Just 2 beers....

Yesterday was pretty uneventful, until the bars closed. A girl driving her boyfriend in a Cavalier thought they were on a highway on-ramp. Turns out they weren't, but they didn't figure that out until they hit the dead end @ 70 mph. Went into a city park via a metal gate that had been chained and padlocked shut. Luckily, neither one was hurt very bad. It was around 2:30 am, (last call in the bars). Of course, when we asked either one of them if they'd had anything to drink, we got the typical "just 2 beers" answer. You could smell the alcohol before sticking your head in the car...
Then I asked her if she had her seat belt on. "Yes, I always do" she said. I pointed out that usually the steering wheel doesn't get bent and there usually isn't a "face print" in the windshield when they have their seat belt on... "Well I thought I'd put it on..."
I know accidents are traumatic events for people, and the more traumatic they are, the less people think straight. Firefighters/medics aren't cops, we only ask questions like that to determine medical care. The police can't give a ticket because we write in our report that the patient admits to drinking or not wearing a seatbelt.

OK, enough with that rant. Now I'm on vacation until a week from tomorrow and will be out of town, so no posts for a little while.

Thanks for reading!!

"What a nice day...

I think I'll spend it at the emergency room"
That has to be what people are thinking. It was sunny outside yesterday, one of the nicest days we've had for a while. I knew we'd be busy on the medic. Yesterday was diabetic/seizure day. Out of the 16 runs we had yesterday, probably half of them were diabetic related, or seizure. Our first run of the day came in @ 0710, and was both. A guy was found below an overpass, face down in the dirt, unconscious and unresponsive. You could tell that he was hypothermic and had probably been there most of the night. He was drooling, and had blood in his sputum like he'd been seizing. Got him in the medic, gave him narcan and dextrose, (that's our uncon/unresponsive protocol), and he started to come around. When we got him to the hospital, turns out the police were looking for him because they had found his car into a pole the night before, but couldn't find him. At the time we found him, his blood sugar level was 15, normal is 80-120. It appears that his blood sugar dropped while he was driving, he hit the pole, got out and began wandering around. He traveled across a highway, and got to the section he was found in. It was surrounded by a chain link fence that he evidently couldn't manage to get over in his condition. As his blood sugar dropped lower, he seized and that's how we found him. Lucky for him, he had several tattoos and just a few teeth, so he'll end up being fine.

Our remaining runs were the typical, "Yeah, I have a seizure disorder but I haven't taken my meds because I ran out", or people trying to regulate their diabetes. A few cold and flu pt's. Just typical stuff.

One of the other medics did have an interesting run. A girl decided she wanted to end it all so she went upstairs to the bath tub and stabbed herself in the stomach with an 8" butcher knife. One of our cops arrived and began talking to her, she got frustrated at him and pulled the knife out of her stomach and proceeded to wave it at him. He stepped back, drew his gun. She looked at him and turned the knife around and stuck it back in her stomach. Medics arrived, stabilized the knife and took her in to the hospital. She went right up to surgery, and she'll probably make it. She must have LOTS of tattoos and VERY few teeth...

"Linda, This is God"

I'm changing the names in this, well, just cause it seems like that's the thing to do... So we'll call her "Linda".

Any given day, all the EMS runs seem to be all the same. There are the real emergencies
sprinkled in every now and then, but for the most part, they're all the same. But, I've learned not to say "I've seen it all". Of all the runs we go on, I have my favorites. Sure, all the medics look forward to the traumas, you know, GSWs, stabbings or the big car wrecks. I also like the OD's, I just feel like they kind'a deserve whatever treatment they get. (I know the hospitals feel the same way, they get too big of a kick out of pushing a nasty charcoal substance into people and pumping their stomachs.) Another of my favorites are "mentals". Sometimes people just kind of drop off the deep end, because of something they were born with or just for no reason at all. You can mess with them, and they usually don't realize it. "Linda" was one of these people.

