Confrontation Averted

It was fathers day and we had a barbecue planned for mid afternoon. The pager opened up at noon for a patient with abdominal pain, located on the other end of our district, 20 minutes from my station. I went to station 73, fully expecting someone else to get to one of the other closer stations, but that didn’t happen. I went enroute. The dispatcher gave me additional information “28 year old female severe abdominal pain respond 30 alpha 4. Alpha responses typically mean no lights and sirens. Every time we ‘light it up’ we increase the chances we will get into an accident. Dispatchers ask callers key questions to determine the severity of the patient which dictates the urgency of our response. I wasn’t supposed to go lights and sirens, but I was looking at a 20 minute ride, and I wanted to take as much time off my response as I could. I light it up. “What took you so long” is what I hear as soon as I entered the trailer from an irate fiancé. The county was busy and even though I had a 20 minute ride, I even beat the county medic in, so this family waited for any kind of help to arrive for a while. 5 minutes feels like forever. 20 minutes is an eternity. I ignored the comment and went to work assessing the patient, who was in obvious pain. A female patient with severe abdominal pain, who looks sick could be bad, and I tried to rule out the most serious. Triple A or abdominal aortic aneurysm, and ectopic pregnancy. But the fiancé and the rest of the family wouldn’t let the protracted response time go, and I could hear comments through my stethoscope as I listened for bowel sounds. I was out numbered 5 to 1, and I checked to make sure I had a clear path to the door in case things got worse. I usually let these kind of comments go, but the attitude was getting worse so I needed to address it. “I am sorry it took me so long to get here. I am a volunteer and I left a barbeque to respond here. I would much rather be at home with my family on father’s day but chose to come here instead. The county is very busy and a county paramedic unit wasn’t available which is why it took so long to get help here. Now I need your help and cooperation to get the best care possible for your daughter.” I was pretty pissed but hoped my attitude didn’t show in my words. “Well it’s just not right” the father raised his voice. Oh Boy. Maybe my strategy back fired. Maybe my attitude was obvious. I thought about heading for the door. “But thanks for being here anyway” the patients mother said, and I continued with my assessment, relieved. I enlisted the help of the family to get the stretcher and get the patient on it. We had the patient assessed and packaged by the time Paramedic 4 arrived.

System Abuser

The tones woke me up at 1 am for a severe bleed at a nearby trailer park. I went to the station and responded solo in the ambulance. I pulled up to the trailer and was met at the front door by a 40 year old woman who directed me to the tiny bathroom in the back of the trailer. “I told him to take care of that….:” she squawked on and on about how her husband should have done this or that, but I really didn’t want to hear her yapping. I wanted to find her husband, and stop the bleed. I walked into the bathroom. The walls were sprayed with blood, and the floor was slick. He sat on the toilet, pale and sweaty. Blood flowed briskly from his lower leg. I wiped it away with a towel, found the exact spot where the blood came from, stuck one finger on the vein that was bleeding, and pushed, hard. Well focused direct pressure is the fix for severe bleeding. And I may have just fixed this guy, that simple. “Sir, how are you doing?” “I don’t feel so good. One of my veins ruptured.” “Yes it did. How old are you?” “45” “Any medical problems?” “No.” And I continued my assessment, while I kept my finger on that vein. The county paramedics arrived and we started a line. We ran some fluid into the patient and his color returned. We were called back to the same trailer 6 months later for respiratory arrest. I responded at 1 am alone again, walked into the trailer and found this mans wife lying on the couch, blue and snoring 2 or 3 times a minute. “Ma’am! “Hey!” I shouted as I shook her. No response. I nuggied her sternum. Still no response to even painful stimuli. I opened her airway, took out the bag valve mask and started to breathe for this lady. She had a good pulse. I took out a nasopharyngeal airway, lubed it and inserted it into her right nostril to help maintain the airway, and I breathed for her. There wasn’t much more I could do. Her pupils were constricted and that verified my suspicion that she was overdosed on pain medication. She has a history of drug seeking. Ruth, a county paramedic arrived also alone. I told her what I had, that I suspected an overdose. She agreed, took out a prefilled narcan syringe and gave a squirt of the atomized drug up her left nostril. The patient began to fight the bag valve mask and supported her own respirations. She came very close to death this morning. Had it not been for her husband finding her, and for me and Ruth making the response, she would be dead. A few months later we are called back to the same residence for back pain. It is the same patient complaining of back pain that has been going on for days, but she decided to wait till 1 am to call for assistance. She refused to go to the nearest hospital because “they don’t like her there” which I interpret to mean they won’t give her any more pain medication there. As I wait with the county paramedics for the ambulance to arrive this woman goes on about how if the short guy who wears Ravens stuff is on the ambulance I’m not going. “Last time he was here he was mean to me and said I was abusing the system. That we are volunteers coming out and she shouldn’t be calling 911 for non-emergencies.” Tim was good at doing that with frequent fliers. “I told him well if you are a volunteer then you don’t have to come out. If you don’t want to be bothered, don’t come out.” I was pissed. She looks up. “You saved my husband that night he was bleeding. “Saved you too, when you overdosed. But I’m a volunteer, so I guess I should have stayed home.” She got quiet, but I don’t think she got it. The ambulance arrived with Bill on it. I gave him a heads up on what was going on with this patient – really nothing, certainly nothing emergent. “You want to start a line?” I really wanted to. I wanted to start an IV on this lady just to inflict some pain, to give a little payback for abusing the system, and then bashing the people who work tirelessly to serve a leach on society like this. But she didn’t need one. I was grateful Bill was on the ambulance to handle the transport, because I had no patience for this lady. And I haven’t been back to her trailer since.

