Either you're SWAT, or you're not

Wow, amazing how fast two weeks can fly by.  Life has been really busy here.  Starting on a new assignment at work, working on my Masters in Systems Engineering, running calls, working of course, and fighting off a quick flu all seemed to team up on me.  Cat got her call out on here last week, and I’m glad to see the reactions to it.  We finally got to run together again this week, and the night didn’t disappoint us.  When you start in EMS, the idea of a SWAT standby sounds great.  Then you do a few and you know they mean hours of sitting around in the unit…an EMS stakeout.  But there are some redeeming points..

I showed up at the station after work already dog tired from a long couple of weeks.  In the back of my mind, I quietly hoped for a slow night, knowing that it was a slim chance of that.  The weather is warming at least, and I tried to keep things upbeat as we checked out the unit and got into the evening.  We ran out for dinner fast, and of course, that started the calls.  We ran a quick pair of auto accidents, the second one yielding a BLS hip ‘injury’ that we transported.  While at the ER, I see a favorite nurse of mine, we’ll call her ‘V’.  She takes no crap from anyone and used to work in Detroit.  I believe she was a street medic in a past life too.  We always exchange jabs when we see one another, her usual being to tell me to “Go home, you are nothing but trouble, and I have no time for your stuff tonight.”  That night I told her, “Hey, I’ve been good for weeks, but just for you…I’m bringing you one tonight, and they are going to be a mess…you watch, I got a special coming for you!”  I grin as I leave to go get that dinner.  

Leaving the hospital I’m tired and didn’t verify that we were held clear of the hospital after that call and as a result, we were NOT dispatched on a “Stabbing in progress” in our next due as we should have been.  I radio to dispatch that we are, in fact, available to respond and they tell us to do so.  Of course, it sounds interesting so the medic originally dispatched claims to be closer and keeps rolling.  Okay, my bad, didn’t verify I was clear, and what the hell….dinner is waiting.  Over the radio, the call sounds serious, a 7 year old or so boy stabbed a bunch of times (31 was a count given by the engine later, most minor, 8 or so serious. My Lt on the Ambulance assigned tells me 13 good stab wounds) by an older guy who fled the scene.  They fly him out and I’m torn between missing a decent trauma and a nice hot calzone.  We settle into the trailer and have dinner. Cat has to work the next day, and trys to get some sleep.  Wayne is driving, and (bought dinner too!), Tess was not in that night, she was working.  

About an hour later, I hear from one of the engine guys that communications has called and given a heads up that SWAT is active in that area…it seems the guy is back, and barricaded in the house.  It looks like they’ll want us for a stand-by, but not for a while.  Approximately 10pm, the call comes out for us to go stage for the PD at a school near by the address of that previous call….”time to go play with the SWAT team” I think, and start to the unit.  I climb in and start getting messages on the computer console:  “Come in quiet”, and “how long until you get there”.  I tell them just a couple minutes as Wayne parts the seas until we are close, and then we stop the lights and sirens and sneak in the rest of the way.

The parking lot of the school is starting to fill some, and I see the predicted car with maps and papers all over the trunk, surrounded by uniformed officers, suits, and an obvious SWAT commander. The CP.  The police are loose, and chatting, and several are on radios and phones.  Wayne sets us up out of the way, with easy access out, off to one side.  I hop out to see what’s up, and how we can help.  I’m assigned a POC, get an address for where the fun is, and tell them I’ll stay out of the way, mostly in my unit and do whatever I can to help.  In return, they promise information, access to the school for a bathroom and an interesting evening.  I’m introduced to a Police Captain who is settling in for the night, cigar in mouth.  He’s relaxed and friendly, glad to see us etc.  He confirms the department I’m with, and when I tell him he says, “Glad it’s you all.  Y’all always take good care of us on these things…coffee and such.”  I can take a hint, and get on the horn to the Rescue Chief to pass on the polite request for some refreshment help.  I later learn that police Captain and our Dept. Chief go way back, and the Capt and I share a joke.  

“Lets see how this goes” was the response from the Rescue Chief, and we promise to get back in touch if it looks like we are going to be here a while.  I’m seeing more marked cars arriving, and the detectives are showing up….yeah, we’re camping for the night.  It’s only about 20 min later when another POC from the PD tells me that they are relocating people from the surrounding townhomes to the school, and they ask if we can get them some snacks and drinks.  Time to wake the Chief.  I call the Rescue Chief, (I can tell I woke him), and he agrees that we should talk to the Dept. Chief.  When he asks if I want him to do it, or do it myself, I volunteer.  The Dept. Chief moves fast and about 15 min later I hear that the Auxiliary is notified and moving with an ETA of 45 min.  The police are thrilled to hear it; even more so 20 min later when the Auxiliary members arrive and set up in the cafeteria of the school.  Wayne and I know a long night is coming, so you know some of that coffee made its way to our unit too.