The way we were dispatched on the run was for a "sick" person. Sick can mean anything, "I just don't feel good" or in this case, a mental. We have MDT's in the medics and ambulances. They are like little computer monitors that dispatch sends info to. Run location, type and any special info they might have on the run. This time it said "Mental. Female, nude, throwing things into front yard". Police were also in route, along with an engine crew. As we all pulled up in front of the house, there was Linda. Linda weighed somewhere in the neighborhood of 400 - 450 lbs. She was naked. At the time we arrived, she was ripping the storm door off the front of the house and throwing it into a pile of other stuff in front of the house. She'd disappear into the house, come out with another armload of stuff, and throw it on the pile. All the time she's doing this, she was laughing, singing church hymns at the top of her lungs. Linda's husband, who weighed maybe 90 lbs soaking wet told us that Linda hadn't been taking her medication and suddenly went nuts. So there we were, 2 firefighters on an ambulance, 4 firefighters on an engine and 2 cops looking at each other waiting to see what the others would do. Linda kept throwing books, magazines, furniture... on the pile singing gospel at the top of her lungs, giggling like a little girl. Finally, the cops started for the door, with us firefighters behind. 10 minutes later, we finally had Linda on the floor, handcuffed. Believe me when I tell you, it's not any fun wrestling with an naked,obese, crazy woman. No mater what you're into. She wasn't giggling anymore, now she was just plain mad. We had to pull our cot out of the medic unit and put it on top of the engine. We put 2 reeves stretchers side by side and strap Linda to those. A reeves stretcher is a flexible stretcher, most people can fit on 1, we needed 2 for Linda. We backed the medic into the hill in front of the house, and carried/slid Linda across the front yard and onto the floor of the medic. Linda started singing hymns again as we put her in the medic, and even giggled again when my partner Andy tickled her feet before we closed the doors. Now Linda's strapped face down on the stretchers, handcuffed, on the floor of the medic. We take off for the hospital with me driving the ambulance, Andy in back with Linda, the cops following in their cruisers and the engine last with our cot on top of their hose load. As we were heading down the road, Andy suddenly yelled up to me that maybe we should try to hurry because Linda was struggling and had almost kicked free of the straps. I don't think Andy was looking forward to wrestling with Linda by himself. Linda was still singing about Jesus and God at the top of her lungs, and I suddenly decided to try to have a little fun. We have a little dash mounted intercom that goes to the back of the ambulance, and I pushed the button and said "Linda, this is God". Andy said that at this point, Linda snapped her head up and said "Yes God?" I said "Linda, these people are here to help you, and I want you to lay still and be nice to them". Linda said "Oh God! I will. I promise."" From that point on, Linda was good, still singing, but not struggling. We pulled up to the hospital, slid her out of the medic on to a hospital bed, and the last I ever saw of Linda was her being wheeled of to a room, singing hymns at the top of her lungs.

I'm not sure what caused this episode, and we were never called back to her house for another. I later found out that "Linda" had died some time later from another ailment.

And so on...

I once had a run where a guy chewed on a morphine patch. He was at a homeless clinic, out cold in the waiting room. He was blue, breathing a couple times a minute, pinpoint pupils. We gave him some Narcan and of course he came right out of it. I started right in on him, "How much Heroin did you do?"
"None" he said, "I don't do that kind of stuff".
"Don't lie to me, you think I just started this job?" I even went into the speech about how the drug we gave him only counteracts narcotics.. blah blah blah.
"I don't do that stuff" he insisted.
I told him "Fine, it'll all come out in the autopsy".
Well, turns out he was standing there that morning and another guy gave him this patch and told him to just pop it in his mouth and chew on it, it'd give him a buzz. I guess that's not a good idea cause buzz him it did, right into a Morphine OD. He didn't know what it was, or what it'd do. Let that be a lesson to you, don't just pop any old skin patch into your mouth and chew on it. Besides, I wouldn't think it'd taste good...

A few other lesson's I've learned...
The more tattoos you have, the harder it is to kill you.
The fewer teeth you have, the harder it is to kill you.
The drunker you are, the harder it is to kill you.
The less you work, the harder it is to kill you.
Now I'm not saying that if you have a lot of tattoos, just a few teeth, a good binge going and are out of work you'll live forever. Chances are that you'll die from some illness at an early age, but, it'll make you like a cockroach, hard to kill. I've had patients in the medic, treating them for GSW's, see a scar across their belly and ask em what that scar is from. "Oh, that's there from the last time I was shot".

Another lesson...
Don't go to a large town, drive into a government funded, low income housing project and ask for directions.
I'll bet I've personally been on 6 runs where we'll have a young kid in a nice car, windows shot out, GSW to the back. I'll ask em what they're doing over in the projects. "I just stopped and asked a group of guys for directions cause I'm lost and they just started shooting at me". "Riiighht... did I mention it's my first day?"

