the back and that Ernie would drive the medic to the now-established LZ. I grabbed Rookie Dan and other Matt to help me inside.

Patient number four was a lady who had been in the study of the house quietly using the internet for most of our visit. She is brought to us by a police officer who noticed her injury as she was being questioned. She had a full-thickness 8-10cm cut on her anterior/medial forearm. It looked horrible, but was not bleeding so badly. Matt started to help her, and Dan and I went off to find the rookie. Turns out that patient three’s recovery had been so dramatic and was so complete that some police officers took her out into the street to try to find the still-not-in-custody assailant. We got back to other Matt and helped him conclusively bind up pt. 4’s arm. Next, I handed off patient 4 to the now-arrived second medic unit, who needed some explanation of how their potentially ALS patient turned into a cut arm. As they worked, this medic unit took a look at the moderately-controlled chaos around them, and sort of understood.

At this point, it was like being at a multiple vehicle accident. I started feeling like the longer we stayed on-scene, the more patients we would develop. Once that second medic unit had patient 4, I gathered my guys, gathered the big pile of EMS gear from the kitchen, and got out of the house. We loaded this ton of crap into the pumper and I drove to the LZ, where we arrived in time to see the second helicopter take off. The EMS folk were high-fiving and quite excited about a job well-done. I was happy with the patient care too, but I was livid with the way the police handled the scene. All things considered, the call went very well. Some elements of chaos and disorder cannot be predicted or controlled. The cautionary note to all public safety providers is to never take your scene safety or security for granted, even if there are 20 police officers with you.

As I write this on December 29, 2005, I have seen that the local paper finally saw fit to do a story about this call. They said that three patients were transported with “non-life threatening injuries”. That can’t be right, but I will take the fact that patient number 1 apparently didn’t die as a good sign.

By the way, Rookie Dan nearly felted me when he hit his flush on fifth street. I didn’t even see that coming. I wasn’t really paying attention to the game. I look forward to everyone’s comments. I will reply in due course. Be safe, everyone!

DTXMATT12

1000 visits

Okay, so in the annals of internet history 1000 visits is hardly a ripple in the ocean.  But, for some guy basically telling stories around a bay table, 1000 visits is impressive, and flattering.  Last night, as of the Clustermaps update, we crossed the 1000 visit mark.  There are between 10-20 on days when I haven’t posted in a while, and posting days drives the number up to something like double that.  According to that map, we have had visitors from all but one continent, and we seem to have a regular and diverse viewership from not only the US, but England, and other parts of Europe as well.  There is also a bit of a group forming in southeast Asia and Australia and New Zealand too.  That’s quite a big table to tell a story at, and when I tossed up my first entries, I really never thought anyone would be interested other than some folks at the station and my mom.  

Thanks for stopping in, and thanks for the comments.  The conversation with Hank, on here, about the legal aspects of EMS in the states lead to some interesting conversations on the topic back at the firehouse too.  Sharing a laugh with CD, or empathizing with Andy about pedi-codes has really shown us that brotherhood among fire and rescue personnel is universal.  No matter where you go in the world, there are people who feel like you do, and see what you see.  Nice to know. Stacey, Fox2, and Soldier’s wife, thanks for the encouraging words, you make it fun to share.  Soldier’s wife, not all the calls you run will be notable, a topic I intend to cover here too.  When I was doing ride-alongs to see what this EMS thing was like, I was lied too. Grin, not really lied to, but we ran a series of truly cool calls, and I thought every night was like that.  Only after getting involved did I learn that there are weeks and weeks of Flu calls, small auto accidents, and tummy aches.  You’ve been warned.  And of course, as you all must know, to DTXMATT12, the fire captain in the stories, Jen the newest member of the crew (Can’t say rookie anymore, she has a pretty blue helmet now), Jon my mentor in the department and closest of friends, and S. a long time friend in the department and out, your comments here and at the station always make me laugh. Thanks for the support and the ideas.  Just as important, but behind the scenes as far as the blog goes, thanks go out to the people in my department, and in the area I run in general who keep nudging me forward, and your kind words.  I’m starting to get comments every night I run, or at the hospital etc.  Still surprises me that people come to listen and share.

