I don't really have a lot of stories about holiday calls, mainly because I was usually back up in the wilds of the Poconos with the family for Christmas. I do have lots of winter calls, but somehow that doesn't equate to the same thing.
'Tis the season for stove fires,
Fa la la la la, la la la laa!
Suicides and frequent fliers,
Fa la la la la, la la la laaaaa!
Food on the stove calls and kitchen fires are common this time of year, since people start cooking a lot more with the cold weather and holidays, and then forget that they left the stove on with the pot still on the burner as they bustle off to wrap presents or whatnot. Then the kitchen fills with smoke, and they call 911.
Myth says that suicides are up during the winter holidays, due to those with family troubles or problems with the long dark nights. Truthfully, I haven't ever run more suicides during the holidays than any other time of hte year. However, I have noticed a trend towards more attempted homicides during this time of year, usually towards family members. Several years ago, a medic I know went on a call for 'one stabbed' on Thanksgiving. Turns out Son wanted to carve the turkey and Dad said no. So Son grabs the carving knife and carves Dad's arm instead.
The frequent flier calls usually do edge up around now though...either due to the cold and needing a bed and a couple square meals, or the elderly and lonely who just want someone to talk to. For some elderly, especially the widows and widowers who live alone, the holidays can magnify the lonliness, and that can magnify that little ailment that they deal with on a daily basis into something huge and troublesome. Sometimes they only need someone to sit and talk to for 10 minutes, sometimes they need an actual trip to the hospital to ease their mind (not that I like burdening the ER any more than it already is).
Another thing my old company did around this time were 'Santa Runs.' We'd take an extra crew, and the reserve engine and the front line ambulance and put Christmas lights on (ambo was available for calls). Every night was a different neighborhood, and we'd head out with supplies of mini-candy canes. Once at the start of the neighborhood, the unlucky guy would dress out as Santa and we'd replace the deck gun with an old seat. Santa would sit on the seat with the scene lights shining on him, and everyone else would hop on the tailboard or sideboards (or running board of the ambo) and we'd put the lights on and head down through the neighborhood. Short bursts of the siren would call all the kids out and the firefighters, dressed out in their turnouts with Santa hats on, would hand out the candy canes. The ambo usually had on the 24-hour Christmas music station on the radio and would blast it out the PA speakers. And just so no one felt left out, one of our Assistant Chief's neighborhood would have a Hannukah party and we would head over with bags of chocolate coins and blue lights on the engine. Lots of fun for all.
All in all, this was a good time to be at the station. Neighbors would bring candy and cookies and such for us, kids made us Christmas cards, and there was always something going on. One year we had a spare fridge sitting out in the day room (it broke and hadn't been taken to the dump yet). One of the captains and one of the master firefighter's were from an area that was well known for it's farms and 'hicks.' So someone wrapped extra lights around the fridge, duct taped up 2 old socks (one with a hole cut in the toe) and wrote 'Redneck Christmas' in black Sharpie on the fridge, and the name of the captain and the master FF under each of the socks.
You know, much as I like life now, there are times I miss living at the station.
Tuesday, December 23, 2008
Thursday, December 11, 2008
Disturbed
I can only remember being disturbed by a call a handful of times in my career as an EMT. By disturbed I mean totally grossed out, or horribly sad, or scared for my life, making me rethink that whole 'emergency button' thing.
Horribly sad.
Call for an elderly man 'not right,' possible stroke. We got there first, the medic was on it's way. I seem to have wiped the details from my mind (thank God) but I remember that the guy was just totally blank. As in, not seeing who was there, not speaking, the whole thing. The medics took him in. I have no idea what happened to him eventually, but the thing that made me cry was his wife of 60-something years, holding his hand as they wheeled him out to the ambo. "It's ok dear, I'm right here with you. Dear, it's me, look at me." I got back to quarters and cried like a baby. All the calls I've been on, and none have hit me as hard as that one. For whatever reason, I was able to empathize with her on a level I never had with any other family member before, and the idea that this man who had known her for 60+ years, had been with her through thick and thin, children, grandchildren, and who knew what else, would most likely never recognize her again. The thought terrified me, and made me mourn for her in a way that my tiny little black heart had never mourned for a patient before.
Flat-out gross:
Called to the local stacking shack (I can't in good conscious call this a nursing home, as that would imply the act of nursing and care) for an elderly man vomiting, possible GI bleed. Luckily the pt was pretty far gone in dementia. Dude had a colostomy bag, and it wasn't till we were halfway to the hospital that I looked more closely at the bag. The stuff in the bag was eerily familiar, and I realized that the same stuff in the bag was the stuff that the staff had tried (unsuccessfully) to clean off his face (to be fair, they mostly got it off his face, but there was stuff stuck to his lips and in his fake teeth). Um...WOW!!!
Terrified for the lives of myself and my partner:
Called out at 2am for the MO (mentally off, yes it is a call-category). Arrive on-scene to find the son outside. Mother hasn't taken psych meds for a bit, and is acting 'crazy, but she won't hurt you.' Against my better instincts, we go in without calling for the police. My partner, Ostrich Boy, stands just inside the doors, propping it open slightly just in case we need to bug out.
Seems the patient really hasn't been taking her meds. She's pacing in the house, wandering back and forth, not really lucid to us or her son, pretty tight in the grip of mania. The few times she stops and stares at me in her hallway, I am spooked. She has that totally blank look on her face, the blank stare in her eyes is a reminder of others I've seen just before I've been attacked.
I generally pride myself on my ability to talk to patients and get them to do what I want. I have a good bedside manner when I want it, and I've had all manner of patients open up to me. So I talk to the woman, keeping my voice low and slow, asking her what meds she's on, asking her if I could take her BP (son says she's also HTN and called someone earlier this evening cause she didn't feel well). She has a few moments of calmness, when she asks her son to find her meds cause she really needs to take them. He finds them and she takes one, but continues her pacing. My partner and I stand in the hall, waiting for the resolution. Ostrich Boy has already called for local PD to come without lights and sirens but to not hang around. By now they are waiting in the parking lot for us, and dispatch has called us 3 times, checking our status and making sure we're ok. Another 10 minutes goes by and she's finally calm enough that she lets me take her BP. Her face is still blank for the most part, but her eyes are no longer empty, and I can see humanity flickering deep in there. Her BP is high, and we tell her we'd like to take her to the hospital to get checked out and maybe get better meds. Her son pleads with her, and, now that she is clear, she is more worried about him studying for his final tomorrow (later today) than she is about herself. He convinces her that he'll study in the waiting room while she gets checked out, and she finally relents and lets us take her in. I can tell she's a good mother. She doesn't live in the best part of town, but her son seems like a good kid, and the whole ride to the ER she's crying about what a good kid he is and that he deserves better than her and how proud she is of him.
All in all, it ended well, but there was a period of time there when I was sure I'd be pressing that emergency button on my radio.
Horribly sad.
Call for an elderly man 'not right,' possible stroke. We got there first, the medic was on it's way. I seem to have wiped the details from my mind (thank God) but I remember that the guy was just totally blank. As in, not seeing who was there, not speaking, the whole thing. The medics took him in. I have no idea what happened to him eventually, but the thing that made me cry was his wife of 60-something years, holding his hand as they wheeled him out to the ambo. "It's ok dear, I'm right here with you. Dear, it's me, look at me." I got back to quarters and cried like a baby. All the calls I've been on, and none have hit me as hard as that one. For whatever reason, I was able to empathize with her on a level I never had with any other family member before, and the idea that this man who had known her for 60+ years, had been with her through thick and thin, children, grandchildren, and who knew what else, would most likely never recognize her again. The thought terrified me, and made me mourn for her in a way that my tiny little black heart had never mourned for a patient before.
Flat-out gross:
Called to the local stacking shack (I can't in good conscious call this a nursing home, as that would imply the act of nursing and care) for an elderly man vomiting, possible GI bleed. Luckily the pt was pretty far gone in dementia. Dude had a colostomy bag, and it wasn't till we were halfway to the hospital that I looked more closely at the bag. The stuff in the bag was eerily familiar, and I realized that the same stuff in the bag was the stuff that the staff had tried (unsuccessfully) to clean off his face (to be fair, they mostly got it off his face, but there was stuff stuck to his lips and in his fake teeth). Um...WOW!!!
Terrified for the lives of myself and my partner:
Called out at 2am for the MO (mentally off, yes it is a call-category). Arrive on-scene to find the son outside. Mother hasn't taken psych meds for a bit, and is acting 'crazy, but she won't hurt you.' Against my better instincts, we go in without calling for the police. My partner, Ostrich Boy, stands just inside the doors, propping it open slightly just in case we need to bug out.
Seems the patient really hasn't been taking her meds. She's pacing in the house, wandering back and forth, not really lucid to us or her son, pretty tight in the grip of mania. The few times she stops and stares at me in her hallway, I am spooked. She has that totally blank look on her face, the blank stare in her eyes is a reminder of others I've seen just before I've been attacked.
I generally pride myself on my ability to talk to patients and get them to do what I want. I have a good bedside manner when I want it, and I've had all manner of patients open up to me. So I talk to the woman, keeping my voice low and slow, asking her what meds she's on, asking her if I could take her BP (son says she's also HTN and called someone earlier this evening cause she didn't feel well). She has a few moments of calmness, when she asks her son to find her meds cause she really needs to take them. He finds them and she takes one, but continues her pacing. My partner and I stand in the hall, waiting for the resolution. Ostrich Boy has already called for local PD to come without lights and sirens but to not hang around. By now they are waiting in the parking lot for us, and dispatch has called us 3 times, checking our status and making sure we're ok. Another 10 minutes goes by and she's finally calm enough that she lets me take her BP. Her face is still blank for the most part, but her eyes are no longer empty, and I can see humanity flickering deep in there. Her BP is high, and we tell her we'd like to take her to the hospital to get checked out and maybe get better meds. Her son pleads with her, and, now that she is clear, she is more worried about him studying for his final tomorrow (later today) than she is about herself. He convinces her that he'll study in the waiting room while she gets checked out, and she finally relents and lets us take her in. I can tell she's a good mother. She doesn't live in the best part of town, but her son seems like a good kid, and the whole ride to the ER she's crying about what a good kid he is and that he deserves better than her and how proud she is of him.
