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.