Anyway, enough love-in for now.  Thanks for stopping in, and sharing, or just reading.  You are all much cheaper than therapy, and much better than any support group I’ve heard of.  Here’s to 1000 visits, and I’ll try to make it worth many more.

Sometimes its all give and take

So, it’s been a week since my last posting, and it has been busy at that.  I’ll have to post on the goings on around the firehouse/trailer park soon, and give more of a picture of the family environment that really makes the firehouse a special place to be.  But for tonight, there is a call that I have been reminded of recently…and no, it’s not an open homicide investigation.

EMS is often as much about relating to people as it is relating to their issue, and with that comes knowing how to relate to everyone at their own level.  On most calls, that means remembering to translate what you are saying to your crew from medical to English, or making sure you let the patient know everything you are going to do before you do it.  Often, it’s just holding a hand, and letting them know you are there.  Sometimes it’s cutting through the crap, and getting their attention.  I’ll tell you a hand-holding story another time.  

It was a Saturday morning, something like 9 or 10 am.  We’d had a quick breakfast and were just getting into the day.  The full crew was there and we were looking forward to a fun day around the firehouse.  The call came out as a Chest Pains call, the address was for a townhouse development not far from the station at all.  We get sent with the engine in tow.  Chest Pains and Difficulty Breathing calls are the bread and butter of our call volume, and can range from truly routine, to true emergency calls.  So, we head down the road, grateful for the morning coffee, not really knowing how bad things are, or are not.

We come to a stop at the middle townhome, grab the bags and the LifePak and head for the door.  The door is cracked open, so I stick my head in first.  “Rescue!” “Yeah, in here” is the response, kinda gruff sounding, but if it’s the patient, then he’s breathing okay.  Opening up and walking in, I see the home of a man who clearly lives alone.  To say it was missing a woman’s touch would be an understatement.  I notice mail and papers piled on the stairs, the kitchen counters and floors.  Books and old take out are on the carpets and tables.  In retrospect, I’m surprised I noticed that first, because the patient was standing at the end of the first floor hall, in the back.  He’s standing there, left hand clutching his chest, right at his sternum – the classic no-kidding heart attack stand.  He’s kinda pale, a little sweaty, and fully possessed of that “I’m sick” look that you learn to recognize from across a room as an EMT or Medic.  In his right hand, is a cigarette, that goes right to his mouth as I work my way into the house.  I immediately think to myself that the “Those things will kill you” argument is right out the window at this point, dude is smoking through a possible MI.  That’s world class resistance to education.