In the mean time, Cat is curled up on the bench in the back trying to sleep.  She’s looking at 24 hrs starting at 0700 the next day, and knows this will take a while.  I’ve been given a new POC by PD, a former medic himself, who does a really great job at keep us informed.  Wayne and I settle into the front seats of the unit, tell stories, confirm the location of the address, drink coffee and wander around the unit killing time.  We learn from the POC visits every 15 min or so that the guy is the Uncle of the kid who got stabbed, and that he did it because the kid didn’t get off the computer.  He’s got a very violent history (no details) and is recently out of prison for something violent too.  He leans in to me and confides that he doesn’t think this is going to end calmly, and may well proceed rapidly due to the guy’s nature.  When he asks how we are at gunshot wounds, I perk an eyebrow.  Wayne assures him that he has the right crew for that.  

About this time, a Television truck shows up.  Nice.  PD gets to them quick and tells them to stay out of the way, and seems to give them a contact as well.  I send a message to communications over the computer:  “The Lt didn’t tell me that I was going to be on TV…I would have done my hair”.  A dispatcher responds that the Lt didn’t think about the hair because he doesn’t have any.  That gets a laugh from Wayne and I in the cab of the unit.  The dispatcher and I kill some time sending text messages back and forth, joking mostly.  There aren’t many calls in the county so she’s probably bored, and I’m entering my third hour in an ambulance, so I know I am.  I tell her that we got coffee and snacks brought to the Command Post, but that in retrospect I was thinking that may not be the way to motivate the police to move faster.  She types back a laugh, and says she was a Police dispatcher for 7 years, and NOTHING makes this go faster.  


About midnight (almost 2 hrs in) we get the five minute warning that they are going to gas the house.  My POC tells me that they will put a couple gas cans into the windows, wait a few minutes then add more.  Works for me.  It occurs to Wayne and I that if the guy goes down, it could be in the house and we don’t know for sure if PD will drag him out.  We take the opportunity to get a hold of our air masks, and double check our SCBA, the airpacks for our backs.  Wayne tells me that the gas does not affect him much and I tell him we ain’t going in until everyone is on air.  Our department equips us with full suppression gear, and that includes airpacks and masks, but we don’t need them much in EMS.  So, I review proper donning with Wayne, who also runs fire on another crew.  Okay, so now I CAN deal with it, but I really don’t WANT to.

A bit of time passes and the POC returns.  Something is up, they did gas the house, but are not going in yet…and the guy is not coming out. He says it “could be a while.” Great. I hope Cat is getting some sleep in the back, I know Wayne and I are feeling it.  The novelty of this sort of thing wears off fast.  You can tell everyone you know that these stand-bys are dull, but nobody ever believes you.  “So much for getting any sleep tonight” I think.  I think of the full days of potentially contentious meetings I have for my ‘real’ job starting at 0900, and hope I’ll be awake for them.  At least we are getting some information, and that makes all the difference.  

Its about 2am when we get another five minute heads-up and I think more gas goes in.  We’d seen the K9 units going in earlier, so I know the dogs are around.  The POC comes over and says that they have one in custody, and asks for us to call for a Squad to come stage here so they can ventilate the unit.  I forward the request to communications, and shortly after, we get called to the scene for a patient.  (Finally, I think as we take our cue and join the party.)

We roll up the street and I’m surprised by the number of marked cars there are. I have to get out and lead Wayne around the scattered police cruisers in the crowded street.  I see the SWAT teams and the K9 officers walking away from the house as I approach.  I note that a couple of the guys look like they are in bomb outfits…interesting, wonder if that was the delay.  The townhouse is question is easy to identify, it’s the one with the guy laying in the yard handcuffed and surrounded by gentleman in police assault gear, automatic weapons and airmasks.  