Stuck Pig

Holy shit, I thought. This lady should be pretty bad. There was blood squirted across the walls of the bathroom. “Hi ma’am. My name is Keith. I’m an EMT with the fire department are you ok?” “Oh, I am fine.” She said in a thick German accent. “But it looks like someone slaughtered a pig in there.” She laughed And it did. There was blood everywhere in her bathroom. “Where are you bleeding from?” “Just a little spot right here.” She points to her ankle. “It’s stopped now.” “Is it ok if I check your pulse and blood pressure?” “I am ok, but sure.” I checked her pulse and blood pressure. Both were normal. “Do you want to go to the hospital to get checked out?” “Oh no, I am fine.” “Ok.” Pretty different from my first varicose vein encounter. We were called to a residence at 4 am, down a long dirt road. Marty and I entered the residence and called out with no response. Marty looked in the bathroom “in here!” he shouted. Inside a woman lay in the bathtub, full of bloody water. I ran out to the medic to get a trauma pad, came back in handed Marty the trauma pad and left him. I was afraid of what I would see. He yelled for help, and I reentered the bathroom. The woman was beyond pale, and not responsive. We pulled her out of the tub and laid her on the bathroom floor. We started to wipe her down to try to find where the blood was coming from. It was a varicose vein on her lower right leg that was ruptured. We put direct pressure on it, then wrapped it tight with kling, put her on the stretcher and rushed her to the ambulance. She was in decompensated volume shock. She lost so much blood it was affecting her brain function. Marty started 2 large bore ivs and ran them wide open to replace fluid. I drove to the hospital. When we arrived and I opened the back doors, the woman who was pale, white and unresponsive on scene was sitting up, pink and talking. It was 5 am, the sun was just coming up, and I couldn’t think of a better way to start the day than knowing I played a role in saving this woman’s life, even if I initially was too cowardly to jump right in, I was ready to charge in first next time, and deal with it, which is just what I did tonight.

Quiet

The quiet after accidents is what often strikes me the most. It seems that a very chaotic scene should be really loud, but they always seem very quiet to me. We were alerted for a pedestrian struck on Route 1, in front of a bar. This section of route 1 has a bar on each side and people often run between them. They sometimes get hit. I went to the station and took the ambulance out by myself since no one else showed up. I could see the woman in the middle of the road as I approached. She was lying face up, like she just decided to lay down and take a nap. I pulled past her and parked the ambulance across the lane, to protect me from oncoming traffic, got out and walked back to the body. A small crowd had gathered, but I didn’t hear anything. The world was narrowed to just me and this lady. A man approached. “I am an EMT and she is dead. She was thrown at least 100 feet. I saw the whole thing.” “Ok” I knelt down beside this woman and felt for a pulse. There was none. She looked perfectly normal except for her grey color. There wasn’t any obvious deformity, but as I did a quick initial assessment I could feel that her skull was crushed through her long blond hair. She was a bag of goo. It felt like her body had no internal support left. I wanted to work her. She was so young, maybe 20, and beautiful. But I knew she was dead. “EMS lieutenant 73 dispatch. Priority 4” It was hard to pronounce her. Priority 4 is a designator that technically means no patient, but in my region it means the patient is dead prior to EMS arrival. There was nothing I or anyone else could do for this young woman. I knelt in the middle of route 1 with this dead young woman, and the world around me was silent. It was just the two of us, even though a group was gathered. “What is that lady doing out driving at 2 am anyway?” one of them said about the woman driving the car. Really? You are blaming the driver who struck this woman, who was out running between bars My patient now became the driver of the vehicle, and my concern became the crowd. I really don’t remember the driver much. I know she was upset, but she didn’t do anything wrong. Law enforcement arrived and helped secure the scene. I put a sheet over the body. The forensic investigator arrived. I didn’t have to, but I stuck around to assist with the forensic investigation. I felt I needed to for some reason. I had some kind of connection to this person I had only met in death. Maybe because I was the one to decide she was dead. Six years later, I met her husband. He had no idea I was on that call. He had no idea I was in EMS. As he described the scene, I knew instantly who he was talking about, and 6 years later he still blames himself for his wife’s death.

