Anatomy of a Butt Kicking pt 2

Well, that was a long post.  I’m going to try to keep the individual calls short here, and focus in on the more fun or interesting points.  I’ll list them all though, just to lay out a timeline.

Okay, so last time we left our dashing hero leaving the hospital and heading out for a well-deserved meal (notice no mention of lunch in that last post), after saving the damsel in distress from vehicular doom.  The crew was feeling pretty full of ourselves, and ready to take on most anything.  Wayne had the radio playing and we were jammin’ in the cab of the unit.  Wayne was thinking a sit-down dinner was in order in light of our day’s adventures.  “At what point in the last 4 hours did you think we were going to get to sit down somewhere and eat?” I ask him and laugh.  All I get is a smirk from him.  We agree on Thomas’, it’s a small Italian deli type place in a strip mall with good Calzones and tables.  I figure we can get things to go, and just sit and eat.  Of course, as we are pulling around to the parking lot….

1752 – 1805:  We get hit for an auto accident in our second due to our south.  The intersection of 234 and 1 is a good site for them.  This one is just up the road from there, but means that while the response down is not too long, the ride back in traffic will take a while.  As we pull out of the parking lot, I notice a lady laying in the grass next to a Checkers.  Nice day for it, the weather was perfect, mid 70’s (not Celsius ya ozzie) and sunny, breezy too.  At any rate, better than driving today I think.  “Put on your vests!” I yell back to Cat and Jon and we are off.

The engine is already there, along with PD when we arrive.  The second due engine is staffed with a bunch of guys from our department who have gone down to fill in while that station does training or some such.  It’s odd to see them running calls in the wrong unit, but good for a chuckle.  There is not much to the wreck, and everyone is parked in a gas station now.  One guy is an asthmatic, and the dust from the air bag messed him up some, but he hit his inhaler and was feeling better. Cat said his lungs were clear and he didn’t want to go to the hospital.  I smile at Jon, and hand him the refusal form. “I believe you know how to use this…” and off he goes to collect the signature.  I chat with the PD Sergeant on scene, and comment on the rash of accidents going on all over.  Must be the nice weather…start of stupid season.  We get the paperwork signed and start the slow drive back to Thomas’.  I start sending a text message to MedicJon when he calls me.  No kidding.  We are enjoying a chuckle, and he is telling me I’m a puss for not running calls as we pull into the lot at the restaurant.  I notice the lady who was in the grass before walking up the sidewalk with what could only be described as a very ‘unsteady gait’.  She’s drifting towards traffic.  “Wayne, that’s a patient” I say to Wayne, and “Uh, I gotta go…no kidding” to Jon.

1821-1849:  I hop out of the unit and jog up to the lady.  “You okay?” I ask.  She turns and smiles.  She looks dirty in a “I’ve been outside all week” kinda way, and has white something or another on her lips.  She says, “I’m TIIIIIIRed.  I been up THREE days.”  “Wow, space cadet.  Helloooo Major Tom” I think (Some people call her Maurice maybe?).  Well, it’s a call anyway.  I radio back to communications that I’m on the scene of a sickness, and pick one of the stores as an address (Actually, I used Thomas’ address).  
I have to help hold her up as we walk back to the unit.  Cat and Jon are coming over, surprised that there is a patient and not a pizza in their immediate future.  She climbs in the unit and proceeds to tell us that George Orwell told her that there is no such thing as liberty, and (more to the point) that she stopped taking her psych meds.  (Winner!)  A look through her bags finds Haldol and Cogentin bottles, both full.  My mind trys to think of how big a party that represents, and wonders how psychotic you are to get a big bottle of anti-psychotics.  Her vitals are stable, and she likes the cot.  She rambling about reality or something, and laughing at her own humor.  I smile as I dial the hospital…they are gonna love me.  “Picked one up off the street…” I start my report.  That went over well.  I explain that I have one for “room 10”, the psych room.  When I get there, the Charge Nurse asks how gone she is and I explain that while I’m not a shrink-ologist I believe the DSM-IV would classify her as “Nucking Futs.”  The nurses get a chuckle and go meet me in 10.  We get her dropped off, and she tells us the hospital beds are even better than the cot.  The charge nurse tells me “Enough of the Good Samaritan stuff…stick to the ones that call..okay?” and she laughs.  Jon tells me that he has never had a psych patient, but the grin on his face tells me he enjoyed his first time.  The turnover and report go fast, and we are back for dinner….again.  This time, we don’t even clear the parking lot when the MDT twinkles the “You’ve got calls” tune.

1850-2003:  I hear Jon and Cat moaning at the sound of the alert, even as I am giving our battle cry de jour, “Put on your vests!”.  MVA, same intersection as before.  New wreck, this time word is two kids are out on the grass, unknown if ejected or removed.  Wayne has a special gear for that, and I hear the unit shifting into it as we clear the parking lot and dive into traffic.  The engine crew was there again, and we got a basic too.  A buddy of mine who is the Rescue Captain of that department came along…calls with kids will do that.  A quick size up shows only the kids as possible patients, and it is very clear that they were NOT ejected.  Grandma took them out of the car and set them on the grass.  The basic crew, some of the engine the crew, and Cat and Jon were checking out the kids.  I chatted with the Captain for a bit, and bemoaned a lack of dinner.  I was thinking refusal or BLS transport, but then they said another lady had an ankle injury…three patients, means two units to transport…we got business.  The basic asked for the ankle, so we got the kids (age 5 and 7)  They looked and behaved fine, but had said that their back and necks hurt, so had people holding c-spine.  We have to Pedi-board them.  They are NOT happy about it, and are screaming.  They start swearing they are okay, and we check with Grandma.  She wants them checked, so we slide up behind them, lay them back and board and collar them as they try to fight us off.  I’m not fired up about traumatizing a couple of kids, but we gotta do this right.  Long, tearful, wailing story short…we haul them to the ER.  The older one wants out bad and pulls at his straps and squirms as we re-secure him a few times, the younger one gives us a scare by using sleep to cope.  He opens up when we call him and all is well.  We take them to minor care, and give parallel reports to the nurse.  Okay, Dinner…really…