My gut is telling me that he could be bad, like right here, right now bad, and I note that there is no room on the floor anywhere for us to work if he goes down.  “You gotta put that out sir.”  He gives me the usual slight resistance, and I explain to him that I’m bringing him oxygen for his pain, and that fire and oxygen do bad things in a house.  To his credit, that works, and still standing he stubs it out.  Wayne was coming with the cot to the door behind me, and I’m thinking we should get to it.  It’s not recommended, nor is it my practice to walk a possible cardiac patient to the door, but he did make it to the hall on his own, and if he goes down, we are going to have to drag his butt all the way through the house before we can do anything because of the clutter.  “Why don’t we get you to the cot here…”  He says something about shoes, and before I can promise to get them for him, he has turned and gone back into the back room.  Doh.  Entering the back room I see posters for imagery, and a haphazard work area setup in the middle of the room.  He’s got computers on a folding table right in the middle, and all of the rubbish seems to surround this area.  Clearly, this is his realm.  And kinda suddenly, I can place him.  “You an Imagery analyst?” I ask.  “Yeah, Was.  And a DAMN good one too.”  More bluster.  He sits on a chair to get his shoes, and my heart sinks.  Doh, here we go.  Change of plans, assess quick here, and probably end up doing the carry…somehow.  But, at least I know who I’m dealing with.  He’s not going to be mean, but he’s gonna bluster, and harrumph and be crabby like an old sailor.  I know many old analysts and this is a personality type.  As he does battle with his shoes, I try to get a bit of a history.  Yes, he woke up in pain, yes he has a cardiac history.  In fact, he was seen just about 10 days ago for a procedure.  (I don’t remember now the exact one, but it was cardiac.  Maybe a stint, but don’t quote me.)  As we talk about medications and allergies, I get a chance to look around a bit more.  I catch a look from Matt and turn to see the morning eye-opener next to the sofa which clearly served as the bed last night.  Next to the cup, is the rest of the bottle.  I believe Mr. Daniels was spending time with our patient this morning.  Apparently, the smell was the first clue for the rest of the crew, but I was a bit stuffy, and didn’t pick up on it.  I start to explain to the patient the things we will be doing for him, and expressing the need to get the process started.  He responds by telling me he knows what he should and should not do, and he has a couple things to get done before we can go.  Now, what we have here….  So, I’m thinking to myself that perhaps he’s actually concerned, but is acting the hard case with me out of habit or fear.  Knowing that different people are reached in different ways I make an attempt to achieve a common understanding.  “You know, we can do this any way you want. But I gotta tell you, there is almost no chance that I’M going to die this morning.”  The thump I heard behind me was Jen’s jaw hitting the floor.  I glanced over and saw her staring wide-eyed at me.  I guess they don’t teach THAT one in EMT class.  Cat was unphased, and setting about vitals and getting moving, can’t tell she’s been there and done that.  I look the patient in the eye as I say it, and after a quick flash, I see it.  We have achieved Quan (to borrow from Jerry McGuire).  We have connected, and a slight upturn in the corner of his mouth lets me know that there will be no more resistance or bluster this morning.  We got the vitals done quick and get things moving.  He seems to be stable right now, but still looks pretty not good, and the engine crew is in sync with that.  We get him to the cot, and as we are loading to the unit, Matt asks me if we want him to hang out a bit.  I’m all for that.  Normally, the patient entering the unit is the cue for us to release them, and there is not too much that we can’t run with just our crew.  But, I know that Cat had just recently run a heart attack turned sudden cardiac death and I’m really not sure that is not what we are seeing here.  Matt’s been around a while, and even ran EMS in the days of Johnny and Roy, and he’s thinking along the same lines.  At least we have room to work now.  We didn’t have the ideal in house situation, and I really would have had a little more information by now, but we do what we have to.  

Climbing aboard, things get going.  We get an ECG, and the 12-lead going.  The IV is already hung in my unit and I get started looking for access.  We ask about ED medications, and get the usual raised eyebrow.  I explain the mix of Nitro and those meds is bad and get a smile.  He’s good to go there he says.  The 12-lead does not show any elevations, and the rhythm was okay as I recall, though there was a bit more PVC activity than normal.  He had some inverted T-waves as well.  Okay, heart is unhappy, may be an MI, may not, but we are running an ACS protocol for him regardless.  (ACS is Acute Coronary Syndrome.  Basically, we are treating it as an MI even though the classic, diagnostic ST elevations are not seen right then.)  He’s on oxygen by mask, and I’m figuring that will do as much as anything else for what we are seeing.  But, based on the stable vitals and this reading I’m feeling a bit better about his condition and I stick my head out and wave on the engine.  The line goes in right away, and we give him Aspirin and his first Nitro as we get rolling.  He’s calmer now, and starting to look better too.  The pain is easing, and the PVCs are settling down.  All good.  I give report over the phone, and get the ER ready for our arrival.  As I turn to the patient to see how he’s doing, he tells me that he hears that we are part of the best volunteer department in the state, and he’s really glad that we were the ones that came.  I tell him, “Well thank you, I like to believe that reputation is just this crew.” And give him an ironic grin.  I can bluster too.  He gives me a full grin and, “That must be it.”  I know he’s a hard case, and will soon be back to arguing, drinking and smoking through chest pain, but for now he’s doing better, and that’s why we came.

I hear he was released the next day, but don’t know what the diagnosis was.  I’m sure I’ll be seeing him again though.  And I’ll be sure to let you all know.