Naked Guy in Trailer Bathroom

Marty and I left the station for a person fallen call. Marty is a truck driver and EMT. He is an avid hunter and is always laughing and joking. He is a solid guy and I enjoy running with him. The call was to an age restricted community of double wide mobile homes. We were met by a concerned neighbor at the end of the driveway. “He is in the back bathroom. I think he is dead. He has been there a few days.” The neighbor tells us. Marty and I prepared ourselves for what we were about to see and smell. A body in a hot trailer decomposes rapidly. We cautiously entered the trailer, and saw a shotgun on the sofa of the living room. I didn’t smell the distinct odor of a decomposing body. We called out with no response, and slowly walked through the kitchen to the back hallway. The trailer was dark. There weren’t any lights on except for the light coming from the back bathroom. I could see a hand sticking out of the doorway. An elderly man laid on the floor of the bathroom next to a tipped over potty chair, and motorized wheelchair. He was covered in urine and feces and it looked like he was there for a while. He was large, tall, bald and naked, and he was an amputee with his left leg removed above the knee. His skin looked normal, not grey or purple like I expected. “Sir, can you hear me”? I shouted, afraid to get close to the mess on him and the floor. His eyes opened. “Help me!” he grunted. We were shocked. We expected this man to be dead. “Sir, what happened?” I asked as I squatted next to him to feel a pulse and start my assessment. He answered in unintelligible words. Marty started to get a bp as I checked pupils. “Can you tell me where you hurt?” “Help me” “We are trying but you need to tell me what is going on.” “What happened? Where do you hurt?” “My leg! my leg! Marty got a normal blood pressure and moved on to check a blood sugar. I went through a list of possibilities of what was wrong with this patient in my mind as I tried again to ask what happened. “My leg!” The blood sugar was normal. Bp normal. Rules out two likely reasons for this guy to be rolling around in his own feces. I stepped into the tiny bathroom to continue my assessment. The floor was slick with shit, and both Marty and I almost wiped out. “Go get a bunch of sheets we can lay down on the floor to give us some traction.” I couldn’t figure out what was wrong with this patient. He really wasn’t able to communicate, or follow commands, so I couldn’t rule out stroke. He had a good airway he was able to support, was breathing adequate and his pulse was strong and regular. I didn’t see any obvious life threats, but he did have an altered mental status. It didn’t look like anything was going to kill him in the next few minutes but we needed to start moving to the hospital now. Tracy arrived just as we were finishing our assessment. There wasn’t any room to work in the bathroom so we decided to slide the patient out into the hallway. There wasn’t anywhere to grab the patient; he was as slippery as the floor. Marty and I both got one hand under each arm and inched him out through the door and tried not to have our feet slide out from beneath us. Neither of us wanted to end up on this floor. He screamed with each move, but we really didn’t have any choice. Our physical exam didn’t reveal any injury, he couldn’t tell us what was causing his pain and we needed to get going. We placed a backboard next to the patient and rolled him onto it, mostly to get the patient from the floor to the stretcher. We wiped him off as much as we could. It was good his neighbor stopped by, but we weren’t sure why he described his neighbor as “dead by a few days” when we arrived. This patient was very much alive and was home the next day. Marty and I joked about with friends like that who needs enemies? But the truth was that man owed his life to a concerned neighbor. His potty chair tipped over when he was transferring to his motorized chair after using the bathroom. He fell to the floor and tried to pull himself back up into his chair. No one could hear his cries for help. He was there in his feces for two days before a neighbor came by to check on him. He was exhausted and dehydrated by the time we found him. We need to look out for each other. If his neighbor didn’t stop by to check on him, he probably would have died.

