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…)