Ripped him a new one

This year started off pretty active, from New Year’s Day on.  And I think that the higher level of interesting calls is entirely due to our rookie this year.  She was a full-on black cloud death magnet right out of the chute.  She rode as a ride along for New Year’s Eve, caught some calls and got bit by the bug.  The next week she was joining the department and signing up for classes.  She smart, and has a degree in Forensic Anthropology, like the chick in Bones on TV, but we saw enough codes and dead people in the first few months, I wasn’t sure we’d keep her.  To her credit, she learned to adapt, and how to cope pretty quick.  As I recall, this was the first call where I thought, “Well, there goes the rookie”.  I’m glad I was wrong.

It was early in the year, and middle of the night.  We get punched for a call just into our second due.  The call is for an unconscious outside a fast food joint, and not in the best part of the area.  The engine from that due was out first, along with my crew and our engine as well.  Unconscious calls get three pieces where we run, just for manpower, just in case.  That night we were all on duty, Cat and Jen in the back, Wayne driving and I was leading.  We didn’t even crack the map book for this one; we know this place pretty well.  The first due engine jumps on the radio as we respond and puts our engine in service, they have a full crew, and enough people to handle whatever comes.  This doesn’t concern me too much, that crew is one we run with all the time, and that station is in our department, so we are all friends and familiar with each other.  To be honest, the odds are we are dealing with someone passed out from drinking too much in this area, so we aren’t too fired up on the way.  

The engine gets there a bit ahead of us and radios back that the call is a hit-and-run, the patient is at least unconscious.  Well cool.  The engine officer adds that the patient is badly lacerated.  I don’t remember his exact words, but I do remember that whatever he said, it wasn’t up to the reality when I got there.  We pulled up about the same time as the police, and I was struck by the mannerisms of the firemen on scene.  They were doing all the right things, but had the look of a bad call.  I know they were glad to see our lights coming up the hill, and they were all looking over as we stopped.  I saw the patient laying on the ground in the entranceway to the fast food place, kinda curled up in a fetal position, with a bike half under him.  He had a huge gash from his backside up to his back.  

We hopped out and headed over.  As I approached I thought “Holy Shit, that’s GOTTA Hurt!!”  The patient was ripped open.  The rip appeared to start somewhere about his anus, and travel up his lower back.  Specifically, I think it went up to about mid-lumbar and stopped mid-way from his spine and his hip.  The wound was flayed open, and at the widest point I could have fit my fist into it without touching the sides.  (I feel I need to tell those who know me that NO, I didn’t actually try that.)  He wasn’t bleeding much, but had been previously, and there was a bit on the ground.  Bad sign.  I can see at 10 feet that we are well past a community hospital here, it’s trauma center or bust.  Time for the universal hand signals of medic sign language:  a finger point (“you”), a finger straight up (“one”), and the finger twirls in the air, like whoop-de-doo (“helicopter”).  I’ve started a clock on myself, I know that things are going to start moving, and I have a lot to do before the bird gets there.  I haven’t started yet, or even fully assessed things, but if this guy has any chance, the time counts.

As I’m kneeling to the patient, the fire Lt. is telling me, “I can’t find a pulse.” And he heads off to make the radio calls for the helicopter, and call my engine back to set up a landing zone at the strip mall at the bottom of the hill.  Well, boo.  That’ll change things.  One of life’s truisms: Dead people can’t fly.  In this case, it means that we don’t fly people in a code, there’s no room in the bird for the number of people it takes to do the job.  I see another firefighter checking, and I ask him.  “I don’t think so.”  I know that means “No”, but it is surprisingly hard to be definitive in making that statement when you don’t do it often.  Okay, either he’s dead or he ain’t.  If he isn’t then we gotta boogie to save his butt – pun intended.  If he IS, then we’re all over a serious crime scene (remember, hit and run) and we need to consider that in what we are doing.  Of course, I have to call in to have the ‘code’ called by a doc for him to be legally dead, and until then we are supposed to be trying to save him.  So we have us a bit of a situation both medical and legal.  Okay, I’m not feeling a pulse either, and I’m not seeing him breathing.  He’s still in the fetal position and a bit face down, but I’m not flipping him over just yet.  His airway is unobstructed so we can work with it.  “Cat, let’s get him on the monitor RIGHT NOW.  You” pointing to a firefighter, “get the BVM out of the oxygen bag and get that ready.”  Nice thing about our lifepacks, they are really good at identifying dead and not dead.  If we see any rhythm, we work with it, if not, well, that’s easy.  The patient’s clothes are being cut off to make sure we aren’t missing something else, and I pass on word to be careful what we do with them.  The monitor is on in a flash, and the three flat lines that appear on the screen are pretty unambiguous.  “Cancel the helicopter, I have to make a phone call.  Get ready with the backboard, but DON’T move him yet.”  I’m already hitting the speed dial on my cell phone to the doctor at the ER.