Bariatric

I responded to a call for a sick person in a local trailer park, and since it was close to my station, I knew I would be the first one there. I arrived and knocked on the door. I heard a faint voice say “Come in.” I opened the door and found a morbidly obese woman, 500 maybe 600 pounds, lying half on and half off the hospital bed in her cluttered living room. She was naked from the waist down and I could smell the diarrhea from the door. “Hi Ma’am. My name is Keith. I am an EMT. Are you hurt anywhere?” I asked as I walked into the trailer. She told me she wasn’t hurt, and that her problem was diarrhea that she has had for 3 days. Her husband died 6 months earlier. I had no idea about how we were going to move her. She enveloped the side of the bed. I called for a manpower assist and continued my assessment. I asked the usual questions about medical history and medicines, and tried not to gag from the overpowering smell of the diarrhea. Paramedic 1 arrived and I gave my report. Annie, a paid paramedic with the county and a volunteer with a neighboring fire department looked at the situation. Teresa arrived along with about a half dozen other people all standing there gawking at this poor half naked woman. I covered her up with an afghan that was folded on her couch. We figured we would try to move her back onto the bed, and get her cleaned up in the process, then transfer her to a stretcher specially designed for morbidly obese patients, which we didn’t have. I called dispatch to have a regional ambulance transport company respond with their bariatric unit, an ambulance specially outfitted to move and transport morbidly obese patients. Annie, Teresa and I decided that we could use the sheet already under her as a sling to roll her back onto the bed. We went over the plan with our patient, and told her that we would need her to grab onto the rail on the opposite side of the bed to help us pull her back up. When we had her up off the floor, we would clean the diarrhea off of her butt and legs. I asked everyone to leave the room except for the 5 people we would need to move this woman. She was humiliated enough and didn’t need any more gawkers standing around. We wriggled the sheet into position, and on three we moved her slowly back up onto the bed. Annie got onto her knees and wiped as much diarrhea away as she could. I left the living room gagging, got a few breaths of fresh air outside and returned. We noticed that she had a vertical bed sore on her hip, right where her skin enveloped a post on the safety rail of the bed. I couldn’t imagine the discomfort associated with laying in the same position, with the rail digging into my skin. The fire department chaplain came in and recognized this patient. He is a retired minister and is approaching 90. He often parks his car in the middle of accident and fire scenes, which makes operations more difficult, and he almost ran me over on the scene of a fire once. He is the photographer for the department and still uses film. But his heart is huge and he has dedicated his life to the fire service as much as he has dedicated his life to the Lord. “Do you remember me?’ he quietly asks. “I deliver meals to you on Mondays.” He adds. “Oh yeah, I remember you.” “How are you?” the chaplain asks and starts to chat with this woman. Which is exactly the treatment needed. We really couldn’t do anything until the bariatric unit arrived. The chaplain kept her spirits up as much as possible while some of the firefighters tried to determine if the rickety porch would collapse under the weight of her, the stretcher and the 6 people moving it. The bariatric unit finally arrived after a 45 minute wait. We placed a transfer board, basically a piece of thin slick plastic that makes shifting a patient from one bed to another much easier, between the patients bed and the stretcher able to carry 800 pounds, and with as many hands as we could fit around the bed, slid the patient onto the stretcher in one move. The porch creaked and sagged, and we worried about it collapsing so everyone was moved off except for two and they slowly moved the stretcher down the plywood covered ramp. We attached the cable to the stretcher and winched the patient up the ramps attached to the back of the ambulance, locked the stretcher into its bracket, closed the door and sent the ambulance on its way. This was the end of the call for us, and soon we would all return to our dinner tables, families and jobs. We did well with a significant challenge. But this wasn’t the end for the patient. Her ultimate problem won’t be solved. She would return home alone, dangerously obese. The chaplain would bring her dinners on Mondays, and we would be ready for the next call here.

Just a Little Dizzy

About 6 months later we were alerted for a patient feeling faint. The address sounded familiar, and sure enough it was the same trailer. I walked into the front door and the patient immediately recognized me. “How are you doing?” I said with a big grin, really happy to see her out of the hospital and home. “I am ok. I did break my hip but they pinned it together.” “Why did you call us today?” “I just feel a little funny, a little dizzy.” Her son barged through the front door, panicked. “What’s going on?!” “She is ok, just feeling a little faint.” I said. “Ma’am when was the last time you checked your sugar?” “Oh I don’t know. Yesterday maybe.” “Ok, can I check it now?” “Yes.” I swabbed her index finger with an alcohol prep, and waited for it to dry. Stings less that way. As I prepared the glucometer and lancet I spoke with her son. “Is she taking her medication as prescribed?” “I don’t know. She is becoming less reliable about those things. She fell twice last week.” His voice shook a little. “You know the drill Mrs Smith. On the count of three you will feel a little prick on your finger one two three.” click. The lancet pierced her skin and a small drop of blood formed. I placed the glucometer strip into the drop and waited for the machine to analyze the sample. I wasn’t sure what was causing Mrs Smith to feel dizzy. Her sugar was normal. Her blood pressure and pulse were good. I wanted a paramedic to do a 12 lead EKG to look for any cardiac problems. We placed Mrs Smith on our stretcher and put her in the back of the ambulance just as the county paramedics were arriving. I heard her son say “Mom you can’t live alone anymore” as I briefed the paramedic on what our assessment found. I was happy to see my patient out of the hospital, but sad to witness the beginnings of her loss of freedom.