All in all, it ended well, but there was a period of time there when I was sure I'd be pressing that emergency button on my radio.
Friday, December 5, 2008
Conundrum
I often bitch about people who I take to the hospital because they call 911 for what I feel are spurious reasons.
But I am often confronted by the feeling of whether or not I should feel sorry for them. Usually it depends on my mood and how tired I am at 3am. I really do try to remember that 'they feel it's an emergency' but when you find people who just use the system cause it's there, it's hard to remember that.
Here are my 2 big conundrum makers.
LOL or LOM (Little Old Lady or Little Old Man) calls around midnight or 0200 or so. They've been sick for a few days, not serious, but now they want to be seen. No fever, vomited sparingly (ie, no dehydration). Doesn't feel comfortable driving at night, especially when they're feeling poorly. Usually you hear from them, 'I'm so sorry to call you at this late hour. Normally I wouldn't, but I just feel so poorly and it's getting worse. I don't know that I can wait till morning to see my doctor.'
These people I generally feel sorry for, and have very little irritation with them. Sometimes they don't even have a car. They're almost always on a fixed income, so getting a cab to drive them may be a hardship, and who knows what kind of health insurance we're talking about, so maybe they've tried a clinic but the wait was too long or something. At any rate, these people usually have some kind of hardship, and they certainly don't abuse the system the way younger people do (sweeping generalization here though...) I have had to convince elderly people to go to the hospital when they are having 10/10 crushing chest pain and trouble breathing.
The second ones are the 30 or early 40-something couples. One of them is sick, and has been for a while, limited vomiting, low fever...generally the same symptoms as above. Usually they call between 0200 and 0400, sometimes earlier, because they are sick and woke up the spouse, or what-have-you. The line usually goes something like this. 'Sorry to call you, but I've been sick for the past couple days. My doctor won't see me till next week, but I'm feeling really sick and threw up twice 2 days ago.'
The spouse usually chimes in here. 'I'd take him/her myself, but the kids/babies are sleeping, and I don't want him/her to drive by themselves.'
Where I ran, we were 10 minutes from 2 hospitals. These people generally also had at least 2 cars in the driveway, and very nicely decorated houses with all the ammenties. These people were the ones I would get irritated with. I totally understand not wanting to wake up the kids or the baby to drag them to the hospital for an unknown amount of time. There are cabs you could call, I'm sure you have neighbors (though perhaps not at 0200). What made you think this was an emergency in any way, shape, or form?
So the conundrum is this. Why, given a fairly similar situation, should I feel sorry for the older person, but have nothing but contempt for the younger family person*? If I am irritated at one, shouldn't I be irritated at both?
And don't get me started about the 40-something people who call us out at 0300 because they don't feel good, but have an appointment with their doc in the morning, and don't want to go to the hospital. Sometimes I suspect the spouse just called 911 to keep the sick one from bitching anymore.
*The middle-aged guy who was vomiting all evening and trying to wait to see his doc in the morning, and couldn't go 5 minutes without dry-heaving is totally exempt. Although he DID try to get in the car and drive. Backing out of the driveway made him hurl.
But I am often confronted by the feeling of whether or not I should feel sorry for them. Usually it depends on my mood and how tired I am at 3am. I really do try to remember that 'they feel it's an emergency' but when you find people who just use the system cause it's there, it's hard to remember that.
Here are my 2 big conundrum makers.
LOL or LOM (Little Old Lady or Little Old Man) calls around midnight or 0200 or so. They've been sick for a few days, not serious, but now they want to be seen. No fever, vomited sparingly (ie, no dehydration). Doesn't feel comfortable driving at night, especially when they're feeling poorly. Usually you hear from them, 'I'm so sorry to call you at this late hour. Normally I wouldn't, but I just feel so poorly and it's getting worse. I don't know that I can wait till morning to see my doctor.'
These people I generally feel sorry for, and have very little irritation with them. Sometimes they don't even have a car. They're almost always on a fixed income, so getting a cab to drive them may be a hardship, and who knows what kind of health insurance we're talking about, so maybe they've tried a clinic but the wait was too long or something. At any rate, these people usually have some kind of hardship, and they certainly don't abuse the system the way younger people do (sweeping generalization here though...) I have had to convince elderly people to go to the hospital when they are having 10/10 crushing chest pain and trouble breathing.
The second ones are the 30 or early 40-something couples. One of them is sick, and has been for a while, limited vomiting, low fever...generally the same symptoms as above. Usually they call between 0200 and 0400, sometimes earlier, because they are sick and woke up the spouse, or what-have-you. The line usually goes something like this. 'Sorry to call you, but I've been sick for the past couple days. My doctor won't see me till next week, but I'm feeling really sick and threw up twice 2 days ago.'
The spouse usually chimes in here. 'I'd take him/her myself, but the kids/babies are sleeping, and I don't want him/her to drive by themselves.'
Where I ran, we were 10 minutes from 2 hospitals. These people generally also had at least 2 cars in the driveway, and very nicely decorated houses with all the ammenties. These people were the ones I would get irritated with. I totally understand not wanting to wake up the kids or the baby to drag them to the hospital for an unknown amount of time. There are cabs you could call, I'm sure you have neighbors (though perhaps not at 0200). What made you think this was an emergency in any way, shape, or form?
So the conundrum is this. Why, given a fairly similar situation, should I feel sorry for the older person, but have nothing but contempt for the younger family person*? If I am irritated at one, shouldn't I be irritated at both?
And don't get me started about the 40-something people who call us out at 0300 because they don't feel good, but have an appointment with their doc in the morning, and don't want to go to the hospital. Sometimes I suspect the spouse just called 911 to keep the sick one from bitching anymore.
*The middle-aged guy who was vomiting all evening and trying to wait to see his doc in the morning, and couldn't go 5 minutes without dry-heaving is totally exempt. Although he DID try to get in the car and drive. Backing out of the driveway made him hurl.
Thursday, December 4, 2008
Non-Medical Rant
And now, from the caffiene-fueled anger center of the Gnome...
I watched Rudolph, the Red-Nosed Reindeer last night.
When the hell did the PC-idiots change friggin' Rudolph?
I can't remember what the song originally was, but it's no longer there. The song when Rudolph and his new misfit pal Hermie the wanna-be dentist leave Christmastown, they sing a song. But the song I heard last night is definately not the same as the one I heard as a kid.
And, pointed out to me by a friend who watched it with his young daughters (I was in the kitchen making cookies), they have removed the part where Hermie reaches up to the general area where the 'Bumble's nuts should be with his pliers and squeezes. The 'Bumble gets a funny look on his face, and Cornelius tackles him off the cliff. Now Cornelius just tackles the 'Bumble off the cliff.
Who the hell was the PC nut-job who made these changes? It's not ok anymore to teach kids that if you act like an asshole, you'll get kicked in the nuts?
It's not ok to sing whatever it is that song is about? (I can't remember the words off the top of my head). Well, hell, while we're at it, why don't we just stop showing Rudolph, since it's a movie that shows that not everyone is a special snowflake, and that sometimes you get made fun of. I mean, we wouldn't want to offend or upset any kid who gets made fun of in school. Seriously...even Santa tells Rudolph's dad that he should be ashamed for having a kid who's different than everyone else. If anything should offend someone's sensitive sensiblities, that should. Isn't Santa supposed to be an equal opportunity gift-giver? Clearly that mind-set doesn't transfer over to those in his employ.
Come to think of it, Santa gets made out to be a real dick in this movie. He's snappy with the elves over that stupid song, he tells Rudolph he's no good cause he's got a light-bulb for a nose (although as soon as Santa needs something from Rudolph, that light-bulb is great and wonderful and awesome and Rudolph is now a member of the community again), gets mad at his wife for trying to cheer him up...the list goes on.
While we're at it, why not just cut out the whole Rulolph song from kid's holiday songs? After all, Rudolph gets made fun of and ostracized by the rest of the reindeer community cause he's got a glowing nose. That might offend someone who has rosatia or something. I mean, this is a clear instance of discrimination based on appearance. Where are the lawyers? Someone should be pushing Rudolph to sue for discrimination and pain and suffering. Come to think of it, are those elves legal immigrants? Does Santa have a license for making toys? How many reindeer does he have? Does he have a license for owning more than 'X' number of livestock? Once the lawyers sue on Rudolph's behalf, they should go after Santa for all those violations.
Honestly people. Come on. Surely there are more and better things you could be censoring than a stupid fucking kid's Christmas special (note, I said CHRISTMAS, not HOLIDAY. Last time I checked, Santa was associated with Christmas). What's next, changing Frosty because it might offend magicians who feel that the magician in the movie paints them in a bad light? How about taking out all instances of Lucy taking the football away and making Charlie Brown fall, because that could upset people who aren't good at sports. Not to mention all the times Charlie Brown gets hit with the ball in baseball and gets his clothes knocked off. Someone may get offended at a semi-naked cartoon character.