As the doc answers, I walk off a bit to get to a slightly more quiet area.  “Doc, it’s Medic 512, I got a mid-thirty’s Hispanic male, victim of a hit-and-run. Unknown how long ago.  He’s got a 10-inch or so open laceration ripped into his lower back, pulseless and apnec.  Unknown down time and asystolic in three leads.  I want to call this and leave the crime scene for the police.”  The doc repeats most of that back and confirms the unknown down time.  (I do have to give my respect to the doctors. Here they are in the ER, probably dealing with some case of the flu when the phone on their hip rings.  Immediately following “Hello Dr. Soandso” they get hit with that report, and a medic they can’t see asking them to declare a patient they can’t see dead, and needing the answer, Right Now.  Tough job description).  “Okay, call it.” He says.  “Thanks, doc” and I’m headed back to the patient giving the hand across the throat signal.  The helicopter was cancelled by the fire Lt.  and I see the engine cleaning up the LZ in the distance.  “Okay, this is a crime scene now, everyone back straight out.  Leave the clothes where they are and disconnect the monitor.  Do NOT cover the body.”  The police have been clear on that one lately.  Seems that EMS crews have been covering bodies, particularly in public, trying, honorably, to preserve the dignity of the patient, but also adding and removing trace samples and driving the forensics guys nuts.

“Oh, I’m going to court” I think to myself as I look over the body again.  The damage was impressive.  The bike had been moved over to the sidewalk to get it out if the way and I see that the seat is busted and missing.  I’m thinking the guy got hit, the seat busted and went up and through the guy.  Ouch.  I look for the officer in charge.  I tell him that we’ve called it, the guy is dead and I’m having my people back off to give him the scene.  “Anything else you need?” I ask.  He has me hang on for a bit until a more senior officer arrives, and tells me that they are going to need the names of my crew.  (Of course they are.)  “Ouch” I say to the officer as I look over at the body.  “No kidding” and a wry grin are his reply.  “Think the seat did that?” I wonder aloud.  “No, check this out…” He’s headed for the bike.  He shines his lights on the handlebar.  Ewww.  The first eight inches or so of one handle is covered in blood and…is it…yeah…fat.  To this day I’m not sure how that works, but I’m guessing the guy was rear ended from the way the back tire was pretzeled in an Auntie Annie meets Tim Burton way.  The front tire may have turned and folded and as the guy went over, he got caught on the handle.  Did I say ouch?  

The lead officer arrives and I give him our contact information and a quick run-down of what we did.  I explain that the body is in place, the clothes are cut off, but over there, and the bike was partially under the patient, but is moved to the side, and has not been touched since.  He nods, thanks us, and gets to work.  His night just got long.  

I go over to Jen and ask if she’s okay.  Not everyday you see someone newly dead, and traumatically so.  “Yeah”.  I can see in her face a look that want’s to say “Coooool”, but is not sure if that is the right way to feel.  She keeps looking back one more time too.  But she’s smiling, and a little bit pumped.  She’ll be fine.  Cat and I share a quick look – ain’t that some stuff?  And we mount back up on the unit.  Wayne is grinning at me, and you just know comments are coming.  “Well, I’ll never hear ‘ripped him a new one’ the same way again.” I say.  We have a laugh, and the stress starts to melt.  Yeah, we’re fine.  Time to make it official.  Over the radio:  “Medic 512 is ready.”