Our patient is a tall, laid out, bleeding from one hip and apparently unconscious.  One of the SWAT guys is tending to the leg wound.  He says a familiar “Hey there!” and is smiling behind a mask.  I say hello as I start to assess what I have here.  “Dogs get him?” I ask the group.  “Dogs woulda messed him up worse than that” one of the masks says.  They show me a small, shallow laceration and tell me that he must have done it to himself.  The bleeding is basically controlled, may need a stitch or two, but is imminently NOT life threatening.  The guy is unconscious and I ask if he was found that way.  Looking up, I see that the officer treating him, the one that said hello, is someone I know and I smile.  “Didn’t recognize you in the mask.” I tell him.  His sister is in our department, and was on the ambulance that responded to the stabbing.  They say he was looped, but conscious when they got to him, and dropped out like this as we were coming.  He’s breathing fine, and looks basically intact.  Wayne and Cat are coming with the cot and I start to get to work cutting away the guy’s clothes.  I’m feeling the first tingles from the gas the police used.  We are outside, but the “gas” is a very fine powder that gets on everything, and is all over this guy’s clothes.  He wearing layers:  Thermals, Sweats, shirt and so on, and they are all giving off more of the stuff.  I need to see if he has any other injuries, and I want these clothes away so they will stop adding to our problems.  As I get to work, I put down my left knee and pivot as I give him a quick head-to-toe.  This stretches my BDU pants, and I promptly rip them from the end of my zipped down and forward about eight inches or so.  Good thing I don’t run duty ‘commando’, or that could have been quite an issue.  As it was, I was feeling plenty ventilated and briefly (no pun) thought to myself how much I did NOT want CS powder in my crotch.  I give a sigh, comment that the rip is about par for the course, and get back to the task at hand.  

We move quickly to the unit, away from the house, and the whiffs of gas rolling from the door.  We finish getting his clothes off, and we toss them out the unit to the police.  The vent fans are all running, and the windows are open.  An officer, our POC, climbs on to ride with us.  He saw the kid that our patient stabbed, and I think he’s determined to see this call to the end.  The patient is exposed, has dreadlocks to his waist which are also holding the gas, and really unconscious, only occasionally moving slightly as we work.  He is handcuffed behind him, and I use a cravat to tie the cuffs to the cot…just in case he wakes.  His room air oxygen saturation is only 93%, I’m thinking he sucked in plenty of the gas, and we get him on big oxygen fast.  His ECG is fast, but steady, and his B/P is fine.  I’m obviously not getting a history on him.  Cat gets the IV, as the police officer and I hold his arm.  He doesn’t even flinch at the needle.  His Sat comes up fast to 100%, lungs clear, and we find no trauma other than the small laceration.  Wayne gets us moving to the hospital, and we basically settle in for the ride.  As I’m calling in the report, I pull back one eyelid and Cat confirms that his pupils are pinpoint.  That is a classic and telling sign of narcotic overdose.  

Normally, we give Narcan for narc overdoses, but the people often wake up fast, and pissed off.  They are known to fight us and a sudden bad hangover.  The last person who upset this guy was stabbed many times, and had at least a collapsed lung (I later heard), and being family and only 7 didn’t stop our patient.  If the narcotics were not actively killing him, and he was still breathing okay, I was not about to do anything to wake him in the slightest.  The trip was short and surprisingly uneventful, we basically just kept a very close eye on him.  His sats stayed good, and his respirations were fine the whole way, so there was very little to do.  

We get to the ER, transfer him to their bed and give report.  The nurse looks at me like, “Another odd call from you?” and thanks me for the information.  The officer stays with him, and makes it clear that he is not leaving.  As I write the report, they give him the narcan, and when I’m done, I notice that he is stirring, and snorting some, but not entirely awake yet.  ‘V’ is there working on him and I take the time to rub it in.  “See, told you I got one for you!  That’ll teach you to talk your stuff to me.”  She gives me bilateral single finger salutes and says, “You see these, see them??  Yeah, go…See them?” Now Cat is right next to me as I just give ‘V’ the biggest two-dimpled grin I have, standing there with this huge hole in my crotch and a cool breeze on the family jewels.  I make no motion and just fire back, “You See these…see them…Yeah I got yours…see them?” She gives a puzzled look, and I see her glance down.  That’s it, the impossible happens.  The unflappable ‘V’ loses it.  She comes over laughing and rests her head on my shoulder. “YEAH, see how we roll?” I say.  “Oh, I’m sorry, it’s been one of THOSE nights huh?” she laughs. I have tears in my eyes, and not from the gas, as we turn and leave…yeah, it’s been one of those.  We head back for a shower and bed.  It’s about 3am, I’m exhausted, I’ve been gassed, and my pants are trashed.  Oh, I’m SO out of service, that other medic can have all the calls they want.

Checking in

Hey all, I’m still alive and well, and almost done writing up a call we caught just this week.  I’m stuck up north (Hello New Hampshire!) on travel for work, and have an early start so I have to stop for tonight, but I’ll get the call posted tomorrow.  Besides, I like doing this better than studying for a midterm I have next week.  The call was a SWAT assist call…hours of boredom followed by minutes of actual EMS.  Of course, this is our crew, and Murphy’s law is always with us…nothing like hanging out on a call.  Grin.