Many generations of kids grew up to be perfectly fine adults seeing that stuff on TV (don't get me started about Looney Tunes being too violent). In fact, I don't know any sane adults who think that it's ok to kick people in the nuts and tackle them over a cliff for being a jerk (much as some of us dream of doing that), and I don't know anyone who's been scarred for life because a talking reindeer with a lightbuld for a nose, and an elf who wants to be a dentist rather than make toys say they're misfits.
There is only one thing I personally find insulting about Rudolph the Red-Nosed Reindeer. And that is when Donnor essentially tells Rudolph's mother to 'stay in the kitchen and make me a pie, bitch!' while he goes out and looks for Rudolph (cause, you know, he's the big bad male with horns on his head. Never mind he's useless in a crisis and gets his ass knocked the hell out by the 'Bumble.) Of course, the 'women-folk' go out anyway, and of course get into trouble, and have to be saved by the men. But you know what? This stupid movie is a MOVIE that was made in the 50's or something, when that was the attitude of the day. And if I feel that it would anger me too much (not that it does, because I know how to take something in the context of the time in which it was made) I can always exercise my right to not watch it. I don't need some weenie in a suit who got beat up by the other reindeer making my damned decisions for me.
If you can be offended by a stop-motion photography movie about elves and talking reindeer, I think you have bigger issues.
I watched Rudolph, the Red-Nosed Reindeer last night.
When the hell did the PC-idiots change friggin' Rudolph?
I can't remember what the song originally was, but it's no longer there. The song when Rudolph and his new misfit pal Hermie the wanna-be dentist leave Christmastown, they sing a song. But the song I heard last night is definately not the same as the one I heard as a kid.
And, pointed out to me by a friend who watched it with his young daughters (I was in the kitchen making cookies), they have removed the part where Hermie reaches up to the general area where the 'Bumble's nuts should be with his pliers and squeezes. The 'Bumble gets a funny look on his face, and Cornelius tackles him off the cliff. Now Cornelius just tackles the 'Bumble off the cliff.
Who the hell was the PC nut-job who made these changes? It's not ok anymore to teach kids that if you act like an asshole, you'll get kicked in the nuts?
It's not ok to sing whatever it is that song is about? (I can't remember the words off the top of my head). Well, hell, while we're at it, why don't we just stop showing Rudolph, since it's a movie that shows that not everyone is a special snowflake, and that sometimes you get made fun of. I mean, we wouldn't want to offend or upset any kid who gets made fun of in school. Seriously...even Santa tells Rudolph's dad that he should be ashamed for having a kid who's different than everyone else. If anything should offend someone's sensitive sensiblities, that should. Isn't Santa supposed to be an equal opportunity gift-giver? Clearly that mind-set doesn't transfer over to those in his employ.
Come to think of it, Santa gets made out to be a real dick in this movie. He's snappy with the elves over that stupid song, he tells Rudolph he's no good cause he's got a light-bulb for a nose (although as soon as Santa needs something from Rudolph, that light-bulb is great and wonderful and awesome and Rudolph is now a member of the community again), gets mad at his wife for trying to cheer him up...the list goes on.
While we're at it, why not just cut out the whole Rulolph song from kid's holiday songs? After all, Rudolph gets made fun of and ostracized by the rest of the reindeer community cause he's got a glowing nose. That might offend someone who has rosatia or something. I mean, this is a clear instance of discrimination based on appearance. Where are the lawyers? Someone should be pushing Rudolph to sue for discrimination and pain and suffering. Come to think of it, are those elves legal immigrants? Does Santa have a license for making toys? How many reindeer does he have? Does he have a license for owning more than 'X' number of livestock? Once the lawyers sue on Rudolph's behalf, they should go after Santa for all those violations.
Honestly people. Come on. Surely there are more and better things you could be censoring than a stupid fucking kid's Christmas special (note, I said CHRISTMAS, not HOLIDAY. Last time I checked, Santa was associated with Christmas). What's next, changing Frosty because it might offend magicians who feel that the magician in the movie paints them in a bad light? How about taking out all instances of Lucy taking the football away and making Charlie Brown fall, because that could upset people who aren't good at sports. Not to mention all the times Charlie Brown gets hit with the ball in baseball and gets his clothes knocked off. Someone may get offended at a semi-naked cartoon character.
Many generations of kids grew up to be perfectly fine adults seeing that stuff on TV (don't get me started about Looney Tunes being too violent). In fact, I don't know any sane adults who think that it's ok to kick people in the nuts and tackle them over a cliff for being a jerk (much as some of us dream of doing that), and I don't know anyone who's been scarred for life because a talking reindeer with a lightbuld for a nose, and an elf who wants to be a dentist rather than make toys say they're misfits.
There is only one thing I personally find insulting about Rudolph the Red-Nosed Reindeer. And that is when Donnor essentially tells Rudolph's mother to 'stay in the kitchen and make me a pie, bitch!' while he goes out and looks for Rudolph (cause, you know, he's the big bad male with horns on his head. Never mind he's useless in a crisis and gets his ass knocked the hell out by the 'Bumble.) Of course, the 'women-folk' go out anyway, and of course get into trouble, and have to be saved by the men. But you know what? This stupid movie is a MOVIE that was made in the 50's or something, when that was the attitude of the day. And if I feel that it would anger me too much (not that it does, because I know how to take something in the context of the time in which it was made) I can always exercise my right to not watch it. I don't need some weenie in a suit who got beat up by the other reindeer making my damned decisions for me.
If you can be offended by a stop-motion photography movie about elves and talking reindeer, I think you have bigger issues.
If you can beat me down the hill to the ambo, you don't really need one...
Last story in the blizzard trilogy, I swear...
John-Boy of the first evening had left sometime during the second day, and in his place was a new driver. A nice enough woman, I'd worked with her enough to know that her EMT skills were not that great, but she was a good partner, and knew enough to know what her limits were. We got along well, but she didn't drive that well. Normally, she was slow, seemed to hit every pothole in the road, and often got lost once off the main roads. On a day when the roads were mostly covered with an inch or more of snow/slush/ice, the slow driving was a plus, the potholes were non-existant, and it was hard to get lost on the back roads when a huge county plow/dump truck with a flashing yellow light was leading you in and out.
It was evening when we got toned out. I know we hadn't eaten dinner yet, but it was dark. The call was for the possible stroke. 'This better be an 80 year-old woman who is fucking paralyzed on one side,' I growled. (Most times, 'stroke' calls are really strokes, but for some reason, they send it BLS rather than ALS, since 'there is nothing that ALS can do for a stroke.' No really...I swear...but that's a rant for another time...)
We get to the road leading to the development, but it hasn't even been touched since the snow began (it had stopped by now). There is a small plowed-out area at the end of the road, mainly just the place where the plow was pushing all the snow from the main road across the street.
Oh, did I mention this road we STRAIGHT UP A FUCKING HILL????? So help me God, it looked like it was straight up. Slow Driver pulls across the street (the ass-end of the ambo is sticking out into traffic) and says to me, 'Where do I park?' Mind you, there is zero road shoulder.
'Just pull into the clearing as much as you can to get us off the main road,' I tell her. What does she do, but pull practically straight in, launching the ambo's front tires into the pile of plowed snow. I told her, 'That's not what I meant, exactly,' but it's too late, we're stuck. She tries to back out, but all she's doing is digging holes with the tires. We decide to leave it as is, call for a back-up just in case, and slog up the hill (dragging the Reeves, the O2 bag, and the aide bag). I'm wearing my bunker pants, and the snow is packed in up to my knees, which ironically, is lower than the level of the snow I'm slogging through (I could have sat down without moving much). We finally get up to the house, and knock on the door. A middle-aged woman answers, with a 4 inch thick pile of folders and papers in her hands.
Now knowing this to be a complete BS call, totally exhausted from dragging my ass and all the associated crap for a real stroke up a huge fucking hill with snow up to my hips, I nevertheless attempt a smile. Slow Driver is at the bottom of the stairs with the O2 bag and the Reeves, since the stairs are about 10 ft off the ground, and are coated in ice, and the landing up top is even worse. 'We're with the ambulance, Ma'am. Did you call 911?'
'Why yes I did, but that was 20 minutes ago. What took you so long?' I want to say Two feet of fucking snow, bitch. But I don't, and she goes on without really waiting for a response from me. 'Well, you see, 2 nights ago while we were eating dinner, I experienced some slurring speech, fuzzy vision, and some tingling in my right arm. But it only lasted about 15 minutes, and then went away. Yesterday afternoon I had the same thing, only it lasted a little longer, maybe 20 minutes, right Frank?' Frank, who I assume is her husband, is a little squirt of a man, and stands behind her, nodding emphatically at all she says.
'So why did you call us tonight?' I ask, forcing my eyeballs not to roll back and stare at my brain.
'Well it happened again tonight, for about 10 minutes so I figured I would go to the hospital. I brought all my medical records too.' This she says proudly, as if it will be a huge boon to the hospital that all these papers will be around. Because, you know, no one in the ER knows how to get your damned records from the computer.
'What time did this happen?' I ask. Meanwhile, we are still standing outside. She hasn't invited us in, and normally a patient or family member will step back from the door to allow us to at least access the light of the house for a proper assessment. But she stands directly in front of the door, blocking what little light is coming out, and not allowing me to come in. At least I have the warm air coming from the house. Poor Slow Driver is stuck 10 ft below me, on the snowy walk. The temperature is dropping, and the wind is picking up. The roads are not going to be nice soon.