Not all our calls are traumas

Not all of our calls are traumas, or involve medivacs, of course.  And not all illnesses are physical either.  The week before Thanksgiving we caught a run to remind us of both.

The call came in the middle of the night, and in the middle of a marathon poker game as well.  (See a trend..)  As I recall, we were sent for an “unknown situation”.  The engine was with us again, and we were heading for an address in our first due.  This particular night, Jen has hopped onto the engine to allow an EMT preceptee who needs time on an ALS unit to get his calls with us.  Just this month, the county installed new Mobile Data Terminals (MDTs) in our units, which allow us to get dispatch information and updates, as well as message between units.  I was still getting familiar with the system, and as Wayne headed for the address, I took the chance to pull up the call and see what was up.  Cat was in the back shaking off the little bit of sleep she had managed to grab before the call.  At this point, none of us are particularly concerned or excited – unknown situation calls usually mean hang-ups or tentative calls and we tend to clear them rapidly, often without anyone actually needing care.  Sometimes they are domestic arguments and that can be dangerous, but there was no indication of unsafe conditions from dispatch…  But, thanks to the new MDT, I see that the call taker HAD put a note in that there was some yelling in the background, and a recommendation that EMS stage for PD.  We’re pretty close at this point, and I have Wayne grab some curb nearby to see what’s up.  “Company 12 units staging…” I tell communications, along with our location.  The engine catches the hint and pulls in behind us.  I’m reaching for my Nextel to raise Matt, when it starts to chirp.  He’s a bit faster on the draw than me.  “What do you know that we don’t?” he asks.  A little smile comes to my face and I think to myself that on other crews the question is “What are you doing?”, but not with this group.  I tell Matt what I see on the MDT and we hang out for just a minute.  “Medic 512, PD is en route, but we have further information that this is a chest pain call.”.  Okay, now we know what’s going on I think (wrongly) and we start into the scene.

Pulling up in front of the house, I see that the police car is arriving from the opposite direction at the same time.  Nice to see, doesn’t look like we’ll need him, but it’s always good to have the coverage, just in case.  The door to the house was open, and two people were standing in it.  One of them must be the patient, I think to myself, noting that they are both moving well, and neither one seemed in obvious distress from the curb, good signs so far.  When you get on a scene and there is one person in the door, that’s the “lookout”, usually a family member who has been assigned by the people inside to “wait for the ambulance”.  They are sometimes an indication of what’s in store.  When someone is bad, or at least when the people there think they are, you get the “Steal second” sign, that swinging hand calling you in.  I always let the folks in the back know when I’m getting that sign as we pull up.  When there is two at the door, one is the patient, usually the one hunched, or with the luggage.  (Wish I was kidding).  In this case, as I walk up to the house, there is a man and a woman, and I see that the man is going to be our patient, he’s walking out to meet me, and the woman, who is now labeled “wife” in my head, is behind, one hand on his back.  Greeting the patient, I note that he’s walking on his own, good even gait, not sweating, good color, closed posture, hands loosely clutched at his belly.  He looks from me to the unit, and glances towards the police car, and then down to the ground.  “The wife” is looking at me with a steady gaze…she’s got something to say.
Okay, we’re outside, it’s cold, something is up, and the patient is moving.  Let’s keep him moving to the unit.  Stopping is almost always bad, stopping becomes treatment on the lawn and carrying and just higher cluster potential.  I toss one arm around the patient and start guiding to the unit, while asking the usual things, “What’s going on tonight?”.  Cat or Matt must have picked up on the wife’s stare, and they hang back to talk to her.  The patient is able to answer clearly, but starts to lapse into a bit of a mumble, something about “My Heart hurts” with a couple, “I’m so sorry” and “I’m okay” tossed in there.  The guy is distraught a bit, but doesn’t have “that sick look.”  I gotta check out the chest pain angle, and make sure we don’t have a full-on MI going on, but already I’m thinking more like panic attack.  As we get into the unit, he does not want to sit back on the cot, but instead is sitting sideways with his feet on the floor to one side.  He is holding his head in his hands and is very closed in his posture.  I pull the doors shut, sit across from him and start trying to sort things out.  His position, elbows on knees, hands on his face, just to one side of me and facing my direction, and me, sitting across from him, leaning forward, talking softly and listening for answers that come back a bit hesitantly, pull my thoughts to a confessional, with him in the role of the penitent.  Instead of asking about his pain, medical history and allergies, I have the urge to ask him how long it has been since his last confession.  At the time, I almost discarded that as my own sarcasm, but then, I always trust my gut on calls, it was pretty much on target here too.