Instant Karma?

Okay, so I posted the below story about my beloved wife handing me..well you read it. Anyway, I'm not usually a "Put a thought into the universe..and it will manifest and come back to you" sort of guy. That said, a quick update. Cat and I have duty tonight, right now in fact, but I am home not feeling well, so Cat is there with Wayne (Tess has class tonight, so she's not there yet). So, instead of our massive four man crew, it's just the two of them.

I just got a call and was informed that my life is in danger. It seems that Cat just got sent down to Quantico (hoo rah) to pick up a Congestive Heart Failure patient from the clinic. That's about 3rd due south of us, and a pretty good run. In her words to me: "When I get home I'm wringing your neck. You send me here, and that CHFer crashes on me. They got no veins, so I get the IV on the 4th try. I have to tube them, I pushed Lasix, Morphine AND Versed....you are SO dead." I managed not to laugh out loud. A bit of Captain came out and I asked if she made sure to follow our Protocols, which are WAY too tight, and not her's from work. "Yeah, Had to call twice to get more med orders, but I got them all." Apparently, she talked to the new doc at the ER...a lady I do not know. I told her to tell the doc that if she keeps letting us be aggressive, I'll buy her dinner. More to come...well for ME for sure, I'll make sure to update.

Guess we are even on that bucket....

Can't say Cat never gave me anything.

When I was a ride-along, not even a member of the department yet, I was lied to.  Well, perhaps mislead is a better word for it.  I rode with MedicJon, and about every call was a no kidding ALS emergency.  I mean, I had two respiratory arrests in a single shift with him.  We had heart attacks, serious overdoses and auto accidents.  It was intense, it was life saving and it was COOL and I was hooked.  That was over seven years ago.  Since then, I’ve learned a lot of things.  I’ve learned how to start IV’s, how to intubate, what drugs to push when.  I’ve learned that KED and slow are not synonyms, how to use a scoop stretcher, and that ADC puts errors into mapbooks.  I’ve also learned some cynicism; Sunlight causes roofs to burn (nod to DTXMatt12 for that one), all fires go out and all bleeding stops…eventually.  And sure as death and taxes, I learned that it had to be a cosmic conspiracy that kept me from seeing any of the ‘regular’, bread-and-butter calls during my ride alongs.  So, when Cat came to me and said she had a ride along for us this past weekend duty, I just hoped that he’d get a more representative sample of what EMS is really like.  (Okay, I hoped he’d be a ‘white cloud’ and scare off all the calls, but I knew better than that…not in our due.)

We spent most of the afternoon hanging out in “Trailer 1”, the trailer with the TV room in it watching bad movies and telling stories for the ride along.  He was the son of Cat’s hairdresser, and his mom said that he was a ‘good kid’, interested in EMS, and ‘looking for some direction’.  He found the right place, Lord knows our house has been a home for wayward boys before.  He seemed a good enough kid, a bit amped about being at the firehouse, but hey, that’s normal.  A couple hours of TV hadn’t damped that in him when the call went out for us to assist a second due engine from the neighboring department on a “CO Alarm Sounding.”  

Hmm, we don’t go on those normally, so there must be someone feeling funny in the house, I figure as we walk to the unit.  Not exactly exciting on my end, but the rider is psyched.  The crew was Me, Cat, the rider and my ALS preceptee Tess.  Wayne was off for a bit, wooing his woman I believe.  Cat fills in the driving role and we head off to the call.  The extra info on the call is that everyone is out of the house, but someone is “feeling ill”.  I anticipated the feeling ill, but the ‘everyone’ perked my ears.  I type out a quick message on the MDC to the dispatchers, “Do we know how many patients there are?”  The MDC is nice, I can stay off the radio, but still chat with the dispatchers, or other units.  I’m a text messager from WAY back so that feels normal to me.  (Started texting on Ytalk on an RS6000 in college…NERD!)  One dispatcher responds that there is one patient, another chimes in that they do not have a patient count at this time.  Okay, no biggie, but different answers gets a cocked eyebrow again.

We arrive on scene and I see that the engine is already there.  The house is a typical split-level for the area, and there is a gas company truck out front.  The engine officer seems to be talking to the patient, a Hispanic male, next to a van parked in the road.  As I walk over the engine officer comes to me to give me the low-down.  He’s an unending string of bad news.  His report goes something like, “Hey, this guy says they’ve been feeling bad all week..” THEY?  Oh, him and the van full of kids…four of them, smallest in a car seat…great.  “…and yesterday they went to the doc and were told they had a stomach virus, so they came home.  Today, he thought he smelled gas, so they called the gas company.  The gas guy got a CO reading of 200 parts per million at the front door.”  Holy Shit.  A CO reading of 35 ppm is I-gotta-fix-that bad.  “…When we got here, we got a reading of 200 too.”  