'About 3 hours ago,' she replies. 'Frank, get my coat.' Frank scurries to get her coat, and hands it to her, along with her keys, cards, and cell phone. She hands me her 'medical record' while she pulls the coat on, and then steps out, oblivious to my caution about the ice. Somehow I make it down the steps carrying the aide bag and her medical records, which she takes from me the minute she's on less slick ground. I point towards the ambo at the bottom of the hill. 'That's our ambulance,' I tell her. Slow Driver has already headed down the hill to work on getting us un-stuck, and I struggle down the hill, dragging the aide bag and now the O2 bag (Slow Driver left it so she could high-tail it down). The patient has set off at a pace worthy of Sir Edmund heading down Mt Everest, and is down at the ambo before I can get halfway down the hill. I finally make it down, and find that Slow Driver had been digging more holes with both the back and front tires. I check with dispatch to see where our back-up is, and fill out the paperwork. The back-up that arrives is an ALS unit, whose medic is less than impressed to see an upright, walking talking stroke patient. I explain that we got stuck, and all the woman needs is transport. He rolls his eyes and they take off.
So, now we are stuck. Slow Driver has dug holes so badly that the entire weight of the ambo is now supported by the snow packed in underneath it. And remember, this is not new-fallen snow. This is snow and ice plowed from the roads, so it is hard and chunky. I am in turnout pants, with snow packed up to the knees, rubber turnout boots, and my job shirt. There is no hat, there are no gloves. I take out the shovel and Z-hook from the side compartment, and attempt to remove enough snow to at least allow one set of tires traction. No dice. I go back to the front of the ambo to get rid of the snow behind the front tires. Still nothing. I try not to snap at Slow Driver's inability to do anything but gun the engine when she tries to rock it out (not that rocking an automatic transmission is the easiest thing to do). I'm standing to the side during one of her attempts to gun it out of the space when I hear the knocking of metal on metal. Sure enough, we've thrown a chain. But only half a chain, since the side in by the dualie is stuck fast. Maybe I can get it off when we get out and I have a bit more room.
Luckily, about 30 minutes after our patient left with the ALS unit, a county plow comes up and takes pity on us. He comes at us from the front, piling up a good bit of snow to protect the ambo, and pushing the ambo backwards out of the snow. He also gives us some heavy-duty zip ties to hold the chain on, swearing that it'll work. We thank him profusely, and head on our way home.
The trip home took at least an hour. Mainly due to the stops we had to make to replace the zip tie after it broke. We are crawling at about 10 mph, well below the 25mph you are required to use when driving on chains. I am hungry, cold, and my hands are wet and frozen and dirty. About 10 miles from the station we run out of zip ties, and have to just pray to make it home.
Once back at the station, we find a lovely thing has happened. The chain has caught on the sheet metal that comprises the wheel bed for that wheel, bending and pulling it up so that is caught on the chain that covers the rest of the wheel. We can still drive, but it just continues to bend the metal. We put ourselves out of service, and call the mechanics, one of which come out to the station to see what he can do. Unfortunately, our air line in the station is compromised, and the engine is out on a run, so there is no way to run the air jack to raise the ambo on that side to pull the wheels off and cut the metal. He manages to get the chain off, and heads back to headquarters, where we will meet him shortly. The metal sheet is touching the tire, and there is not enough room to get leverage to cut it off or bend it back.
The engine gets back, we tell the captain we're heading to HQ, and slowly head out with no chains. The problem is fixed there (the metal is cut off) and we find out we aren't the only ones experiencing issues. The truck tried to get down a road in a development known for tight roads, and not only slid and hit a couple cars, but was stuck and had to be towed out. The ambo at HQ went on a call with the medics for a heart attack, and there were no plows available to get them down the small side road. The patient ended up staying dead because they had to walk a quarter mile down the road in knee high snow with the cot. The young EMT I was mentoring had a hard time with this one, as she was riding on the medic unit at the time. She couldn't wrap her head around the fact that he was already dead when they got there, and regardless of how much CPR or drugs they pushed in the guy, he would likely have stayed dead. The fact that it was her first death didn't help. What did help was that they went on a labor call not long after, and they helped deliver the baby at home. Circle of life and all that.
We get back to our station, and put ourselves back in service, now with only half a wheel well on one side. The chains go back on, and I get ragged on by the engine crew for throwing a chain and allowing my ambo to get dinged up from the chain banging around.
Yeah, the blizzard was much more exciting than the un-hurricane we went through later. That was just boring.
John-Boy of the first evening had left sometime during the second day, and in his place was a new driver. A nice enough woman, I'd worked with her enough to know that her EMT skills were not that great, but she was a good partner, and knew enough to know what her limits were. We got along well, but she didn't drive that well. Normally, she was slow, seemed to hit every pothole in the road, and often got lost once off the main roads. On a day when the roads were mostly covered with an inch or more of snow/slush/ice, the slow driving was a plus, the potholes were non-existant, and it was hard to get lost on the back roads when a huge county plow/dump truck with a flashing yellow light was leading you in and out.
It was evening when we got toned out. I know we hadn't eaten dinner yet, but it was dark. The call was for the possible stroke. 'This better be an 80 year-old woman who is fucking paralyzed on one side,' I growled. (Most times, 'stroke' calls are really strokes, but for some reason, they send it BLS rather than ALS, since 'there is nothing that ALS can do for a stroke.' No really...I swear...but that's a rant for another time...)
We get to the road leading to the development, but it hasn't even been touched since the snow began (it had stopped by now). There is a small plowed-out area at the end of the road, mainly just the place where the plow was pushing all the snow from the main road across the street.
Oh, did I mention this road we STRAIGHT UP A FUCKING HILL????? So help me God, it looked like it was straight up. Slow Driver pulls across the street (the ass-end of the ambo is sticking out into traffic) and says to me, 'Where do I park?' Mind you, there is zero road shoulder.
'Just pull into the clearing as much as you can to get us off the main road,' I tell her. What does she do, but pull practically straight in, launching the ambo's front tires into the pile of plowed snow. I told her, 'That's not what I meant, exactly,' but it's too late, we're stuck. She tries to back out, but all she's doing is digging holes with the tires. We decide to leave it as is, call for a back-up just in case, and slog up the hill (dragging the Reeves, the O2 bag, and the aide bag). I'm wearing my bunker pants, and the snow is packed in up to my knees, which ironically, is lower than the level of the snow I'm slogging through (I could have sat down without moving much). We finally get up to the house, and knock on the door. A middle-aged woman answers, with a 4 inch thick pile of folders and papers in her hands.
Now knowing this to be a complete BS call, totally exhausted from dragging my ass and all the associated crap for a real stroke up a huge fucking hill with snow up to my hips, I nevertheless attempt a smile. Slow Driver is at the bottom of the stairs with the O2 bag and the Reeves, since the stairs are about 10 ft off the ground, and are coated in ice, and the landing up top is even worse. 'We're with the ambulance, Ma'am. Did you call 911?'
'Why yes I did, but that was 20 minutes ago. What took you so long?' I want to say Two feet of fucking snow, bitch. But I don't, and she goes on without really waiting for a response from me. 'Well, you see, 2 nights ago while we were eating dinner, I experienced some slurring speech, fuzzy vision, and some tingling in my right arm. But it only lasted about 15 minutes, and then went away. Yesterday afternoon I had the same thing, only it lasted a little longer, maybe 20 minutes, right Frank?' Frank, who I assume is her husband, is a little squirt of a man, and stands behind her, nodding emphatically at all she says.
'So why did you call us tonight?' I ask, forcing my eyeballs not to roll back and stare at my brain.
'Well it happened again tonight, for about 10 minutes so I figured I would go to the hospital. I brought all my medical records too.' This she says proudly, as if it will be a huge boon to the hospital that all these papers will be around. Because, you know, no one in the ER knows how to get your damned records from the computer.
'What time did this happen?' I ask. Meanwhile, we are still standing outside. She hasn't invited us in, and normally a patient or family member will step back from the door to allow us to at least access the light of the house for a proper assessment. But she stands directly in front of the door, blocking what little light is coming out, and not allowing me to come in. At least I have the warm air coming from the house. Poor Slow Driver is stuck 10 ft below me, on the snowy walk. The temperature is dropping, and the wind is picking up. The roads are not going to be nice soon.
'About 3 hours ago,' she replies. 'Frank, get my coat.' Frank scurries to get her coat, and hands it to her, along with her keys, cards, and cell phone. She hands me her 'medical record' while she pulls the coat on, and then steps out, oblivious to my caution about the ice. Somehow I make it down the steps carrying the aide bag and her medical records, which she takes from me the minute she's on less slick ground. I point towards the ambo at the bottom of the hill. 'That's our ambulance,' I tell her. Slow Driver has already headed down the hill to work on getting us un-stuck, and I struggle down the hill, dragging the aide bag and now the O2 bag (Slow Driver left it so she could high-tail it down). The patient has set off at a pace worthy of Sir Edmund heading down Mt Everest, and is down at the ambo before I can get halfway down the hill. I finally make it down, and find that Slow Driver had been digging more holes with both the back and front tires. I check with dispatch to see where our back-up is, and fill out the paperwork. The back-up that arrives is an ALS unit, whose medic is less than impressed to see an upright, walking talking stroke patient. I explain that we got stuck, and all the woman needs is transport. He rolls his eyes and they take off.
So, now we are stuck. Slow Driver has dug holes so badly that the entire weight of the ambo is now supported by the snow packed in underneath it. And remember, this is not new-fallen snow. This is snow and ice plowed from the roads, so it is hard and chunky. I am in turnout pants, with snow packed up to the knees, rubber turnout boots, and my job shirt. There is no hat, there are no gloves. I take out the shovel and Z-hook from the side compartment, and attempt to remove enough snow to at least allow one set of tires traction. No dice. I go back to the front of the ambo to get rid of the snow behind the front tires. Still nothing. I try not to snap at Slow Driver's inability to do anything but gun the engine when she tries to rock it out (not that rocking an automatic transmission is the easiest thing to do). I'm standing to the side during one of her attempts to gun it out of the space when I hear the knocking of metal on metal. Sure enough, we've thrown a chain. But only half a chain, since the side in by the dualie is stuck fast. Maybe I can get it off when we get out and I have a bit more room.