We get back to Thomas’, even get to order.  Good thing too, because we are all starting to loose our sense of a good time here.  Blood sugars were getting low.  They toss in the drinks for free, and having seen us drive through the lot and respond off a few times, they promise to take good care of us. Mmm, Calzone.  

2020-2023:  As we are waiting for the food to come up…the call comes.  Auto Accident, of course, this one just up the road.  Groaning, we pile back on the unit and put on our vests of course.  We make it just up the road when the engine gets on the air and declares the accident PDO (Property Damage Only) and we are put in service.  “Thank God for small miracles” I think, and Wayne pulls a u-turn and we go back.  

This time dinner is waiting, and smells GREAT.   We even got to eat it back at the station.  Calzone and Onion Rings are NOT on the diet, but sure tasted good.  Jon is saying that he is getting some calls he has not had yet, and is pretty excited about the way the day has turned out.  I plow through dinner and head over to the radio room to log the days events, when I see the guy on the ramp.  “Dear God, please let him need directions.” I think.

2106-2114:  I open the door, and the guy asks if we can check him out, and look at his blood pressure.  Sure thing, come on in I say, and I have Cat walk him back to the unit.  I go to the CAD terminal and message communications that we have a walk-in, we are on the scene and don’t need any help.  They acknowledge, and I hear the dispatch hit the air.  I go back to the unit, and climb in to hearing Cat talk to the guy.  It seems he was in an accident (of course) a few days ago, and is feeling stiff in the neck.  He was checked out at the time, and has a bruise to his right ribs, but was okay.  He was concerned about his pressure, and while a little elevated, it was not bad.  Looked like someone in pain.  He said he’d take something over the counter for pain and see his doc on Monday.  Another refusal and we are good to go.  It has gotten dark and we walk back to the trailer to finally relax.  For a solid seven minutes.

2122 – 2140:   We get sent with a basic unit (a good sign) to an injury in our first due.  Injuries from a fall.  Further information is a baby of like 10 months fell from bed.  No, another message says Dad dropped it.  (Paging Mrs Spears…)  Baby is crying the dispatch conveys.  Sounds odd, but the description makes it sound pretty minor.  The ambulance gets in ahead of us and beats us to the scene.  (Wayne later explains to Jon that that was not a coincidence, they ALWAYS seem to be able to “smoke us in” on BLS calls.  Must be something about the roads….).  En route, we all make the critical patient care decision to go to WAWA for coffee after the call.  We enter to find mom holding a baby, still sniffling some, but basically calm, curious and wary of strangers.  There is no laceration, on consciousness issues, and everyone but mom seems calm.  Dad is downstairs in the basement apartment, and I have someone take me down to see where it happened.  The BLS crew is checking the baby, with Cat peering over their shoulder when I get back.  There was nothing remarkable about where it happened, though Dad seems surprisingly disinterested.  (Something I passed on to PD when they got there.)  The basic crew said they were good to go with the call and we head out.  I hear them marking clear with a refusal a short time later.  Coffee time!  (I recommend the Kenya AA, good stuff when it’s fresh…kind of a warm wine taste to it.)  

A bit of time passes and things are a bit more calm.  I know there is more to come, so I lay down with my boots on for a couple minutes.  I have 8 years of station 12 living, and I know how these days go.  It’s far to early to stop, and you rest when you can.  Wayne, Cat and I are starting to share inside grins and comments.  Jon is hanging in so far, but slowing just a touch.  We know we are not likely to sleep much, and we know it will hurt, but then, we are also sharing a bit of “good old station 12 butt-kicking” veteran camaraderie too.  