If you know why Carbon Monoxide is bad, skip this part.  If you don’t the easy version is this:  Hemoglobin in your blood carries oxygen to your body it can do what it does.  There are receptors on the hemoglobin just for this.  Carbon Monoxide, CO, once inhaled attaches itself to those same receptors, but does it MUCH ‘better’ than oxygen does.  So, as you get more and more CO in your blood, all the slots for oxygen get used up and your blood can’t carry the O2 it is supposed to.  So, your tissue ‘suffocates’ for lack of oxygen.  It can cause vomiting, heart attacks and irregular rhythms, and brain swelling. That’s bad (Yeah, that is a bit over-simplified, but it works for here.)  You treat it by bombing your system with O2 until the CO gets pushed off…kinda.

As I’m hearing this, the patient is walking off, that’s never good.  I start over to see where the heck he’s going when he bends over by his car…oh.  He’s puking again. Wonderful.  The engine officer also tells me that he doesn’t speak English either, so that’s a bonus challenge for us.  Fortunately, Tess is a native Spanish speaker, so she gets translation duties.  She starts talking to the guy, while I look in on the kids.  They all look a bit like sick kids, but none of them are in distress right now.  I give a call for the oxygen and instruct Cat and Tess that everyone gets O2 as quick as we can get it going. The kids all tell Tess that they have upset tummies and headaches, but nobody has thrown up.  They are answering appropriately, and behaving normally, so that is a plus.  I ask if they are all the guy’s, and how old are they, and I’m told that two are his, and the ages run from 11 yrs to 11 months.  

So, I have five patients, and they ALL need to be seen at the hospital.  Some or all of them may need to go to a hyperbaric chamber for treatment, but I can’t tell which ones from the field, and the nearest one is a helicopter ride.  I am NOT flying 5 people out of here, if only because I’m not calling in that much air support.  (Interesting mental image though…I’d have a bigger air force than most countries).  The idea is to get them oxygen, get them to the ER, let them do the blood work and sort out who needs what.  My limiting resource, besides the fact that we aren’t supposed to transport that many people, is the number of oxygen regulators I have.  We are going to need help, but everyone is stable for now, so I tell the engine officer to get me a basic unit to help transport.  None are available nearby, so I get a Medic from the local department.  Even better I think.  I ask which kids belong to the guy here, and he points to one boy and one girl.  “Where’s mom and dad for these others?” I have Tess ask.  I hear that they are ‘coming’, and only a few minutes away…oh, and one of them feels bad.  Of course.  I give the ER a quick call and warn them that I got at LEAST 5 coming, one adult, possibly two, along with four kids all exposed to really high levels of CO…more to follow.  The ER thanks me for the warning, and I’m sure starts getting ready.

“Let’s split by family.  Take him to our unit, and we’ll take him and his kids, the other unit can take the others.”  This way the minors are with their parents for treatment permission etc.  There are built-in regulators in the unit, as well as the big O2 tank, so between that, my portable tank and one from the engine, I can mask all but one right away.  Dad’s puking, he gets one.  The baby is a baby, she gets one.  The boy and girl go with Dad to the unit with Cat, and they buddy breath a mask.  The rider follows them and gives Cat a hand.  Tess and I give the littlest one blow by oxygen and take care of the last child.  

In fairly short order, the other medic arrives and I think that we are doing good.  Then the crew walks up empty handed and I go talk to the medic to get her up to speed.   I’ve seen her several times, and have always been fairly impressed.  Frankly, I must have caught her off guard, or on an off day, because as I explain what’s up and what the plan is, I get nothing but a blank look.  I finish the report and she just stands and looks at me, then around at the scene and back at me.  Period.  So, I tell her again.  And not much seems to click.  She asks about the kids, and I tell her once again.  The one family (Dad, boy, girl) are in my unit, and going with me, the other family (Baby and boy) are going with her, parents should be here ANY second….this time it seems to click and she heads over to see her patient.  She also asks her crew to get their O2 so we can get ours back and get moving.  While she talks with Tess about the kids, I check in with Cat on the unit.  She’s busy but holding her own, getting history and vitals as best she can on all three, with the help of the rider.  The guy is puking still, but into a bucket now.  I hate pukers.  She tells me that we should roll sooner than later, and points to the reading on the on board oxygen tank.  There is plenty of pressure, but with multiple lines running, I can see it dropping as we talk. There’s a first.  She says they are all stable, and Dad’s the worst…no kidding.  