Luckily, about 30 minutes after our patient left with the ALS unit, a county plow comes up and takes pity on us. He comes at us from the front, piling up a good bit of snow to protect the ambo, and pushing the ambo backwards out of the snow. He also gives us some heavy-duty zip ties to hold the chain on, swearing that it'll work. We thank him profusely, and head on our way home.
The trip home took at least an hour. Mainly due to the stops we had to make to replace the zip tie after it broke. We are crawling at about 10 mph, well below the 25mph you are required to use when driving on chains. I am hungry, cold, and my hands are wet and frozen and dirty. About 10 miles from the station we run out of zip ties, and have to just pray to make it home.
Once back at the station, we find a lovely thing has happened. The chain has caught on the sheet metal that comprises the wheel bed for that wheel, bending and pulling it up so that is caught on the chain that covers the rest of the wheel. We can still drive, but it just continues to bend the metal. We put ourselves out of service, and call the mechanics, one of which come out to the station to see what he can do. Unfortunately, our air line in the station is compromised, and the engine is out on a run, so there is no way to run the air jack to raise the ambo on that side to pull the wheels off and cut the metal. He manages to get the chain off, and heads back to headquarters, where we will meet him shortly. The metal sheet is touching the tire, and there is not enough room to get leverage to cut it off or bend it back.
The engine gets back, we tell the captain we're heading to HQ, and slowly head out with no chains. The problem is fixed there (the metal is cut off) and we find out we aren't the only ones experiencing issues. The truck tried to get down a road in a development known for tight roads, and not only slid and hit a couple cars, but was stuck and had to be towed out. The ambo at HQ went on a call with the medics for a heart attack, and there were no plows available to get them down the small side road. The patient ended up staying dead because they had to walk a quarter mile down the road in knee high snow with the cot. The young EMT I was mentoring had a hard time with this one, as she was riding on the medic unit at the time. She couldn't wrap her head around the fact that he was already dead when they got there, and regardless of how much CPR or drugs they pushed in the guy, he would likely have stayed dead. The fact that it was her first death didn't help. What did help was that they went on a labor call not long after, and they helped deliver the baby at home. Circle of life and all that.
We get back to our station, and put ourselves back in service, now with only half a wheel well on one side. The chains go back on, and I get ragged on by the engine crew for throwing a chain and allowing my ambo to get dinged up from the chain banging around.
Yeah, the blizzard was much more exciting than the un-hurricane we went through later. That was just boring.
Wednesday, December 3, 2008
Here's Your Sign..
First things first...
Yay! Someone commented on my blog! I am loved! Thanks EE, glad you like it, and I hope things are going well with the new little one. Good to see that the pup is doing better as well.
So, in the last post, I wrote about the stupid things people call you for during bad weather. I have much more where that came from...that was just the one day. The next day had a fun call as well, which I will relate later. This post is all about the Night the Snow Started Falling.
As some may know, here in the People's Republic of Maryland, snow is considered to be a strange thing. Many people born here don't see it often enough to understand how to drive in it, and for many of those who move here from colder climes often quickly forget how to handle themselves in the cold and snow, perhaps having had their brains bleached by the intense summer sun (which has gotten so hot a co-worker of mine had the nylon string on her fuzzy dice in the car melt. I'm sorry, but your damned car SHOULD NOT get that hot unless you are in a fucking desert).
Ahem.
Anyway, the snow (really, and precipitation falling from the sky, regardless of temperature) seems to turn the people around here to mush-brained, mouth-breathing idiots. On this particular night, we were hunkering down, waiting for the other shoe to fall as soon as the snow started (the night already had boasted a woman attacked by her son, who insisted we come into the house with her while the son was still there. Um, no). The snow had started falling lightly, and soon the roads were covered with a good 2 inches of the stuff. Tones drop for an MVA (we call them PIC's) on a road that is at best a hell to drive in the sun. As we head out, driving slowly, we are updated. Now dispatch is telling us that the patient is at home. We pass the car in a ditch, and make it to the house. The patient is a woman who was driving home, slid into the ditch, but was only going about 10 mph anyway. She has a cut on her hand from her fingernail. We, of course, offer to take her to the hospital, but she refuses, and we head home again. The engine has beaten us there, and is in the middle of putting on their tire chains, as the snow was getting too deep to use the on-spots anymore.
My driver, who otherwise was a reasonable, well-intentioned man, and a good partner, decides that he doesn't want to wait for the engine to finish with the blocks, and decides that he could put the chains on himself, without raising the tire up. First he tries with the air-jack, but the air line in our station runs under the concrete floor, and has a hole in it somewhere. The engine is still on blocks, so we can't use their air chock. So he decides, on the virtue that he did it with his daddy's pick-up truck, that he can just lay the chains on the floor and drive on them, then hook them up.
Insert banjo music here.
He decides to do one at a time, 'in case we get a call.' The first one he gets on but can only hook the front. He can't get enough slack to pull it around inside the dualie. Suddenly the bat phone rings (the bat phone is our direct line to dispatch. When they call, you either have a fire in your first-due, or someone screwed up). Sure enough, we have a first-due fire. My driver, John-Boy, is still fighting with the tire chain, only now he's frantic (having just completed Fire School I). The engine driver has literally just dragged the blocks over to me, and as soon as the engine company is dressed, they are gone. I finally convince John-Boy to go up on the blocks so we can take the offending chain (now twisted around the dualie axel once cause he spun the tires on concrete trying to move forward to loosen the chain) off the tire and just get going. After digging holes in the concrete floor, we get up on blocks and get the chain off, and follow the tracks of the engine (which is good, because the engine took the print-outs and John-Boy was cursing at me so much that neither one of us heard the address).
John-Boy parks at the bottom of the hill, at the hydrant the engine dropped at. He's parked the ambo across the road, in clear violation of the policy against ambo's blocking access that other fire equipment might need. He hops out, intent to charge the line to the engine as soon as they call for water. (While our SOPs state that ambo drivers and officers must be able to do this, it rarely happens, as the second-due engine is so close, by the time the first-in engine needs water, the whole box assignment is on scene and another engine driver usually performs the duty.) Meanwhile, the squad from headquarters is tearing (as much as a multi-ton apparatus can 'tear' in 5 inches of snow and tire chains) around the corner, with the driver motioning wildly for us to get out of the way. I can't drive the ambo. John-Boy can't hear me yelling for him. Luckily for me, Bald Old Man, who is a driver, hopped on just before we left, and moves the ambo out of the way, with a few choice words for John-Boy when he gets back to the ambo.
The fire is put out quickly, being contained to just the car port. The engine had hit an hydrant across the street from the house; the hydrant wasn't marked on the map books, and made a quick knock. However, lugging 1200 ft of frozen LDH (Large Diameter Hose; ie 4 inches or larger in diameter) up hill in what was now 6 inches of snow and then forcing it back into the hose bed was decidely NOT fun. Forcing the frozen handline and supply line that had been used back onto the engine was also not fun.
And what was the cause of this fire? The home-owner, in a fit of...something...had decided to build a fire in his (mostly) un-used fireplace that evening. Wanting to go to bed, but not wanting to leave warm coals in his fireplace, he shoveled them out into a plastic trash bag. He knew better than to leave them inside, and figured that even if they were still warm, it was cold enough outside to toss them out and let them cool. In the closed plastic trash bag. So he tossed the bag out into the carport, next to his car. Several hours later, an explosion woke the neighbors several houses down, who went outside and saw Mr Intellegent's car port on fire, and called 911. Mr Intellegent and his wife never woke up until the fire dept started knocking on their door. It was assumed that the 'explosion' was the tires on the car popping.
Ah yes. Winter here does seem to make people's brains ooze out their ears.*
Tomorrow the finish of the blizzard stories, including how my driver broke my ambo, and the patient who had to go to the hospital so badly, he beat me down the hill to the ambo in 2 feet of snow.
* People's brain's oozing out their ears during 'weather' is not isolated to MD, as I saw it happen often enough in PA. Nor do all people in MD take leave of their senses when forecasters say that 'weather' is coming....I'm sure that there are people in Western MD and up near the border of PA who are sensible about this kind of thing.
Yay! Someone commented on my blog! I am loved! Thanks EE, glad you like it, and I hope things are going well with the new little one. Good to see that the pup is doing better as well.
So, in the last post, I wrote about the stupid things people call you for during bad weather. I have much more where that came from...that was just the one day. The next day had a fun call as well, which I will relate later. This post is all about the Night the Snow Started Falling.
As some may know, here in the People's Republic of Maryland, snow is considered to be a strange thing. Many people born here don't see it often enough to understand how to drive in it, and for many of those who move here from colder climes often quickly forget how to handle themselves in the cold and snow, perhaps having had their brains bleached by the intense summer sun (which has gotten so hot a co-worker of mine had the nylon string on her fuzzy dice in the car melt. I'm sorry, but your damned car SHOULD NOT get that hot unless you are in a fucking desert).
Ahem.