After asking a slow series of questions I only have a little bit of information.  I know his first name, that he feels very guilty, that his “heart hurts”, that he didn’t want it to come to all of this, he is not on any medications, he’s not allergic to anything, and he doesn’t want us taking his vitals or checking his heart just yet.  Consistently, when asked about his chest pain, he says it is his heart that is hurting.  Now, I’m sure someone, somewhere, when feeling cardiac chest pain, has described it that way, but I’ve never seen that.  It’s always “my Chest” or “here” and a finger or a fist to the chest to indicate where.  So I ask, “Is this emotional pain or physical pain?”.  This is an important, but delicate question:  I need to know the answer so I don’t fail to treat a physical pain, but then, I’m not a fan of blindly administering cardiac meds or vasodilators to people to cure a broken heart either. But again, if he is having an emotional or psychological issue, calling it such to his face can be a dicey move.  “Well, I guess it’s physical now” he says.  Great, worse answer.  Now I know it’s almost certainly a psychological issue, but he’s saying the magic cardiac words too.

About this time, Cat is joining us, and Matt opens up the back of the unit.  They are mouthing something to me behind the patient..”B-I-P-O-L-A-R”.  Great.  There is more to it I can tell from their looks, but they don’t want to say it in front of the patient.  Trying a classic move, I get Cat to try to allow us to get some vitals and run an ECG, while I hop out to get the rest of the story from Matt and the wife.  (The move being to get the pretty lady to talk the upset male into letting us do what we need.  Works almost every time).  

The ‘wife’ ( I later learn it’s actually girlfriend, but I don’t know that yet) tells me that the patient is bipolar, but won’t let the doctors officially make that diagnosis, or prescribe anything for it.  Not sure what the ‘won’t let them make diagnosis’ part means, but I know what “no prescription” means. Appears that he was seen in a psych consult just about a week ago, but left it before they got things handled.  Great.

I climb back to the unit, and see that Cat has gotten vitals, AND the ECG done.  (She’s very persuasive when she wants to be.  I know, I married her.)  He’s being monitored, and I see everything looks good.  No surprise.  Okay, I wave to the engine and they start to head for the unit to leave, and the Police officer does the same.  I’m not exactly clear what we were all doing shortly thereafter, but Ron (the preceptee), Cat, Wayne and I were all still in the back with the patient when he looks over at the monitor, sees the tracing and starts to panic.  “Oh no, there it is, oh my God, now it hurts, Oh  Oh…” he starts to say, rising to a yell quickly.  At the same time, he has hold of Cat’s knee and is squeezing.  “ow, Ow, OW, OW!” I hear, and in the tone that  I know is real pain from her.  Bang, bang, I pound on the back window quick and wave for the engine to come back in, and I’m hoping they’ll grab the Cop too.  I spin back, and Wayne and Ron already have the patient by the shoulders, and are pulling him off of Cat.  I dive in, and we quickly have him restrained, pinned to the back of the cot.  The engine crew arrives through both doors, just as the patient starts sobbing and saying “I’m sorry, I’m sorry, I’m okay, It’s okay.”.  Now, We have him held, and I don’t know how hurt Cat is, but I know that we either have to ease up quick, or know that if we keep him held, it is likely to escalate and we are going to keep holding until the Cop cuffs him.  Slowly we back off, and he stays cool.  I tell Matt that we are okay I think, and things settle down a bit.  Cat is saying she’s cool, that it was just a panic death grip, but that his fingers were digging in.  The patient is repeatedly doing the “sorry, sorry, sorry” when Matt tells me that the patient’s dad has arrived outside.  I hop out quick and ask dad if the patient tends to listen to him.  He assures me that he’s seen this before, and that yes, he can calm the patient.  Having seen the positive effect that a family member can sometimes bring, I have him climb in and talk to the patient.

