Maybe it was the one-armed man

I have a confession to make.  Sometimes I have been guilty of mocking a dispatch.  Now, I know they are often just passing on what the person on the line is saying, and that person is the member of the public.  And as the little old ladies here would say, “Bless their heart”, we all know we can’t trust the public’s description to in anyway match reality when it comes to our emergencies.  So, a couple weeks ago, when Cat, Wayne and I get dispatched early in the night for a “Possible injury from a fall”, I admit I asked allowed of Wayne, “Well, did he, or did he not fall down?”  As it turns out, the dispatcher was correct.

The call was for our second due, and the MDT (our onboard computer) passed an update that Police were on the scene, and that the patient is disoriented, and saying someone attacked him.  “What does this have to do with a fall?”  I’m thinking as Wayne accelerates north, negotiating the moderate traffic.  The address is an apartment building in a part of town that has seen better days.  The apartments are known for a fine history of fires, and having multiple families per unit more recently.  We often get sent there for assaults, and unconscious calls that end up being cases of lots of alcohol, very little sense.  The first due engine gets there just ahead of us, and as we pull up, I see that there are one or two police cars waiting and the Rescue Chief has come along as well.  Yeah, just another call on Bayside.  

We trot up the stairs (again, it’s always upstairs) to the apartment.  Again, easy to see which one we are headed for, the door is open, there is plenty of people in the first room, and a Police officer at the door.  We get to the door, and I ask, “Where are we headed?”  I should have known the answer before I got it, “In the back room”.  Of course.  As I make my way through the apartment, I can’t help but notice that there are about 15-20 people in the front room, kitchen, hallway and bathroom.  Now normally, this would be a mix of all ages, and represent a couple of families.  In this case, they are all between the ages of 18 and 30, mostly male, and all in pretty good physical shape.  There are about three Police on the scene, and the further I walk back to the room, the more of these guys that are between my crew and the door.  That is not necessarily bad, but it is never good.  The engine crew seemed to be noticing it too, and they kinda spread out in a line from the front door to the back room.  There, I find the patient, face down on the floor, handcuffed and being held down by a female officer, who is kneeling on his back.  He looks confused, and while dressed, is a bit wet.  I notice that while she is on his back, she’s scanning the room as we enter….SOMETHING went down here.  

Her words to me are something along the lines of:  “I’m not sure what is wrong with him.  He says someone attacked him in the shower, but he’s all confused and not answering questions.  They,” motion to the door and the people beyond, “were fighting with him when we got here.  They say he came out crazy and was fighting all of them.”  The patient has his head lifted up and is looking about, and muttering something, but it is unintelligible.  The room is dark, lit only by the light from the attached bathroom, but I don’t see any real obvious clues.  But, I have one guy in police restraint, no obvious trauma, conscious but confused, looking around slowly…kinda like, “Hey, look…people.” And he was taking on a group from the other room.  Now, I know with family etc, they were probably taking it easy, but that group looked like a sports team, and I didn’t give my crew, plus the cops, plus the engine guys much better than a 60/40 edge if things went bad in here.  So, this thin guy must have been pretty ramped up.  (Any of this sound familiar, because it LOOKED familiar).  

Well, I got a string of guys from me to the exit, and the Rescue Chief is in the doorway to the room.  I know he’s thinking what I am, and has placed himself in a security position.  I stifled the urge to say to him, “Holy Shit Custer, look at all them Indians.”  I’m sure he’d have slowed down a rush long enough for us to do something before he got run over, and I’m glad he did that.  So, while the group is kinda anxious and walking around nervously, we are as good as we are getting, and I can’t hold past experiences against them…even past experience in this neighborhood.  I ask the patent a few questions, and basically get no answers, but he seems to be intent on conveying that he was showering, and “some dude attacked me”.  Eventually, we get out that this ‘dude’ reached in while he was showering, grabbed his ankles or legs and pulled him down.  (A-ha! A fall, now I get it.)  His girlfriend, nearby, tells me that she was in the other room, there was nobody in the bedroom but the patient, and nobody went in until he came out of the shower, “all crazy”.  Maybe it was the one-armed man, I think to myself.  His vitals come back okay, nothing out of the ordinary.  Pulse was up a bit I believe, but that makes sense here.  He’s not diabetic, not on any medications.  I check his pupils and they DO seem a bit small, not really pinpoint, but too small.  I’m thinking drugs, and so is Cat.  “Any chance he took something?”  I ask his girlfriend.  Now we are in front of the cops and everyone, so the “no, no” answer is neither surprising, nor necessarily accurate.  But, one has to ask.