Anyway, the snow (really, and precipitation falling from the sky, regardless of temperature) seems to turn the people around here to mush-brained, mouth-breathing idiots. On this particular night, we were hunkering down, waiting for the other shoe to fall as soon as the snow started (the night already had boasted a woman attacked by her son, who insisted we come into the house with her while the son was still there. Um, no). The snow had started falling lightly, and soon the roads were covered with a good 2 inches of the stuff. Tones drop for an MVA (we call them PIC's) on a road that is at best a hell to drive in the sun. As we head out, driving slowly, we are updated. Now dispatch is telling us that the patient is at home. We pass the car in a ditch, and make it to the house. The patient is a woman who was driving home, slid into the ditch, but was only going about 10 mph anyway. She has a cut on her hand from her fingernail. We, of course, offer to take her to the hospital, but she refuses, and we head home again. The engine has beaten us there, and is in the middle of putting on their tire chains, as the snow was getting too deep to use the on-spots anymore.
My driver, who otherwise was a reasonable, well-intentioned man, and a good partner, decides that he doesn't want to wait for the engine to finish with the blocks, and decides that he could put the chains on himself, without raising the tire up. First he tries with the air-jack, but the air line in our station runs under the concrete floor, and has a hole in it somewhere. The engine is still on blocks, so we can't use their air chock. So he decides, on the virtue that he did it with his daddy's pick-up truck, that he can just lay the chains on the floor and drive on them, then hook them up.
Insert banjo music here.
He decides to do one at a time, 'in case we get a call.' The first one he gets on but can only hook the front. He can't get enough slack to pull it around inside the dualie. Suddenly the bat phone rings (the bat phone is our direct line to dispatch. When they call, you either have a fire in your first-due, or someone screwed up). Sure enough, we have a first-due fire. My driver, John-Boy, is still fighting with the tire chain, only now he's frantic (having just completed Fire School I). The engine driver has literally just dragged the blocks over to me, and as soon as the engine company is dressed, they are gone. I finally convince John-Boy to go up on the blocks so we can take the offending chain (now twisted around the dualie axel once cause he spun the tires on concrete trying to move forward to loosen the chain) off the tire and just get going. After digging holes in the concrete floor, we get up on blocks and get the chain off, and follow the tracks of the engine (which is good, because the engine took the print-outs and John-Boy was cursing at me so much that neither one of us heard the address).
John-Boy parks at the bottom of the hill, at the hydrant the engine dropped at. He's parked the ambo across the road, in clear violation of the policy against ambo's blocking access that other fire equipment might need. He hops out, intent to charge the line to the engine as soon as they call for water. (While our SOPs state that ambo drivers and officers must be able to do this, it rarely happens, as the second-due engine is so close, by the time the first-in engine needs water, the whole box assignment is on scene and another engine driver usually performs the duty.) Meanwhile, the squad from headquarters is tearing (as much as a multi-ton apparatus can 'tear' in 5 inches of snow and tire chains) around the corner, with the driver motioning wildly for us to get out of the way. I can't drive the ambo. John-Boy can't hear me yelling for him. Luckily for me, Bald Old Man, who is a driver, hopped on just before we left, and moves the ambo out of the way, with a few choice words for John-Boy when he gets back to the ambo.
The fire is put out quickly, being contained to just the car port. The engine had hit an hydrant across the street from the house; the hydrant wasn't marked on the map books, and made a quick knock. However, lugging 1200 ft of frozen LDH (Large Diameter Hose; ie 4 inches or larger in diameter) up hill in what was now 6 inches of snow and then forcing it back into the hose bed was decidely NOT fun. Forcing the frozen handline and supply line that had been used back onto the engine was also not fun.
And what was the cause of this fire? The home-owner, in a fit of...something...had decided to build a fire in his (mostly) un-used fireplace that evening. Wanting to go to bed, but not wanting to leave warm coals in his fireplace, he shoveled them out into a plastic trash bag. He knew better than to leave them inside, and figured that even if they were still warm, it was cold enough outside to toss them out and let them cool. In the closed plastic trash bag. So he tossed the bag out into the carport, next to his car. Several hours later, an explosion woke the neighbors several houses down, who went outside and saw Mr Intellegent's car port on fire, and called 911. Mr Intellegent and his wife never woke up until the fire dept started knocking on their door. It was assumed that the 'explosion' was the tires on the car popping.
Ah yes. Winter here does seem to make people's brains ooze out their ears.*
Tomorrow the finish of the blizzard stories, including how my driver broke my ambo, and the patient who had to go to the hospital so badly, he beat me down the hill to the ambo in 2 feet of snow.
* People's brain's oozing out their ears during 'weather' is not isolated to MD, as I saw it happen often enough in PA. Nor do all people in MD take leave of their senses when forecasters say that 'weather' is coming....I'm sure that there are people in Western MD and up near the border of PA who are sensible about this kind of thing.
Friday, November 21, 2008
There's 2 feet of snow out, and you called me for THAT?!?!?
Which is what I wanted to say, but didn't. I try my hardest to be nice to everyone, despite my callous thoughts. I don't get bitchy till the patient starts it.
It had been snowing since last night. The county plows couldn't keep up with it, and were only keeping the most main of main roads clear. Once we got into the developments and such, we were on our own. Sometimes, if there wasn't another call, and they got to you in time, one of the small guy plows, the guys with plows on their pick-up trucks, would preceed us into the communities, making sure we wouldn't get stuck. More often that not, especially as the day went on and the snow accumulated, we were on our own.
The call toned out for the 'sick person.' I grumbled as I climed into the officer's seat. "This better be for real," only I'm sure there were more expletives in it than that. It was barely 9am, and I had been out all night on car wrecks and a house fire (never put your warm ashes in a plastic bag and pitch it into your carport, where it falls under your car. No, it was not cold enough outside. Obviously). My partner didn't say anything, but we drove out into the snow.
The snow in the development was brushing the undercarriage of the ambo. In another few hours, we wouldn't be able to make it in here without help from a plow. It was a nice development with modest townhouses, and we found the right one with little trouble. The patient was inside at the kitchen table, looking fairly normal, if slightly pale.
I started with my usual. "Hi, my name is Gnome, and this is my partner M. What seems to be the trouble today?"
The woman smiled at us, not looking very sick. "Well, I've had this stomach bug for a few days now, along with some head congestion and coughing. I just feel sick, and can barely keep anything down. I tried eating breakfast this morning, but it came right back up, and then I couldn't stop vomiting." Her husband is patting her shoulder, and I hear the unmistakable sound of Saturday morning cartoons coming from the other room.
"And then she tried to blow her nose and her nose was bleeding and it wouldn't stop either, for like 15 minutes!" the husband chimes in.
Through questions, I find that this happened around 7am, and it took them about 2 hours to decide to call for an ambo, mainly because she was still feeling ill, and when she tried to drink some orange juice, which came right back up. We take vitals, all which are within normal limits, though she does feel a little on the warm side. She says she's been running a low grade fever since yesterday.
I start giving them options. "Well, we could take you to the hospital, and you'd probably get in pretty quick, but there's no garuntee you could get home today. The roads are all closed to all but emergency traffic, more or less, and your development has almost 2 feet of snow on the roads. The main roads are not much better; the plows can't keep up with the snowfall. So there aren't any taxis that would get you home."
They nodded, and after a brief discussion, decided to stay home. I gave her some ideas to keep food and drink down, because she was likely dehydrated. "When you drink something, make sure it's close to room temp. Not too sweet, not too acidic, or that will upset your stomach. Take a small sip, barely enough to swallow, because your stomach is sensitive right now, and large quantities will make it reject anything that gets put in it. Same for food. Dry toast, or crackers are good right now. But nibble on it so that you don't shock your stomach." They nodded, and seemed to feel better. We told them to call us back if they felt they really needed to go to the hospital, and left.
We got sent from that call to a man with horrid stomach pains. Met us at the curb, hopped into the back as soon as we pulled up. I sat him in the captain's chair. "I have these horrible pains, I don't know what they are. I've never felt anything like this before. I think it might be appendicitis." Pains were centered over the abodomen, spanning both the LRQ and the LLQ. NO change in pain level on palpation, rated 10/10. We head off to the hospital, and I'm in the process of getting vitals when he lets one of the biggest farts I've ever heard from someone. Thank God it didn't stink, cause our windows don't open.
Red-faced, the man apologized. "I am so sorry! I never meant to do that. But hey! I feel better now. The pain's all gone!" He seems more embarrassed that he farted in front of me than that he called 911 for gas pains. Then he asks the coup de grace. "Can you take me home? I don't want to go to the hospital now."
I sigh, inwardly. We are closer to the hospital than his house now, and at the rate the snow is falling now, we'd never get back into his development, plus the man is wearing slippers, so it's not like he could walk the half block back to his house. "I'm very sorry, sir, but we are a one-way service. We can't take you back to your house. We can only take you to the hospital. I am sorry." And I am. Sorry that the hospital staff will have to deal with him when there's nothing wrong with him.
He takes this news well, smiling and sitting back, and talking to me about the improbability of gas pains sending him to the hospital. He still doesn't seem embarrassed; rather he's talking about 'better safe than sorry' and how it could have been something more serious. I just keep writing, wondering how the hell a man in his 40's could possibly not know the difference between gas pains and appendicitis. We pull up to the emergency room waiting area door, and I walk him in. He has a seat in the room, and starts watching TV. I go to the nurse's window and give her a brief report. She chuckles. "At least now I've got a good story. Things are pretty dead here today, for obvious reasons."
Two hours later (about 15 minutes after we get back to the station) we get tapped out for the same address as the first call. This time, we have to wait for a plow to get us into the development...the snow is now above the undercarriage, and when the drop-down step comes out of the side door, I have to knock the snow off of it. We arrive at the house, and the husband and wife are waiting outside for us. Bags are packed. They hop in the back. "I did what you said and it was working," she tells me. But then I fell asleep on the couch for a bit, and when I woke up I was so thirsty that I drank the whole glass of water and it just came right back up. So we decided to call you back."
