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.