Things settle down rapidly, and Matt tells me that they are going to follow us to the hospital…just in case.  I’m good with that, and glad for the help.  I know those guys are tired, but they are going to stay on this call longer to help cover our back.  You have to appreciate those things.  Wayne gets going, with the patient and dad sitting side by side, talking softly.  Cat is in front of them, keeping an eye on things and noting vitals.  Ron is standing behind the patient causally, but I know he’s keeping an eye on things, and protecting Cat.  I have a phone call to make.

I call in the report, and try to explain that while we were called for “Chest Pains” and there are some pains claimed by the patient, it truly appears that we are looking at a psych patient.  Now, I’m in the back of the unit with the patient, and history tells me that I cannot say things like “Psych” or “nuts” or “mental” etc out loud without risking an issue.  (No, I’ve never said “nuts” in a report, but you get the idea).  I do say that we had to restrain the patient briefly, but that things are calm, with dad’s help and that we are not going to perform any further interventions to avoid conflicts.  I did also get out that there was a diagnosis of bipolar disorder, and no meds taken, and that they would be well advised to get a consult ready.  The plan sounds good to the nurse and we are on the way.  The transport, fortunately, is uneventful.  On the way, I try to look over things again:  “Heart hurts”, “guilty”, “I’m sorry”, and a wife at the door.  He cheated on her, I think to myself, and he’s bipolar, and the guilt is causing an episode.  Interesting thought to me, but I figure it’s not my business, and let it be.

Arriving at the hospital, the patient is pretty adamant that he walks in, with dad.  I’m okay with that, and I’m not looking to get into a scuffle, so in we go.  I see a nurse waiting for us and waving us into one of the “big rooms” usually used for traumas or seriously ill patients.  The engine crew arrives right behind us, and join us for the walk in.  I scoot ahead a bit to try to talk to the nurse before the patient gets there.  “Why is that patient walking?” is my greeting.  Great.  “To avoid a fist fight in the unit” I tell her.  Now THAT got a look.  Fortunately, the patient came to my rescue.  About this time, he’s turning the corner into the room.  He sees Security is there, along with several Nurses, Techs and even the Doc.  I see him glance around the room, and fix on the equipment.  “Here it comes…” I think.  “oh god, Oh GOD, IT’S HAPPENING AGAIN….” He yells, and drops to the floor in a ball.  You know, You can’t script this stuff.  We end up picking him up, still in a ball and carrying him to the bed.  The team gets him settled, as I talk to the nurse.  I give her the run-down, explain that the call was dispatched as Chest Pain, but I believe it’s a psych run, and why.  I know this nurse and she’s a bit of a hard case, but fortunately, the doc is there listening and nods that he agrees, and see’s what’s up.  He asks whats going on, and why does the patient feel bad.  “I’m so guilty….I have such a good woman…” I’m thinking “oh, here it comes...” and I’m kinda thinking the Doc should put it together by now.  But, here we are in a room full of people and he’s sticking to his guns, asking away.  Finally, the patient says, “well…it’s kind of a Scarlet Letter thing…”.  Thank you. Dr. Phil has nothing on me, my work here is done, I think.  I check with the nurse to make sure she’s good and head out the door.  

As I head out to write up my report, the nurse who took report calls me over.  “Hey, I thought you said he was calm?” he asks.  “Yeah, He was.  I also said we restrained him.” He agreed.  “That’s why he’s in for psych…” The nurse was okay with that, and kinda shook his head with a grin.  You gotta love running nights.