I only nod and sigh. They tell me that they got a neighbor to watch their kids. It takes us 45 mintues to get to the hospital, which is normally a 10 minute drive. This time, the patient was on the stretcher, so we wheeled her into the emergency entrance. I gave report to the nurse, and we headed back home. AN hour later, we pulled into the station.
Yeah, I try to be nice to my patients. I try very hard to believe that they really and truly thought that this was an emergency. Usually I succeed.
It had been snowing since last night. The county plows couldn't keep up with it, and were only keeping the most main of main roads clear. Once we got into the developments and such, we were on our own. Sometimes, if there wasn't another call, and they got to you in time, one of the small guy plows, the guys with plows on their pick-up trucks, would preceed us into the communities, making sure we wouldn't get stuck. More often that not, especially as the day went on and the snow accumulated, we were on our own.
The call toned out for the 'sick person.' I grumbled as I climed into the officer's seat. "This better be for real," only I'm sure there were more expletives in it than that. It was barely 9am, and I had been out all night on car wrecks and a house fire (never put your warm ashes in a plastic bag and pitch it into your carport, where it falls under your car. No, it was not cold enough outside. Obviously). My partner didn't say anything, but we drove out into the snow.
The snow in the development was brushing the undercarriage of the ambo. In another few hours, we wouldn't be able to make it in here without help from a plow. It was a nice development with modest townhouses, and we found the right one with little trouble. The patient was inside at the kitchen table, looking fairly normal, if slightly pale.
I started with my usual. "Hi, my name is Gnome, and this is my partner M. What seems to be the trouble today?"
The woman smiled at us, not looking very sick. "Well, I've had this stomach bug for a few days now, along with some head congestion and coughing. I just feel sick, and can barely keep anything down. I tried eating breakfast this morning, but it came right back up, and then I couldn't stop vomiting." Her husband is patting her shoulder, and I hear the unmistakable sound of Saturday morning cartoons coming from the other room.
"And then she tried to blow her nose and her nose was bleeding and it wouldn't stop either, for like 15 minutes!" the husband chimes in.
Through questions, I find that this happened around 7am, and it took them about 2 hours to decide to call for an ambo, mainly because she was still feeling ill, and when she tried to drink some orange juice, which came right back up. We take vitals, all which are within normal limits, though she does feel a little on the warm side. She says she's been running a low grade fever since yesterday.
I start giving them options. "Well, we could take you to the hospital, and you'd probably get in pretty quick, but there's no garuntee you could get home today. The roads are all closed to all but emergency traffic, more or less, and your development has almost 2 feet of snow on the roads. The main roads are not much better; the plows can't keep up with the snowfall. So there aren't any taxis that would get you home."
They nodded, and after a brief discussion, decided to stay home. I gave her some ideas to keep food and drink down, because she was likely dehydrated. "When you drink something, make sure it's close to room temp. Not too sweet, not too acidic, or that will upset your stomach. Take a small sip, barely enough to swallow, because your stomach is sensitive right now, and large quantities will make it reject anything that gets put in it. Same for food. Dry toast, or crackers are good right now. But nibble on it so that you don't shock your stomach." They nodded, and seemed to feel better. We told them to call us back if they felt they really needed to go to the hospital, and left.
We got sent from that call to a man with horrid stomach pains. Met us at the curb, hopped into the back as soon as we pulled up. I sat him in the captain's chair. "I have these horrible pains, I don't know what they are. I've never felt anything like this before. I think it might be appendicitis." Pains were centered over the abodomen, spanning both the LRQ and the LLQ. NO change in pain level on palpation, rated 10/10. We head off to the hospital, and I'm in the process of getting vitals when he lets one of the biggest farts I've ever heard from someone. Thank God it didn't stink, cause our windows don't open.
Red-faced, the man apologized. "I am so sorry! I never meant to do that. But hey! I feel better now. The pain's all gone!" He seems more embarrassed that he farted in front of me than that he called 911 for gas pains. Then he asks the coup de grace. "Can you take me home? I don't want to go to the hospital now."
I sigh, inwardly. We are closer to the hospital than his house now, and at the rate the snow is falling now, we'd never get back into his development, plus the man is wearing slippers, so it's not like he could walk the half block back to his house. "I'm very sorry, sir, but we are a one-way service. We can't take you back to your house. We can only take you to the hospital. I am sorry." And I am. Sorry that the hospital staff will have to deal with him when there's nothing wrong with him.
He takes this news well, smiling and sitting back, and talking to me about the improbability of gas pains sending him to the hospital. He still doesn't seem embarrassed; rather he's talking about 'better safe than sorry' and how it could have been something more serious. I just keep writing, wondering how the hell a man in his 40's could possibly not know the difference between gas pains and appendicitis. We pull up to the emergency room waiting area door, and I walk him in. He has a seat in the room, and starts watching TV. I go to the nurse's window and give her a brief report. She chuckles. "At least now I've got a good story. Things are pretty dead here today, for obvious reasons."
Two hours later (about 15 minutes after we get back to the station) we get tapped out for the same address as the first call. This time, we have to wait for a plow to get us into the development...the snow is now above the undercarriage, and when the drop-down step comes out of the side door, I have to knock the snow off of it. We arrive at the house, and the husband and wife are waiting outside for us. Bags are packed. They hop in the back. "I did what you said and it was working," she tells me. But then I fell asleep on the couch for a bit, and when I woke up I was so thirsty that I drank the whole glass of water and it just came right back up. So we decided to call you back."
I only nod and sigh. They tell me that they got a neighbor to watch their kids. It takes us 45 mintues to get to the hospital, which is normally a 10 minute drive. This time, the patient was on the stretcher, so we wheeled her into the emergency entrance. I gave report to the nurse, and we headed back home. AN hour later, we pulled into the station.
Yeah, I try to be nice to my patients. I try very hard to believe that they really and truly thought that this was an emergency. Usually I succeed.
Monday, October 20, 2008
To Fly, or Not to Fly?
That is the question.
There's been a lot of talk on various sources about the pros and cons of HEMS. Don't get me wrong. I'm all for it in the right circumstances. I have flown several patients out myself. Five, in fact. In the 10 years I've been an EMT. Three were peds cases, two were adult traumas. In all 4 cases, I had (as did the medics with me) every reason to believe that time was of the essence. Both peds cases were head injuries, and while one of them could have been driven, it was rush hour in the metro area, and getting to the Big Children's Hospital would have taken over an hour, if not closer to 2 hours. The second peds case I flew was a status epilepticus secondary to a fall down the stairs. The third was a toddler who had been 'run over by a car' and while he didn't appear to have any obvious injuries, there was a large patch of hair missing from his head, which lead both me and the medic to believe the by-standers story that it was his head that was in contact with the tire. How much? Who knows, but I'm not really one to take chances with a toddler.
The first kid actually ended up only having a moderate concussion and depressed skull fracture (after pulling a fully loaded bookcase on himself!) and spent 2 nights in hospital, only because mom wanted him to stay the second night just in case. They stopped by about a month after it happened to say thank you, with cookies. Lucky kid.
Both adults were head injuries from an MVA, with altered mental status and other injuries like bilateral humerus fractures or a femur fracture, etc. In one case I was driving home from work and came on scene before the FD. Luckily, I knew the Lt on the engine, and when I said that the guy was going to need a helo, he listened to me. Granted, the guy could have gone by ground, but again, it was rush hour and even with lights and sirens, it would have taken over an hour to get to the Level II trauma center.
I got my EMT certification in a state with a lot of rural areas, and I happened to work in a semi-rural area (some small cities, with LOTS of emptiness and the closest trauma/burn/anything bad center was about an hour away on the state turnpike). The closest helo was about 45 minutes away by ground, and had to be called special by the county to the state in order to get them going. I can't remember EVER flying someone when I was up there. Granted, I didn't have much of a chance to most of the time, but the mentality up there was to get a good assessment and learn to deal with a lot of shit yourself, because the helo was only for REAL emergencies. Good, bad, or indifferent, that was the way it was.
Then I move to a smaller state with a much higher population, in one of the most populated areas in the country. The HEMS around here is run by the state. No 'helo shopping' around here. And a federal police service has medics on their helos, so they can help out when we need them to. Their AC are also larger, and can carry more people/patients. I see a lot more patients being flown to various places here than I ever saw in Rural Area state. One would think it would be the opposite, with my primary call area being within spitting distance of 3 hospitals, one of which is a Level II Trauma center, and within an hour (in good traffic) of 3 Big City Hospitals. I've had an opinion about this proliferate use of HEMS when you are so close to relatively definitive care, and a recent call I went on before my surgery only cemented that belief.
My EMT instructors HAMMERED us on assessment. How can you decide what is best for the patient when your assessment is lacking? And in areas where the closest hospital may easily be an hour away, assessment is key. Continuing assessment is also key. And by having a good assessment, and KNOWING your assessment is good, you have confidence. Confidence that you haven't missed anything glaringly obvious, and confidence that what you write on your run sheet will stand up.
When you lack confidence in your abilities, you are more likely to call for someone with more skills to help out. This can be a good thing sometimes. But when that someone is a flight medic who comes on a big whirly bird, this can be a bad thing. The flight medic is unlikely to refuse the flight, because flights mean money and continued existence (and jobs) for him or her. In private companies, that money comes in the form of billing the patient (and a helo flight is VERY expensive). In public, like where I'm at, that comes in the form of state and federal monies, which are given based on need...in this case, usage of the service. So, because of the lack of confidence of the medic, and a poor report to the doctor (which does not paint an accurate picture of the patient) and a doctor afraid of 'zebras' and the extra money it will cost the hospital if the patient really IS a trauma who needs to be at a trauma center and has to be flown by private HEMS, a helo is dispatched, extra flight hours are put on the helo, taking it out of service faster, and in general, risk is run to everyone.