2317-0035:  We aren’t disappointed.  Just after 11pm, we get hit deep into our 3rd or 4th due for and unconscious diabetic, 23 or so year old female.  It’s going to be a bit of a haul there, so I’m hoping she’s not out TOO bad.  The first due crews are there fast, but I don’t hear anything over the air.  We eventually arrive to find 5-6 20-somethings standing outside a townhouse.  They are all hammered.  They were at the chili-cookoff in DC that day and I smell the alcohol at 10 paces.  I’m starting to think the diabetes has little to do with it.  Upstairs we find the girl laying in bed, with LOTS of people around her.  A dexi comes back okay, so we know her diabetes is not the issue.  She apparently talks some, so I weave in and ask her what’s wrong.  She eventually moans that she is tired.  No shit.  She reeks of stale beer.  At one point she says that she does not want to go anywhere.  Well, To F’in Bad.  I’m not letting her refuse.  I am thinking that there is no way that one holds up in court.  I have the crews bring up a reeves and get the cot ready.  We flop her onto the reeves with no reaction.  I’m asking about possible drug use, and she swear no.  She did say that she was the Designated Driver, so she only had “3-4”.  Nice, the unconscious one is the DD and the ‘sober’ one.  Good plan kids.  The girl is best described as “pliable”, she basically sleeps the entire time we haul her through the house, down the stairs and out the door.  (the halls were very narrow, and we could only get one person on each end of her.  I had to carry her head directly in front and beneath me.  I described it as the “tea bag carry” to the ER Tech…that one got a chuckle. For a visual, but not at work!  Okay, bonus points for the dude’s tee shirt…that’s funny!  She didn’t react the whole time, she was out.)  We get a stable set of vitals, good ECG, and a line. No trauma, good dexi level.  She’s really gorked, and we start talking about why on the way up to the hospital.  I let her boyfriend, who I put at a BAL of .2 up front with Wayne.  (I love the look the truly wasted get when they are trying to be serious). Everyone there, including boyfriend, says that there was no chance she got slipped something in a drink too.  She takes a med for low blood pressure (pressure is fine) and has flexoril for back pain.  She said that she didn’t take the flexoril because she was drinking.  Jon is thinking something heat related because of some sunburn she has, but we kinda doubt it.  We are really leaning toward the beer + Flexoril solution.  When we get to the hospital, the boyfriend tells me that HE gave the girl her B/P med that night…making me even more confident in the drug mixup.  The techs at the ER get her prepped pretty fast, and she does not react at all to being disrobed.  The Nurse comes in and I am able to give report.  As we get ready to head out, Wayne thanks us for giving him the boyfriend.  It appears that when Wayne hit the first intersection and turned on the sirens, he started to hear “woo, WooooOOOoooo” from the guy in the passenger seat.  My Boy played siren all the way to the hospital.  THAT got a laugh from all of us, and a plan is immediately hatched to use the PA system and a “woo WoooOOOoooo…I’m am ambulance” up the street on some early AM call, but only past a Police car.  

I actually got into bed and started to drift after that one.  Of course..that only makes it hurt more when..

0107-0206:  Damn, woken up, JUST drifted off, and I hear those words we at 12 hate…”Box 12-01, for a sickness…” Wayne, Cat and I all say the address in unison…the Fossil Farm.  This time it is for a lady we have taken to the hospital before.  She’s a former nurse, is deteriorating fast, and has a real issue with the staff there.  I don’t blame her for that, of course, but she is developing a pain med issue and has a habit of calling us directly without letting the staff know.  This time the staff is calling us, and they are pissed at the patient.  We get in and out fast so they don’t argue.  The stories don’t match, of course.  Staff says she refused her meds all day, She says she was in dialysis and they forgot to give them when she returned.  Staff says she is on fluid restrictions, but drank about 32 oz of Orange Juice.  She says she has no restrictions.  As we get in the unit she is telling us she may code.  I’m telling her she better not.  She says that the last time she went to the hospital, she coded, and she remembered it all. (she didn’t like being shocked).  She was in A-fib, rapid ventricular response, and a blood sugar that read “HI” on our unit.  Lungs clear, BP good.  I thought I recalled her having crap for veins, but I it it on the first run.  Well Hot Damn.  “you got good veins after all.” I say…”Like hell,” she says, then looks over, surprised, at the access in her arm.  I reach over to get the end of the IV tube from Jon, and he’s zoned for a minute.  I bust his balls a bit (verbally, not literally) and he snaps out.  He’s just tired, and hitting the wall some.  I see Cat start to dive towards me and look down to see that my finger has moved, and I’m no longer blocking off the catheter correctly.  I have blood flowing off her elbow, down my shin, over my boot and on the floor.  (told you I got that line!)  A pretty solid stream of obscenities  go through my head, and I snare the line and place it quickly.  Cat blots up the blood with a towel, and I spray my pants with a disinfectant.  It seems fatigue is sneaking up on us all, but I’m displeased.  The patient is stable, if unpleasant, and we get her to the ER.  I give all her paperwork and report to the RN, and explain the possible stories.  The unit gets a quick mopping as well as restock, and we get back to the house.  We enjoy a grin at our day again, and know we are showing Jon what running a Medic “is really like”.

0218-0234:  We aren’t back long when we get sent with the engine for an assault.  Some dude has shown up bloody at a 7-11.  We are told to stage and head over to a nearby McDonalds to wait and see.  We are sitting there a while, tired and bored when I look at Wayne.  “Hey, look into the cab of the engine…they look mostly asleep?” I ask.  “yeah.”  Grin… “Okay, when I say…turn on the lights, haul ass forward and circle the McDonalds.  Don’t go to the call, just come back here.”  “yeah, right.” Wayne responds.  I explain that I’m dead serious, and a big ole shit-eatin grin comes over his face.  I grab the PA mic, turn it all the way up…”LEROOOYYYY JENKIIIIIIINS!” I cry into the mic, and Wayne takes off.  He whips around the building, lights on, no sirens, and about half way, I have him kill the lights.  (Turns out there are other cars in the lot over by a bar…ooops)  As we come back to the start, we see that the engine has moved, and started towards the call.  Oh Shit!  “Turn on your lights so they see us!”  The engine stops. Pauses, and starts to turn back.  Wayne and I chuckle like 10 year olds at a fart contest.  I put on a straight face as the engine comes back and the driver pulls up by Wayne’s window.  “What the hell was that?” he asks.  “Sorry, I was bored” I explain.  The look on his face was classic.  He bends down Wayne’s Fisheye mirror and pulls off to turn back into position.  Wayne and I laugh so hard we cry.  I can hardly breath, and I’m pounding the mapbooks.  We pull it together, and I text communications for a status.  Shortly after we are placed in service by PD.  We are still chuckling as we get back to the house.  I crack me up.  Time for bed again.