Okay, let’s roll.  I’m thinking we’ll be trying the Narcan, a narcotic antagonist, to see if that doesn’t bring this guy back, but it’s a bit of a stretch.  The idea of un-cuffing him is never even discussed, so he’s going out like he is.  I have the engine crew get our Reeves from the unit.  I don’t know if I’ve described that here or not, but basically, it is a series of small strips of wood, about six feet long that are have been laid out side by side and wrapped in a plastic wrapping with handles.  The result is a very portable litter that is rigid from head to toe, but can be rolled up, or wrapped around someone.  We use it all the time.  Now, I’m thinking he should go out on his back, face up, so I can keep his airway clear as we go down the stairs.  The Chief opines that we need to take him face down so he’s not on top of his cuffed wrists.  I’m not so sure I like that, and I express some concern about positional asphyxia etc.  He points out that his legs are not bound, and that is a big part of the positional asphyxia thing.  Okay, I’m more interested in moving than arguing, and if he has issues when we get going, I have plenty of people to deal with that too.  Face down it is.  I had already made the call on the possible backboard issue – He was unclear on his falling or not in the shower, there is no sign of trauma, no pain or tenderness when I press on his neck/back, AND he has been wrestling his entire family since then.  Boarding would mean uncuffing, and we are not doing that if we didn’t have to.

We roll him onto the Reeve’s and get ready to carry him out.  As we exit the room and start down the hallway, the Chief gets a better look at the patient and the situation.  “Hey Chris, I think you’re right, he should be on his back.”  Now, we’ve discussed this moment between ourselves since then, so, while he may well be a reader, I feel confident when I say the thought, “Gee, that’s great timing on that one Chief.  Thanks for the help.”  (During the later conversation, he clarified that his concern was over stressing the wrists of the patient, and putting his torso’s weight on them.  As it turns out, the patient was kinda loose in the cuffs and able to move his wrists to his side…as we’d see in the unit.)
Now, I’m moving, carrying the patient, and we are NOT stopping again until there is an issue or we are at the cot.

The engine company has the cot waiting outside the door of the building, and when we get there, we open the Reeve’s and flip the patient over, careful to bring his arms to one side to help his wrists.  We load to the unit, and have an officer come with us.  They are okay with that in light of the struggle they had before our arrival, but to be honest that was only a minor concern.  We still didn’t know for sure what the deal was, and while he seemed stable now, if something happened, we’d need the cuffs off fast, and that is not something we can do.  Also, considering everything, I’m okay with an officer there to observe the fact that we take care not to harm the guy.  We get vitals, and Cat does a nice job getting the IV going in spite of the odd positioning on his arms.  The patient is starting to talk more now, and is making more and more sense as he does.  He’s calming and generally becoming “OK”.  I decide against the Narcan at this point.  While this may be a narcotic deal, it doesn’t feel like it, his behavior doesn’t dictate it, and even his pupils are looking okay in the light of the unit.  While Narcan is often considered one of those drugs that, “It doesn’t hurt ‘em to try”, I also was taught to remember that all medicines are poisons, but that they have really beneficial effects, so we use them.  I’m still thinking drugs are a possibility, but his behavior is more PCP or hallucinogen than narcotic.

His ECG is good, no ectopy, not tachy or anything.  He’s oxygenating well, and starting to hold a conversation with the police officer.  I try not to interrupt too much, the cop is asking good questions, and I’m more watching his level of response than anything else.  He is concerned about the cuffs, and the cop tells him that they can come off at the hospital.  We basically monitor him on the way, and don’t do much else.

Arriving at the hospital, we get him transferred quickly, and the officer loosens the cuffs after a clear explanation of the consequences of acting out once they are off.  I give report to the nurse, and she gives me a quizzical look.  He may or may not have fallen in the shower, he says he was attacked, but everyone says that is not possible.  He was certainly not responding well on scene, but recovered quickly in the unit.  He was battling his whole family, but is now calm and cooperative.  His vitals are good, and everything is stable.  I’ve got a line, cause that is what we do, and here you go, best of luck, gotta go, see you with the next one.  

In the report room, we compare guesses and notes.  Drugs, always a popular choice, but wow, that wore off kinda fast with no intervention, and they say he didn’t have any there.  That could be a fabrication, or perhaps it was a flashback.  Seizure of some sort, postictal when we got there, awake now, but that does not quite fit either.  Low sugar, no diabetes, and the number was okay.  Actually fell in the shower?  Possible, but that does not explain the rest.  Actually attacked?  Possible, but again why the incoherence?  Psych issue, again, a popular choice always, but who knows.  Was it an act in the house, looking to get out for whatever reason, domestic issue etc, and then the ‘wake up’ was just dropping the act now that he was out?  Again, fits well, but we don’t know.

These calls are always interesting, and frustrating at the same time.  We never did get a diagnosis from the hospital, as usual, and will never know for sure.  No matter what the cause, it does make you appreciate the complexity of humans and the things, internal and external, that affect them.  That’s something they don’t cover in class though, the “Gee, I dunno, he’s sick and I brought him here” calls that make up a fair bit of our practice.  Or, maybe I missed that day.