I get back to the van, and the other Mom and Dad are arriving.  And of course, Mom is very upset.  Now, she’d just left there, but something about the ambulances there really got to her.  I start trying to extract Tess to the unit so we can move, and check in on the other medic.  She’s in the groove now, and things are moving finally.  I feel like I’ve been on scene forever, and my mental clock has long since sounded.  I hear the second dad saying he’s feeling bad, so that makes three for the other crew too.  I double check that the other medic is okay, get a yes (She has a translator too) and get back to the unit.

Inside, I do a quick check on “my three” and see things are about the same.  We get a quick set of vitals all around, start paperwork on each of them, monitor dad, and I believe dad got a line too.  (I didn’t do it, one of the ladies did).  I ask Cat if she’s ready to drive to the hospital, that I’m good with the folks back here and she says “yeah” but has one last present.  “If I take off with this like this, it’s going to splash all over.”  “This” is the open bucket of vomit she’s holding.  Nice.  Yeah, it’s basically a plastic bucket like you might get cheap ice cream in, and it’s about 80% full of this dude’s puke.  It’s yellow, warm and it smells bad, and now it’s all mine.  Can’t say Cat never gave me anything.  Cat, quite reasonably, suggests I dump it, but I’m uneasy about opening up the door to the unit and chucking out a bucket o’ chum in front of all the neighbors, and while he fertilized his own law with great vigor before he got into the unit, I don’t think I can toss his biohazard myself.  On the other hand, I am NOT trying to balance this all the way to the ER without spilling it.  One more challenge.  (And they don’t advertise this stuff).

I look around and see the bucket for the onboard suction system.  “Give me that” I say.  It has a top, and there are caps for the suction holes, so I can seal it up.  The rider grabs it for me just as I get a nice, big, open mouthed tasty whiff of this puke and start to gag.  I motion to Cat to head up front, and that I’ll take care of this.  I’ve never blown chunks in my own unit, and I’m not starting today.  So, with all the care of a hazmat technician, and while fighting off repeated gags, I pour the stuff into the new bucket and get it sealed.  Then I turn, hand it to the rider and tell him to put it on the counter, but make sure it won’t spill.  (Welcome to EMS buddy! No glamour today).  

On the way, I call in a report for each patient and explain that more are coming on a second uint.  After I hang up I hear that the engine crew has done a reading from the kid’s room: 1200 ppm, six times as bad as we thought.  We get to the ER quickly, and they are waiting for us.  They ask who’s the worst and I tell them Dad is.  He gets taken to a “Big room” for fastest evaluation, and Cat goes with him to give report.  I take the two kids to another room, with two nurses close behind.  It takes a while to get everything sorted out in the ER, and explain who was with whom in terms of parents etc.  It turns out that putting one family on one unit, and the other on the other really helped minimize confusion.  In relatively short order, everyone has their own nurse and is getting oxygen from the ER.  

In the report room, our rider is full of good questions and we are explaining carbon monoxide and things he saw on the call.  We basically just gave oxygen and monitored people, no biggie but for the number of patients, but the rider is just as stoked as if we had shocked them back to live just for him.  He even got to be a part in disposing of the vomit…lucky him.  While I write reports, I hear him asking Cat how he can join up and when the meeting is.  I guess he got hooked too.  We’ll see.  At any rate, he can’t say he wasn’t warned.  I didn’t falsely advertise to him.  And I’ll be a bit more careful the next time Cat wants to hand me something on a call.

** UPDATE **
For a related, and extremely humorous look at another CO related call we ran, and perhaps why the delayed reaction on the part of the other medic, do yourself a favor and check out Matt's Wonderful World of Woodbridge. I promise you’ll get a laugh.

Where does THIS plug go?

It has been really busy since the last post, personally starting a Master’s program, and at the station as well.  The department ran one of those truly difficult calls that you know is out there somewhere.  I was only peripherally involved in the call itself, as I was busy on a taxi run when the call went out.  I’m going to write up the call, and my understanding of the great job our entire department really did on it…but not tonight.  CD’s comment on the last posting (and by the way, I’m choosing to assume that the scary part of the post was the Doc not believing us and sitting the guy up again) reminded me of another call, one that abruptly ended upon arrival at the ER.  