This time, I even break into REM…..

0445-0528:  We get woken up to run to our second due to the north for difficulty breathing.  The patient is a little old lady who woke up and was scared.  She is friendly and lucid, but we check everything just in case.  Good BP, clear lungs, Dexi is okay, ECG is fine.  In short, pretty damn good for 85 or so.  She told me that she woke up nervous. I asked if she had a date that she was nervous about, and that got me a smile and a denial.  She has been a friend of our department for quite some time, as evidenced by a sticker on the window by her door of an old logo we had.  We mostly chat for a bit, and she decides everything is okay.  We have her sign a refusal, and tell her it’s good to see her, that she can call anytime.  Then we head back for the beds.

I tell Jon that we might be done now.  Too late for the drunks, too early for anyone to wake up dead.  I explain that pretty much our only issue is heart attacks.  Chest pains waking people up to call us.  As we climb into bed, a call goes out for another medic unit nearby…Chest Pains.  I smile and pull up the blankets.

0652-0703:  The sleep of the just was broken by a string of tones.  A fire call.  Well, that’s different, I didn’t think there WERE fires anymore.  (grin Matt)  Turns out I was right.  We respond off into the risen sun and stage.  It’s food on the stove, or smoking dryer or something generally not on fire yet.  We are placed in service and head off to WAWA.  It’s time for some Kenya AA.

The shift ended, we ask Jon how he liked it.  He’s enthused and tired, and may even come back.  I assure him that there is more where that came from.  We double check the unit, and pack up for the day.  I photocopy a log of our calls to write this from.  All in all, probably no lives saved, but a good dozen people helped.  Some bad, some not so much.  But, they called, we came, and even got a couple Thank You’s for the run.  We cursed, laughed, and told stories.  All in all, it felt good at the end.  We were tired but content, and we are all looking forward to next time.

Anatomy of a Butt-kicking Part 1

Alright, as I promised earlier, (and I hear expected by several of those around me) I am finally getting some time to lay out a good solid busy day-in-the-life of a medic at DTX.  This Saturday had us staffed from 0844 until 0720am Sunday morning.  During that time, we got 16 runs.  While not a record setting day, it is certainly a full one.  That we had a rider with us, a lead EMT off a sister unit looking to “See what being on a medic is REALLY like” was just a case of perfect timing.  I don’t know if this will all fit as one post...but we shall see.

The story really starts the night before, at one of our other stations, with DTXMatt and I playing poker with seven others.  I had a weak night and went out somewhere in the middle.  Matt played well, but was up against one of the longest hot streaks of cards I have seen.  During that game, Matt shows us an online video that is funny as hell (Leroy Jenkins! -- link below).  We laugh and I promise to use it on duty.  As a result, I arrived at Station 12 about 0230 Saturday morning, and crashed out on a sofa in the main room of one of the trailers.  There were bunks available in the ‘medic bedroom’, but the basic crew on duty was in there, and I did not want to wake them.  As it turned out, they ran quite a bit.  I would not have disturbed them much, and I should have seen it as an omen.  

Morning came early and I awoke to see the Engine boss on duty with his little boy on the sofa asleep.  Cute.  They played some as they awoke, and it was a good way to get going.  I got changed and washed quick, started coffee, had a breakfast bar (we have priorities and good thing too!) and went out to check the unit.  Our rider, Jon (not MedicJon) was there and helped by checking out the engine while I did the back.  Cat and Wayne showed up and jumped in getting ready.  A quick tag up on the plan of the day:  run calls and stay out of the bay as much as possible…it was being painted by the renovation crew that day.  That also meant parking outside too.  I had eaten, but the others had not, so breakfast was next in line, we pick a place to meet the engine for breakfast and we were ready to tell the county we were good to go.  The county must have sensed that because as we were doing the final nods-all-around that everything was good to go, the tones dropped for a first due “sickness” call.  

0844 – 0940:  The second due career medic was dispatched, but we quickly radioed in that we were staffed and responding to the call.  As I had the MDT computer recall the dispatch, I see that we are starting off the day nasty…Pregnant female, lower abdominal pain and heavy vaginal bleeding.  Great.  Almost rather ‘start the day, with a D.O.A.’ (doo-dah, Doo-dah)  She was in her early 30’s, third pregnancy, with one child (G3, P1, A1 for those keeping score).  She was in obvious pain and certainly bleeding.  The call, though, was not terribly complex.  Her vitals were okay and we got her loaded up, started a line, connected her to the monitor and got rolling.  Cat got the honors of the visual inspection, being the resident female, and saw bleeding but (fortunately) nothing else.  A trauma pad was placed to help the bleeding and we head to the hospital.  A good first call for our rider, a default O2, IV, Monitor, transport call of the sort that fills a vast majority of our ‘ALS’ calls.  We drop off the patient, I write report and the team restocks and cleans up the unit.  I stop by the nurses station to see who is on, what Docs we have for the day and how full the ER is.  All critical intelligence to a medic.  The Docs on duty affect what orders we will and won’t get, and the nurses and techs, like sergeants in the military are the ones who really run things.  Piss them off, and you are in for a bad day.  We clear the hospital and it is time for breakfast.  Or not.  As we pull out of the parking lot, thoughts of breakfast are set aside by the chirping of the MDT.  I hear groans from the back as Cat and Jon realize we have another call.  