Good Drugs For Bad Drugs

It was back to work yesterday, back on the medic and more of the same. I'll be glad when the flu and upper respiratory season is over. I don't know what it is that make people that feel miserable want to go sit in the waiting room of an ER for 6 hrs just to have the Dr advise them to go home, drink lots of fluids and rest. I try to tell them that for a lot less money. It actually wouldn't have been too bad of a shift except for a Chlorine gas leak that turned into a full-fledged Haz-Mat incident. Kept us out from 2am till end of shift.

The drug bags that we carry on our ALS, (Advanced Life Support), units contain 26 drugs that we are tested on once a year in order to administer them if needed. We go through standing orders testing to prove that we know what drug to give for whatever ails ya'. We carry the basic ones like Epinephrine, Lidocaine, Atropine for cardiac emergencies. We have Morphine for pain, or cardiac. Tetracaine for eye injuries. Lasix to make you pee a lot. Vallium or Versed for seizures. At one time, they were going to give us a couple new drugs to use for rapid sequence intubations. That is for a patient that needs intubated, but wants to fight about it. One of these drugs was going to be Succinylcholine, which paralyzes you, but your still awake and aware of what's going on around you. That would just plain suck wouldn't it? You can't move, talk or breathe, but you're still awake.. Or at least until you become hypoxic and pass out. Would have been a great drug for gags at the firehouse.
Of all the drugs we carry, I personally have a favorite 3. This is just because they are the ones that I see the fastest/best reactions from.
*Dextrose.. I know a lot of people are diabetics, and even if you take your meds or insulin religiously problems can occur, but a lot of our "clients" don't take their meds correctly. A lot of diabetics become combative when their blood sugar drops. I've seen it enough to not take it personally. I had a run a couple months ago where an 80's y/o lady was flat kicking the shit out of the first responding engine crew when we arrived. It took all 4 of them, my partner and I to hold her down long enough to get a line started so we could give her dextrose. 5 minutes later she was the sweetest little old lady you'd ever want to meet. Turns out she was going in for medical tests the next day and was fasting, her blood sugar bottomed out. She even apologized to the firefighter that she kicked in the nuts.
*Adenosine.. This is a way cool drug. Some people have a heart condition that causes their heart rate to speed up. It can get up to over 200 beats per minute. If they are unstable, such as not alert, chest pain or short of breath, then we try to alter their heart rate electrically. That means using pads and zapping 'em. You know... "Charging..... Clear!" That's cool in itself, but sucks for the patient if they're still awake. If the patient is stable, we give them Adenosine. Adenosine is a short acting drug that chemically "re-boots" the electrical system of your heart. It actually stops your heart for 6-9 seconds, then when it starts back up, hopefully it's at a regular rate. We can try this up to 3 times before we have to resort to more invasive measures.
*Narcan.. This is my favorite of all the drugs we carry. I have had patients not breathing on arrival, walk to our medic 5 minutes later. Narcotics, if overdone, can depress the respiratory system. That means that if a person overdoses on Morphine, Vicodin or Heroin to name a few of the more popular narcotics, they could quit breathing. Their heart keeps beating until it arrests due to the lack of oxygen. If you've ever seen Bringing Out The Dead with Nicholas Cage, there is a scene where they go to a bar on an overdose and his partner has all the people hold hands and pray for the girl not breathing on the floor. Cage gives her something and a few seconds later she's awake and everyone thinks it's a miracle. That's Narcan. Heroin overdoses are great patients if you have a medic student with you. The patient will be out cold, breathing 4 times a minutes if at all. Students can take as many tries as needed to get an IV. Students can even intubate. Hit the patient with Narcan and boom, within 1-2 minutes the patient is awake and sometimes pissed as hell because we took their buzz away. Narcan only works on narcotics, I could shoot myself with a dose of Narcan and it wouldn't affect me at all. That makes it a little odd when you come across a person that is uncon/unresponsive, give em Narcan, and they wake right up to tell you that they haven't taken any drugs. I've had patients found with a belt wrapped around their arm and a syringe still stuck in their vein swear to me that they haven't taken anything. Better yet are the ones that admit to shooting up with Heroin, "but it was my first time". I'll ask them where they shot it at and they'll tell me "between my toes". Yep... That'd be my first spot to try it too.

Earned Day Off, or better known as "EDO"

Since we work one day on, two days off, we average a 48 hr work week. Instead of paying us overtime for the extra 8 hours a week, it's in our contract to get an EDO every 3 weeks. Mine just happens to be on Fridays. I'll use these days to either tell of things that have happened in the past, or rant and rave about things I feel are stupid. Hell, it's my blog... I can do what I want.