In our first due, there is a place we all know as The Fossil Farm.  This place is the poster child for every bad story you’ve ever seen under the title “Nursing Home”.   This place makes you want to die young as opposed to risk going there.  I have to follow it with the fact that it IS better than it has been in the past, thanks to law suits and state interventions I understand, but it smells of urine and Funk, the staff is minimally trained, and on the whole doesn’t seem to give a rip about the people inside it.  The patients are generally in pretty bad shape, with med lists and previous conditions as long as your arm, and don’t have the insurance to go somewhere else.  You can see them most days sitting in wheelchairs at odd angles in the hall staring at you as you pass with your cot and gear.  We all know the place, and we all know it well.  So well that we all start to groan as soon as we hear the box 12-01 on the dispatch.  There are few things they do well, but recognizing dead is one of them.  (Okay, sometimes it takes an hour or two, but that is another blog).  

Anyway, when the call goes out for a “Stoppage of breathing” at this place, and we all head over knowing two things: One, someone is dead and two, they probably stink.  The response is a short one, and Cat loaded the cot with all the bags, the lifepak and the drug box as we roll.  We arrive just ahead of the engine, and start to glove up as we ride the elevator to the ‘second’ floor.  (The main entrance to this place is on the lowest floor, but there is a hill to one side, and there is a door from the ‘second’ floor out to the side parking lot at the end of the hall…this comes into play later.)  We exit on the second floor, and turn left towards the dispatched room number.  There is some staff standing around outside a door down the hall.  “No need to be in doing anything, just look from the hall” I think as we head that way.  There were also a few people around who were not staff, possibly family, which struck me as odd.  

Of course odd is relative, pun intended, and when I turned to enter the room, the sight made me forget about the strange non-staff in the hall.  On the floor of the room is a large, apparently dead, man who is on the receiving end of some spirited CPR compressions.  That’s a real plus all things considered, but while he is laying on a board, presumably to give a solid base for compressions and to move him to the floor from the bed, it is laying across him, not along him.  Oh, his head is UNDER the bed, and compressions are being given by a (normally) slight lady who looks a full 40 weeks pregnant while a fairly built guy is struggling with a nonrebreather mask and oxygen tank….maybe they were just ahead of the curve on the “compressions only” CPR trend.

A LOT of things went through my head here…none of them complementary.  The reader’s digest version is something like, “Well, they are doing compressions at least….Holy Cow is she pregnant…If she goes into labor, I’m quitting…Where’s the dude’s head…How did they get his head under THERE?...So much for an airway…Nice guy – lets HER do compression while he tries to put an oxygen mask on a guy who isn’t breathing….Well, let’s do this.”  

Orders get issued pretty quick and we go to work.  We slide the patient out from under the bed, and Cat gets down on the floor to drop a tube into his airway.  The compression job is taken off the soon-to-be-mom’s hands, and I get the lifepak connected quickly to take a look at what we have.  Cat gets the tube in the first pass and now we can breathe for him.  Compressions are paused and the ECG shows an asystolic ‘rhythm’, but also a couple agonal ‘beats’.  If you’ve run for a while, you know the funny looking, wide, ugly wiggles that are the final throes of a heart that I’m talking about.  Well, thank God for combi-pads on the lifepaks, because we were able to get pacing started really quickly.  

Protocols say to do something silly like start with low milliamps and work your way up in intervals until you achieve mechanical capture and then increase it by 10% at a rate of 80 beats per min etc, etc, etc.  Well, technically that’s what I did.  It just looked to the untrained observer like I looked at the 320lbs or so dead guy, hit pace and spun the dial until it stopped.  Hey, I hit every increment!  As Bob Page would say, “Set it and forget it”.    The patient is moving a bit with each beat, and the monitor shows electrical capture.  Cool.  “Hey, do we have a pulse with that?” I ask.  Cat and I check are checking for a pulse, but it is hard to tell at the carotid because of the way the guy moves with each beat.  We check further down the arm and find a faint, but palpable pulse.  He’s still not breathing, but hey, we can do that for him.  

I used to call pacing a patient, “Summoning the invisible elf”.  When you do it, the patient twitches at the chest as the pads deliver smallish shocks to the patient, causing the heart to beat.  If you stand back and look at the patient, they look like there is some little invisible elf kicking them in the ribs about 80 times a minute.  

Well, woo-hoo, check this out, he’s not out of the woods at all, but hey, we’ve been here just a few minutes and we have gone from dead under the bed to a pulse, albeit thanks to our pacing, and that is more than you get most times by far.  The guy is moved to our backboard and cot and we start to head for the unit.  The fire guys have moved the unit around to the side of the building, so we can use the exit at the end of the hall and don’t have to go into the elevator again.  Nice thinking on their part.