0941-1043:  This one is for Chest Pains at the assisted living place across the street from the station.  This is a decent facility and a far cry from the Fossil Farm of previous posts.  We arrive to find a lady in her 80’s waiting for us with one of the nurses from the facility.  She’s really pale/pasty looking and generally has an “I’m sick” look.  The nurse gives me a stack of papers with her history, meds and such and tells me that she had heartburn all night, but really looks bad today.  Well Poo, I think, this lady could be 12 hrs into an MI if we are unlucky here.  She’s a diabetic and has a couple other problems too, but I can’t recall what now.  She gets oxygen right away, and tells me that she’s hurting lower mid-sternum and it is about a 6 or 7 out of 10 with 10 being the worst pain ever.  “We gotta run ACS protocol” I say to Cat and she nods.  (Acute Coronary Syndrome...basically, assume heart attack or similar until conclusively shown otherwise for those non-ems readers).  In the unit Cat goes for an IV.  The patient assures us that we wont get one and is so far correct.  Cat is in the vein, but it blows when she advances the cath.  We DO get a dexi on her and it is high, like 380 or so as I recall.  So, she needs fluids for the sugar and nitro for the ACS and both need an IV to happen.  I give Jon two baby aspirin to give to the patient, and I tell Cat, “ I know we told her we would not keep poking her, but if it’s all the same, I could really use a line here.”  She looking but not finding much, so I swing over to the other side of the patient to give a look-see.  About this time, the patient is rather seriously telling us that she can’t have aspirin.  I ask (again) about allergies and she says she is not allergic, but a doc told her not to have aspirin.  Something tells me she means it and I wave off the pills for her.  I get a flash on my little 22 gauge (a tiny little thing more often used on kids than adults, but meeting the requirement of ‘venous access’) and remembering Cat’s attempt, float the line in place.  The line is opened for fluids, and since I’m in her wrist and her veins are so fragile, I board her arm to keep it still.  She gets one nitro on the short ride to the hospital and we are off.  I give report, make the exchange we are doing the write a story, clean the unit dance again.  Jon comments that this one was pretty cool, by which I assume he likes watching me sweat getting a line quite a bit. Grin.

Breakfast and fresh coffee is secured from WAWA instead of the sit-down place we had in mind, but the coffee was good and the crew needed the food.

1132 – 1222:  Breakfast was done and we were contemplating getting comfortable when we get punched for a first-due injury, Man cut to arm or had with an electric saw.  Hmm, this one could be interesting.  We arrive at the house with the engine and are directed to the back yard by the LOL in residence (Little Old Lady in this case).  There we find a grown man in the fetal position holding a bloodied rag to his hand.  A quick check by Cat shows that he had cut the tip of his left index finger cleeeeean off.  It wasn’t much, only about to mid-nail, but then it wasn’t my finger, so I can say silly things like….it wasn’t much. It seems he was trimming the lady’s tree with electric trimmers and lost control. (ouch) Cat handles bandaging, I get history and other information and the engine crew, along with the engine boss from the previous night who came from up the street, look through the bushes for a finger top.  Steve (the boss) has the guys check with the thermal imager off the engine…it is a long shot, but a good idea.  They call off the search shortly after we load the patient.  The cut was about 15-20 min earlier, and it was a non-critical part, so a good faith effort was all that could be done.  The patient was calm, and even joked that he’d still be able to cook after all was done.  We assured him that he was still going to be very functional, and he seemed okay with that.  The ER Charge Nurse had us roll right through the ER and into minor care for stitches.  Well, not the massive shooting-caused trauma we hoped for, but it was something.

We did actually get a couple hours of quiet.  It was a tease.  We watched part of a movie called “Mean River” or some such, and generally took it easy.  A couple of firemen from out of state came by to take pictures of our apparatus, and we shared stories and comments for a bit.

1444 – 1534:  Fossil Farm.  Damn.  I was hoping that on a beautiful day like it was, sun out and a slight breeze, I would not have to go into that piss-smelling crap hole.  I knew it was a pipe-dream, but a man can dream right?  It turns out that Jon had never been there, only heard about it…which explains the sour look on his face when I turn to him as we get off the elevators and into the smell of urine and ask, “you smell something?”  A rhetorical question obviously.  We find ourselves an old guy in a wheelchair, with a lady that turns out to be his wife, and the nurse from the facility.  He fell the night before, and “was okay then” but now doesn’t seem to be able to talk.  He doesn’t have a facial droop, follows commands, and when asked, is able to put a nice even grip on my fingers with both hands.  He’s with it…but can’t speak well.  He mutters some, and sometimes you can gist what he’s saying but not much.  So much for “he’s fine”.  He’s on a fentanyl patch and was given vicodin earlier too.  His pupils are small and Cat and I are thinking Narcotic OD right away.  We search him quickly for a second patch, as often we find a couple on a patient, and that is too much.  We don’t find any but think we can find out quick with a little Narcan in the unit.  (Narcan reverses narcotics for a time…actually it blocks receptors..but whatever).  When we get in the unit, Cat starts taking off the guys shirt to make a more complete search for any extra patches.  The guy grins and caresses her cheek as she opens his shirt….He’s just fine mentally.  “Oh, you like getting undressed by a pretty lady huh?” she asks.  He laughs and smiles.  I chuckle and think, “You should see her in bunker pants” but I don’t share that one out loud.  We don’t find any more patches, and the narcan doesn’t make him any more able to talk.  We get to the hospital and the nurse is thinking Wernicke's Encephalopathy (stroke-like symptoms from thiamine deficiency) since the narcan didn’t work.  Most common in alcoholics, but not exclusively.  I’m getting ready to write report, and Cat is talking with the nurse when Jon rushes by and says, “A510 is came up on an auto accident at (intersection two lights from the hospital), 6 cars, one overturned, one entrapped.”  Now I just heard a medic from our west sent WAY south on a call, so I know ALS units are thin.  I have Jon tell Wayne we are leaving for the call and to get ready.  I find Cat and pull her from the nurse. And we are off.