I can remember as a kid, the only time I was ever at the hospital was to:
* Get my tonsils out.. overnight stay, then right back home to recuperate.
* Get stitches..
* Visit someone that was really sick..
And the only time I ever rode in an ambulance was:
* Dog bite.. had over 100 stiches in my head
What happened to those days? I have responded to 911 calls for people that want to go to the hospital because they have been "Voodoo'd", had a bad dream, need their prescription refilled, had a bead stuck in their nose, had *you name it* stuck in their ass, have a headache, have no place else to go, need a ride across town, too drunk, "took a new medicine 3 days ago and now I'm having an allergic reaction" and my favorite "I just don't feel good".

I had a run a couple weeks ago. 19 y/o male, good medical history, lives with his girlfriend in a small apartment. Mind you, it is 3:30 in the morning. Girlfriend meets us at the curb. "Hurry! He's real sick. He has ammonia and was at the emergency room yesterday. They gave him a subscription but we don't have no money to get it filled." Here we go again... Turns out the kid wasn't complaining of his "ammonia". He had a headache. I asked him how long his head had been hurting and he told me "about 3 weeks". Then came the story, there's always a story... He had been assaulted 3 weeks ago and had been hit in the jaw. His head has been hurting ever since. And yes, he did go to the emergency room the night of the assault, Doctors couldn't find anything wrong. So now, this kid has had a headache for 3 weeks and has decided that tonight, on my shift, at 3:30 in the morning, that he just cant go on and wants to go back to the ER. He showed us his scripts from the previous nights visit to the ER, and he had one for an antibiotic for his upper respiratory infection, and one for pain for his headache. I asked him what he thought they might be able to do different tonight than last night, but he didn't know.

Thanks to lawyers, we are only able to refuse patients for a few specific things. To refuse them also makes us read them a script about "alternative transport" and do more paperwork. So we almost transport everyone. This kid ended up going to the hospital and was told the same things he was told the night before. I think he'll live to call again another night.

Odor Of Gas

As the title of my blog states, it was just another typical day. We probably ended up with a total of 10 runs, 1 was legit.

It seems that days at the firehouse run in cylcles. Some days are difficulty breathing days, some are seizure days, some are chest pain days.. Yesterday was "Odor Of Gas" day. Out of the whole days runs, I believe we responded to 4 that were dispatched as odor of gas. Now mind you, if you have a natural gas leak in your house, that could be bad for you. If you don't asphyxiate, the impending explosion might cause you grief. If a call comes in for an odor of gas inside a residence, the response is an engine and a ladder, all steaming to your house with lights and sirens hell bent for election to get you out of your home and find/fix/mitigate the leak and end the emergency. Our 4 "odor of gas" runs were like this...
#1 "I don't know what I smelled, it just seemed like it could be gas, so I called 911 to have it checked out." Our monitor found nothing, but our noses thought that it could be related to the half a dozen cats in the house that seemed to not have a litter box.
#2 We were called to a house because the neighbors thought they smelled gas coming from the residence. Monitors showed nothing, but we did find a small, dried puddle of what used to be gasoline in front of the house from a car that was parked there that morning.
#3 Had a mutual aid run to an apartment building where the occupants of an apartment thought they smelled gas. I'm not sure what the first arriving apparatus found, but it must not have been gas, they cancelled us before we arrived.
#4 This run was in the middle of the night, as a lot of the real dumb ones are. We arrived to find a group of obviously drunk people standing in their front yard because their house was supposedly full of gas. I can't blame 'em, that's what you're supposed to do. Our monitors showed no gas in the house, and we attributed this to the fact that they don't even have a natural gas line run to their house. Everything was electric. I'm not really sure what they smelled, but it wasn't gas...

We did have a fire yesterday. A couple in their 80's decided to defrost the 'fridge in the basement with a candle. Candle caught the plastic lining of the icebox on fire, fire spread to the contents of the basement, *poof*, basement fire. It went pretty normal on our part, but they were a funny couple. The man smelled smoke, went down to investigate, and came back up stairs to tell his wife that she may want to leave because the basement was on fire. She said "Why leave if the fire's in the basement?" He went back down to try to put the fire out. Meanwhile, the smoke got too thick upstairs, so the Mrs. decided to, instead of leave the house, got to the bedroom. A brave neighborhood school teacher happened to be passing by the house, so he went in to get people out. Talked the guy into going outside, found the woman in the bedroom. That's when we showed up. The brave guy was stuck in the bedroom window, trying to get out and the woman was on the bedroom floor. We got everyone out and they were all ok. Basement didn't fare so well.