An IV is started in the unit and we go for some vitals.  There was a good flash in the chamber when we got the line, a good sign for a blood pressure, but not conclusive.  We have him by a thread, and I really, really, really don’t want to lose that.  His eyes looked bad, in the I-was-just-dead way, and we noted that his nose started to bleed.  “Hey, he’s bleeding!” I think, and probably for the first time that it was good news.  Bleeding from the nose in this case means not just a pulse, but a pressure.  Cool.  Now yes, gravity can do that too, but he was flat on the floor before and not bleeding, and he was on the cot, somewhat less flat, and blood does NOT flow uphill.  As we take off for the short response to the hospital, maybe two miles away, the BP machine beeps with the news….90/30 or so, not much, but I’ll take it.  

The call goes out to the hospital to say we are coming, and preliminary report is given.  At the ER, I’m pretty much floating out of the unit.  This isn’t a save, and it probably results in no brain activity at best, but I’ve done my part in this one, and we are “Not Dead”.  Not Dead is good on a code, and it happens rarely enough, so it’s good enough for now.  We get into the waiting cardiac/trauma bay where the code team awaits.  They quickly hop into action as we walk in, and I start spouting a report.  The IV bag is on the guy’s chest, and the tube has blood in it, gravity does that too, but a pulse helps.  I see them setting up their machines, and the Doc comes over to inspect things.  

I’m telling him that we got a BP en route, pulses to match the pacing and mechanical respirations, and wondering “What the HELL is that whining, buzzing, ringing noise?”  I look back at the LifePak and am greeted with three parallel, horizontal dashed lines, and a flashing indicator telling me to connect leads.  “What the…”  I scan the patient, and my pads and leads are still on.  Then I see that the wires from the pads end at the connector, and the connector is loose on the cot…Someone disconnected my pacer.  “You have GOT to be kidding me!” I think so loud I almost yell it.  “No pulse” says a nurse next to Cat.  “The Patient has no pulse…in PEA on arrival” I hear the Doctor say to the report taker.  “LIKE HELL!” I think…I’m livid.  (To those now lost, the doctor just said that the patient never had a pulse at the hospital, that I was shocking him, but that it was not causing the heart to beat.  Pulseless Electrical Activity.  It also means he’s saying that I just ran an entire code without doing CPR on someone with no pulse.  My ass I did!)  I hold up the disconnected lead from the paddles towards the Doc, “No shit…Y’all pulled the pads!”  I don’t recall his response, but it didn’t matter.  I go to the nurse taking report and make sure she has all the background on the call and storm out to the report room.

There, for the first time in my life, I actually throw things.  Just pens, sure, but I’m as pissed off as I’ve ever been.  I’m pacing, cannot sit down, and sure can’t write the report.  Cat and Wayne gathered our stuff and were headed back to the unit.  Now, I wasn’t about to let the report stand saying that there was no pulse on arrival.  They boned this one and I was not rolling over.  I stick my head into the curtain, and see that they did not regain capture, and that the code is going poorly.  Frankly, a lot of this time is a bit of a rage-filled blur.

I must have been visibly pissed off, because Doctor Dave, universally liked and respected by everyone I know came over to talk.  “What’s up?” he asked.  I told him what I had, that I got a measured B/P, two providers felt a pulse, and we had active bleeding.  Before I get to the end, he puts his hand on my shoulder, looks me in the eye and says, “We disconnected your pacer didn’t we?”  And THAT is why he is liked and respected.  “Yeah, and the doc said we came in here in PEA, and no compressions.  That’s crap, and I’m pissed.”  He talks me down and assures me that he’ll be talking to the doctor and the team.  I feel better, and I trust him to follow up on that.  Of course, my report is both accurate and complete, and clearly states that we had capture, a blood pressure, and the pacer was disconnected upon arrival.  

I get back to the station, still fuming a bit and the guys ask me how it turned out.  The patient died and I explain what happened.  They empathize and have a story of their own to share.  You see, among the many patient care issues at the Fossil Farm, the staff had been repeated told that they had a serious fire hazard.  The door we left from, the one on the second floor, for years had opened inward, not outward.  This is bad.  If that place burns, heaven forbid, then when people rush the door, it would not open, they’d have to pull it into themselves to get out...that’s not code, and they have been told to change it many times.  It seems that my fire crew, ornery and helpful bunch that they are went to open those doors for us while we worked, and found that they couldn’t push them open.  Well, not ones to be stopped by mere hinge structures, they pushed on the doors until they DID open outward.  I’m sure that did nothing good to the hinges.  They told the staff that they’d have to look at having that fixed, but make sure the next time they came that it still opened outward.  I love those guys.

Well, a good chuckle was had by all, and my anger away quickly.  Nothing makes you get over a bad one like the guys back at the house.  I love this place.