1532 – 1740:   As we climb into the unit, the radio is starting to explode.  I hear the ambulance that found the wreck trying to give a vehicle count and initial assessment and doing okay but sounding very stressed.  Units are starting to head in that direction, and dispatch is getting out an initial assignment.  I try to mark up, “M512A is clear Potomac and….”  That is all that gets out..my portable is on and starts to feed back over the radio, blocking my transmission.  Stupid, stupid, stupid.  Disgusted , I shut off the portable and try to key up again.  The radio traffic is pretty busy, so I type a message to dispatch on the computer.  “M512a Clear Potomac, responding to Gideon MVA”.  “Put on your Vests!” I yell back to Cat and Jon.  Wayne is accelerating out of the parking lot and maybe a minute later we see the intersection ahead.

The entire intersection is debris, and the centerpiece is a car on its side, driver side down, with someone just sticking out of the driver’s window and a firemen leaning in to them.  “M512A on scene” I radio.  “M512a, are you on Gideon?”…”That’s affirmative” I reply and climb out.  There is one ambulance and one engine there on scene.  There are several clumps of people out of cars holding small wounds in a couple of places in the intersection and on medians.  I put Cat and Jon on triage duty, Wayne rushes to support the car that is wobbling some in the wind, to keep it from rocking onto the driver and firefighter, and I start looking for “command”.  I find the Incident Officer off the engine (the default command in this case) and offer to take care of all things medical.  He’s okay with that and I promise him a count of patients, and what units I’ll need ASAP.  I check with Wayne and he is good on holding the car.  (Now, he’s not holding the car up, it is rocking a few inches in the wind and threatening to rock the roof down on the head of the patient and the fireman that is leaning into the window to help her.  It is very much NOT SOP, but it is what needed to be done…and hey, he’s wearing his vest.)

(A brief aside:  we recently got new reflective vests that we are to wear in traffic.  They are more reflective than our old reflective vests…in fact, with one vest and a pen light, you can land a Boeing 777 in a rain storm, at night, during a lunar eclipse.  They are to keep us ‘safe’ in traffic.)  

The lead off of the basic unit tells me I have one more ALS patient and four BLS patients.  I confirm with her a total of 6.  Two ALS (one in the car, and one somewhere else) and four BLS.  I translate that into needed units in my head quick.  I can take one ALS, two if I split Cat onto a Basic, but we are likely to fly the driver.  Okay, need one more medic for the ‘other guy’, and each basic can take two minor injuries so I need one more of them too.  Okay, cool…now where is command off to?  I walk over to the IO and tell him the count.  He’s good with getting more units and is on the radio doing just that when the BLS lead comes back and tells me that one has refused care and is “okay”.  I’m sure seeing the head of the driver sticking out from under a car made them thing that their scraped forearms was fine, but okay then.  

Long story short(ish) we end up with lots of help, the Squad from our northern station comes to stabilize the car and get the patient out.  A couple people refuse care, and the other ALS patient turns out to be a basic run.  In the end we have three BLS patients and the driver of the flipped car.  I make the call to get a helicopter moving for her.  I have not made a full assessment, but I know the hospital is pretty full, we are sending at least 3 to them, she’s been tossed all over, and I’m told by a witness that the car flipped trunk over hood while spinning and every facet of the vehicle is smashed (Boot over bonnet with a pirouette as Wayne put it)  I take turns holding up the car and coordinating EMS efforts.  Cat triages and treats a couple people, then comes back to get with the driver.  Jon helps treat a few and I have him go hang two big IV bags for our patient, the driver.

The Squad frankly kicks ass and does an amazing job securing the vehicle on its side.  I am not trained in that work, but damn, by the time they were done (just a few minutes) I could have jumped up and down on this thing and it would not have moved.  The car was secured with more room between the roof and the ground than before, so the fireman and Cat were able to slide the patient down, through the driver’s window, and with help from Wayne and I, onto a backboard…all while holding C-spine.  I know the squad guys were disappointed at not getting a cut..but kudos to them for a job very well done.  

We start moving fast thinking the chopper must be close, since it was called before the patient was out.  What we did not know was that the first chopper had an engine problem and a second one was coming.  We get the patient boarded, collared, exposed and loaded into the unit.  She’s remarkably unbroken, totally conscious, and saying that she really feels okay.  She’s worried about her kids, who are being checked by a basic unit, and not feeling all that bad…just a bump to her head.  I start to question the need to fly her, but I’m convinced she’s better off getting the full level 1 treatment even if it finds her okay.  We get the lines started, check her pupils, double check her movement in fingers and toes and do a second sweep.  We find nothing of interest, just a knot on her head and a pain in her left hip.  

Then she asks us to stop her head from bleeding.  I check and it isn’t.  I tell her as much and she says she feels it.  Uh-oh.  “Okay ma’am, that’s why we need you checked out from the helicopter” I tell her.  Later she says something is in her nose…nothing is there.  Something is running down her throat…it is clear.  I’m convinced she’s cracked her noggin and is bleeding internally, but can’t prove it.  The helicopter eventually comes and Cat tells me that the patient is saying her left side “feels heavy”.  (I had stepped out to see what the hold up was…that’s when I heard about the failed chopper)  I’m feeling better about the fly-out decision, and when they get there, the flight crew adamantly agrees.  Trust your gut.  Always.  As busy as the ER was, I bet we saved her every bit of 60-90 min by getting her straight to the level 1 center.  

We head back to the hospital and the unit is trashed again.  We have two reports to write since we left before filing the previous one, still have to replace the narcan from before, and the police are there from the auto accident with a couple quick questions.  The basic crew is already there and expresses great happiness that we flew to come help.  (that’s good for the ego too).  We told them anytime, that they had things under control, but sounded like they could use a hand, so we came to help them.  Cat does the accident report, I do the old guy’s report and Wayne and Jon clean and restock.  As I’m finishing my report, the basic crew comes in and asks if I will speak to the daughter’s and husband of the lady we flew.  They are being checked at this hospital and want to know what is up.  I go to Dad and explain that his wife was alert and feeling basically okay, but that I was very worried about the hit she took to her head.  Cat had found a serious hemotoma forming, and we are all feeling pretty sure she had a skull fracture…possibly a depressed one but we didn’t push to see.  He understood and was thankful for our caution….that felt good.  I then went into the room with the little girls about 9 and 5 I’d say and I told them that Mommy was feeling okay when I saw her, had a bump to her head and had to go to a special doctor to check her out.  I told them that mommy was asking about them and loved them very much and I knew the doctors at the other hospital would take good care of her.  In my head I’m thinking “Don’t lie to a kid….don’t traumatize them either….don’t say ‘Mommy will be okay’, cause if she isn’t….”  They seemed to calm some and smiled at me and when I asked if they had questions, the oldest wanted to make sure the car was gone…she didn’t want to see it when they left.  I assured her that it was, and that helped.  She was also worried that there was a movie they had to return in the car too.  That made me smile.  The little one said her shoes were in there still.  I lifted up the blanket and found two little bare feet.  I asked her if they were off BEFORE the accident (thinking…uh oh…if she was knocked out of her shoes..that is BAD.) and she said they were.  I pinched her toe and told her they were probably in the car still, but she might need new shoes.  She giggled and all was right in the world.  They seemed satisfied, the basic crew was happy and my job there was done.  Even the cop watching the girls gave me a smile and a nod on my way out of the room.  (Yea!  All I needed was a cape and a phone booth to change in…does NOT get any better than kicking ass and making the smile over it!)  With the double report, the feel-good duties, an extended clean up…we clear almost 2 hours after jumping the call.  It is almost 1800hrs and time for dinner…or so we think.

That will have to do it for tonight.  It’s midnight and I have a long day of meetings tomorrow and class tomorrow night.  I’ll finish up the night on Wednesday night I hope.  In the mean time, you have homework.  Watch this video.  It is a capture of some nerd-types playing an online game…and a commentary on blind action over too much talk.  It has a cult following, and is inspirational to us later in the night….(Hey Matt…told ya we’d use it on a call…)

Checking in

Just a fast morning hello, and assurance that we are alive and well. I have been contacted by several people asking about a new post. Cat and I just got off a pretty busy Saturday duty and I am in the process of putting the day into a new post. I think it was a pretty good example of a full day at DTX. We went to the Fossil Farm a couple times, played in traffic lots, called in some air support, got us a nut job, were asked by the ER staff to stop showing up, and missed or delayed every meal of the day. In 23 staffed hours, we logged 16 runs. We had a rider with us who wanted to see what the running on Medic was really like. He saw.

I slept a lot yesterday, and did not get it all put together in time to post. I'm looking to finish tonight, subject to Capt's duties, and I'll try to post this evening. Thanks for the patience, and the support!

Chris

It's the people...

While it seems that I am posting less often, it still amazes me the number of responses I get from various people based on the posts.  The post on life at the firehouse lead to some comments on here, several emails and even a couple phone calls.  More than one of them came from people who had either left the department, or are currently inactive.  That people read that post and felt a renewed commitment or a desire to return to running calls is touching.  A big thank YOU to those of you who commented, wrote or called. I have been struggling with deciding to write up the real story of why I run, how I joined etc, but the more I got the comments the more I realized that I forgot part of the big thing about being in, or at the firehouse….perhaps the biggest part, the people there.

See, much like running calls, one of the things about going into duty, particularly on a new or different crew, is you never know who you’ll meet.  I have met people from all walks of life on duty.  Sure, some, even many are firemen or medics by profession, but most have other ‘day jobs’ to pay the bills.  Now, this seems obvious at a volunteer house, but the impact of that is not so obvious at first.  

Need some yard work done?  I once knew two different people at the firehouse who owned landscaping businesses.  Buying a home?  Realtors a-plenty, and Home Inspectors too.  Boat Issues?  Got that covered too.  Need how-to advise on damn near anything, pretty sure you can find someone who’s done that a few times to help.  Everything from baby-sitters to National security advice can be had at the firehouse.  I have to tell you, if I didn’t meet these people here, there is no doubt that I may not have ever met them.  And I’d be poorer for it.  

To say that these people spend their time at the firehouse, or give time to help a community doesn’t quite touch it.  I know people who drive over 2 hours to get to the firehouse on duty night.  I know some who pay up to $300 per month in child care just to run calls (many people call that a car payment).  I know some who run two nights a week, fill in for others, work a day job, are trying to sell a house and will STILL work your bingo for you if you need it.  There are several guys who live at the firehouse and are available for calls four or more nights a week.  We have high schoolers and we have retirees.  I know people who have run marathons, and I know one who has been offered a job as a professional partier in Aruba.  (I was with him on that one, and I swear I would have never believed it.)  Speaking of which, if you ever have cruise questions, I know some experts on that too.  


I have run calls with Soldiers, Coast Guardsmen, Airmen, Sailors, and Marines.  Highest rank I KNOW I have run with is Lt. Col.  I am probably one of a very few people alive who has told an active US Marine Lt. Col to grab my bags before he leaves.  I know a guy who when delayed indefinitely on the domestic leg of a returning international flight, was able to call one of our then Fire Captains and have his flight given priority service to get them home.  (The guy had the dubious duty to call over a flight attendant and say, “The pilot is going to get a phone call from control offering a round-about route….he should take it”.  Let me tell you, in a post-911 world…THAT gets you some looks).  

I mentioned “that I know of” before.  You see, the people who do this, for all the bravado and BS we sling around the firehouse are generally somewhat modest, or reserved about life outside the house, or even other parts of the firehouse.  For example, I know one fireman who has been a medic of sorts in the past, and is welcome to work my patient’s airway anytime.  (For those of you not medics, that is a HIGH complement).  But he spends his time on suppression and actively denies any ALS skills.  Of course, he’s a salesman during the day and also steals cars for a living, so you can’t trust him.  Grin.  Okay, so he steals cars for Repo, so it’s all good.  

I think at one call I looked around and realized that I was on scene with a policeman, a lawyer, a repo-man, a marine, an aluminum siding delivery man, a defense systems engineer, and a network security guy and a just-out-of-college student all at once.  Of course, we all had on “fire and rescue” uniforms.  It is times like that that you don’t feel all that far removed from the neighborhood bucket brigades and hearse drivers from years past.  Just one of the common threads I have seen between us.

I have heard people, often from those who make this their profession, say that this is a hobby for us, or that we are somehow less trained or able than others.  I understand where that comes from, but I resent it too.  I don’t know of a hobby around that has this sort of draw, or hold on people.  Many of our ranks do this as their paying job too.  I don’t know many people in other professions who work at their job all day, come home and do the same thing again for free.  The people I have met at the station love it, or came to love it if they didn’t when they got started.  As for training, many people here seem to absorb as much as they can as fast as they can, and in a way you don’t see on the job.  Speaking for myself, I’m personally kinda proud of the fact that I recertified my ALS certs for state and national registry in spring of last year, and before the year was out had my letter in hand stating that I had already exceeded the training hours needed for my next recert, two to three years away.  

It seems that everyone I meet at the firehouse, particularly if they have been around for any time at all, actually might have a hard time telling you in words why they are there.  I think it is because they all just really want to help people, and be the ones that do the unusual, exciting things that not everyone can.  Of course, saying that sounds either cheesy or arrogant depending on how you phrase it, so you don’t say anything at all.  

I had a conversation with a relatively new person to EMS the other day.  She could not ride at the time for a couple reasons, but had been recently.  It was fun to watch her agonize that she could not be on that next call out.  Even when you know it is likely no big deal, there is still something that makes you want to know what is on the other side of that response.  We have all felt that.  We have all had those first nights at the firehouse where you are almost afraid to sleep at night thinking you’ll miss a call, or too amped from anticipation to sleep.  I bet I didn’t sleep right at the house for a good year.    You get past that one.  I drop into full REM, drooling, snoring sleep now between calls.  I sleep fast and hard now, but then I’m old, so maybe it is just practice.  On the EMS side, the other really common thing  I see is the look on new leads faces.  You get your EMT card, go through training as a preceptee, and pass an oral board to become a lead in our department.  That means you can go out on your own unit and run calls.  (The process is the same to become a lead medic, just longer and more controlled in the precepting phase).  Usually, you are turned over right about the time you start to settle into precepting after class.  You think you kinda know what you are doing, and you are really glad to have that preceptor there to answer questions, or provide another set of eyes.  Then you get turned over, and BAM, you are in charge.  Your partner may be a non-EMT firefighter as a driver, the tones drop and your out the door and there is no net.  I remember my first call like that.  I got turned over at about 730pm, was leading that night with one other guy and my preceptor was GONE.  First call was an overturned truck on the highway and a 15 min extrication.  I was sweating it bad.  We all survived, even the patient.  As a Medic Lead, you break into a small sweat for about a year after turn over.  I don’t remember my first solo medic run though…isnt’ that odd?  I have to imagine the same is true for being a new Incident Officer (the lead on the fire side) on an Engine or Truck company for the first time.  We have all felt that, and lived through it and despite our various outside lives, we have so much in common this way.  

I guess I’ve met almost every sort there is at the firehouse:  Geniuses and window-lickers, saints and assholes (Dennis Leary stuck in my head now), wizened vets and newbie kids, company owners and housewives.  I’ve seen people grow up, mature, grow old and even die while they were members  (Different people for each…I’m not THAT old).  I have celebrated weddings, births and graduations.  I comforted during divorces, unemployments and deaths.  And still, after it all, I’m struck with how very different we all are, and how very much the same.  And I really don’t think the experience would be at all the same without each and every one of them.  So it seems the firehouse is more than the calls and the activities, and the walls and the equipment, it’s more than the firemen and rescuers, it’s all the walks of life, points of view, experiences and goals of about 300 people who have found the one thing around that could possibly take such a diverse group of misfits and mold them into a common course.