Equal to the lack of confidence, (and perhaps, and indirect result of lack of confidence) is the 'what if' scenario. 'What if' the patient has serious trauma injuries that are being masked by EtOH? 'What if' the patient really is hurt and deteriorates while we're taking them to the lower level trauma center? Constantly looking for the stampeding hordes of zebras doesn't make you a better provider. I've heard of doctor's with this same problem. I blame the lawyers and policy makers for making every medical provider from EMT up to surgeon uber-paranoid about lawsuits for 'what if' situations, so we over-treat in the hopes that the zebra will be caught. In the meantime, all those extra costs (or risks) are being passed down to the patient and public. But in reality, is this really totally the fault of the lawyers and policy makers? Why are some providers comfortable in treating patients as they present and others want to do everything under the sun 'just in case?'
In my opinion, it comes down to confidence. Confidence in assessments, abilities, and documentation. If you are confident in your ability to assess and treat, and then document EXACTLY what you did, the times you did it and why (not always needed, but it helps), then there should be no reason for you to call for a higher level provider unless it is truly needed. If you can back up what you did, why worry? Sure, something may slip by. But I was always taught that if you are acting within your scope of practice, and with the best interests of the patient in mind, and you document why you did what you did, then you should be covered.
Sadly, for so many, this is no longer so. Perhaps I just haven't gotten bit by the lawsuit bug yet, or been trampled enough by zebras to have this worry. Hopefully I never will.
There's been a lot of talk on various sources about the pros and cons of HEMS. Don't get me wrong. I'm all for it in the right circumstances. I have flown several patients out myself. Five, in fact. In the 10 years I've been an EMT. Three were peds cases, two were adult traumas. In all 4 cases, I had (as did the medics with me) every reason to believe that time was of the essence. Both peds cases were head injuries, and while one of them could have been driven, it was rush hour in the metro area, and getting to the Big Children's Hospital would have taken over an hour, if not closer to 2 hours. The second peds case I flew was a status epilepticus secondary to a fall down the stairs. The third was a toddler who had been 'run over by a car' and while he didn't appear to have any obvious injuries, there was a large patch of hair missing from his head, which lead both me and the medic to believe the by-standers story that it was his head that was in contact with the tire. How much? Who knows, but I'm not really one to take chances with a toddler.
The first kid actually ended up only having a moderate concussion and depressed skull fracture (after pulling a fully loaded bookcase on himself!) and spent 2 nights in hospital, only because mom wanted him to stay the second night just in case. They stopped by about a month after it happened to say thank you, with cookies. Lucky kid.
Both adults were head injuries from an MVA, with altered mental status and other injuries like bilateral humerus fractures or a femur fracture, etc. In one case I was driving home from work and came on scene before the FD. Luckily, I knew the Lt on the engine, and when I said that the guy was going to need a helo, he listened to me. Granted, the guy could have gone by ground, but again, it was rush hour and even with lights and sirens, it would have taken over an hour to get to the Level II trauma center.
I got my EMT certification in a state with a lot of rural areas, and I happened to work in a semi-rural area (some small cities, with LOTS of emptiness and the closest trauma/burn/anything bad center was about an hour away on the state turnpike). The closest helo was about 45 minutes away by ground, and had to be called special by the county to the state in order to get them going. I can't remember EVER flying someone when I was up there. Granted, I didn't have much of a chance to most of the time, but the mentality up there was to get a good assessment and learn to deal with a lot of shit yourself, because the helo was only for REAL emergencies. Good, bad, or indifferent, that was the way it was.
Then I move to a smaller state with a much higher population, in one of the most populated areas in the country. The HEMS around here is run by the state. No 'helo shopping' around here. And a federal police service has medics on their helos, so they can help out when we need them to. Their AC are also larger, and can carry more people/patients. I see a lot more patients being flown to various places here than I ever saw in Rural Area state. One would think it would be the opposite, with my primary call area being within spitting distance of 3 hospitals, one of which is a Level II Trauma center, and within an hour (in good traffic) of 3 Big City Hospitals. I've had an opinion about this proliferate use of HEMS when you are so close to relatively definitive care, and a recent call I went on before my surgery only cemented that belief.
My EMT instructors HAMMERED us on assessment. How can you decide what is best for the patient when your assessment is lacking? And in areas where the closest hospital may easily be an hour away, assessment is key. Continuing assessment is also key. And by having a good assessment, and KNOWING your assessment is good, you have confidence. Confidence that you haven't missed anything glaringly obvious, and confidence that what you write on your run sheet will stand up.
When you lack confidence in your abilities, you are more likely to call for someone with more skills to help out. This can be a good thing sometimes. But when that someone is a flight medic who comes on a big whirly bird, this can be a bad thing. The flight medic is unlikely to refuse the flight, because flights mean money and continued existence (and jobs) for him or her. In private companies, that money comes in the form of billing the patient (and a helo flight is VERY expensive). In public, like where I'm at, that comes in the form of state and federal monies, which are given based on need...in this case, usage of the service. So, because of the lack of confidence of the medic, and a poor report to the doctor (which does not paint an accurate picture of the patient) and a doctor afraid of 'zebras' and the extra money it will cost the hospital if the patient really IS a trauma who needs to be at a trauma center and has to be flown by private HEMS, a helo is dispatched, extra flight hours are put on the helo, taking it out of service faster, and in general, risk is run to everyone.
Equal to the lack of confidence, (and perhaps, and indirect result of lack of confidence) is the 'what if' scenario. 'What if' the patient has serious trauma injuries that are being masked by EtOH? 'What if' the patient really is hurt and deteriorates while we're taking them to the lower level trauma center? Constantly looking for the stampeding hordes of zebras doesn't make you a better provider. I've heard of doctor's with this same problem. I blame the lawyers and policy makers for making every medical provider from EMT up to surgeon uber-paranoid about lawsuits for 'what if' situations, so we over-treat in the hopes that the zebra will be caught. In the meantime, all those extra costs (or risks) are being passed down to the patient and public. But in reality, is this really totally the fault of the lawyers and policy makers? Why are some providers comfortable in treating patients as they present and others want to do everything under the sun 'just in case?'
In my opinion, it comes down to confidence. Confidence in assessments, abilities, and documentation. If you are confident in your ability to assess and treat, and then document EXACTLY what you did, the times you did it and why (not always needed, but it helps), then there should be no reason for you to call for a higher level provider unless it is truly needed. If you can back up what you did, why worry? Sure, something may slip by. But I was always taught that if you are acting within your scope of practice, and with the best interests of the patient in mind, and you document why you did what you did, then you should be covered.
Sadly, for so many, this is no longer so. Perhaps I just haven't gotten bit by the lawsuit bug yet, or been trampled enough by zebras to have this worry. Hopefully I never will.
Friday, October 17, 2008
Cab-ulance
I've been credited with initiating several partners with this term. I'm not quite sure how or where, since I don't recall first using it, but there you are. And I do tend to forget what I've said when I'm transporting a patient at 3am. Heck, one partner even said I used it over the radio when calling into County that we were enroute. Again, not something I recall.
At any rate, it's no secret around my dept that I have a deep and utter loathing for people who use the ambulance for their own personal taxi. Granted, there are exceptions to this, and I'm ok with that, and I've been told that other EMT's admire me for my 'outward' politeness to these system abusers (though my partners know full well what is going through my head at the time). I know many other EMT's and medics feel this way, and in fact, had an instructor in my EMT-I class who has been in trouble for taking a 'patient' (and I use the term lightly) to the hospital by telling the person to get in the back, and then getting back into the front seat himself, and dropping the person at the doors to the waiting room.
NOTE: I DO NOT condone this action. I did find it funny as hell when he related it to the class, and I wish to hell I had the cojones to do it, but I fear for my certification.
Here are some instances in which I have had the urge to tell the person calling an EMERGENCY VEHICLE for taxi-transport to F**K OFF!!!!
-the guy who has a history of kidney stones, thinks he's getting it again, and has abdominal pain of 3/10. Lives on a road that barely exists and is full of potholes. Has the energy to pack a suitcase, and wait for us at the end of the driveway, and then walk back up the driveway to the house to call 911 back and complain we aren't there yet, because we are lost. Upon putting his keys into his suitcase, I notice 2 car keys on the ring, and saw at least one car in the driveway when I was playing bellhop and loading up his suitcase into the ambo. Total time: 20 minutes getting to his house. 5 minute drive (no flashy lights or sirens because it's 2am) to the hospital, 15 minutes to put guy in triage and wait to give report to the nurse because the ED is full, 15 minutes back to the station.
-the mother who called 911 because her (old enough to know better) son was jumping on the bed and when the mattress slipped off, he cut his foot on the springs. Granted, the slice was deep, and probably painful, though the kid was remarkably calm, and definately needed stitches. Call comes in around 6pm, just as dinner is getting on the table. Upon arrival to the scene, there were so many cars in the driveway (and on the grass, and in the road) that we had to park one house away and walk everything in. Upon being told by the Lt riding charge that Jr needs stitches and a tetanus shot, but mom (or any one of the 15 adults standing around) can take him herself once we bandage the foot up (because arriving on the big white box with lights that aren't flashing doesn't mean you have to be seen immediately), mom states (and I quote) "Oh that's ok. Jr has never ridden in an ambulance, and thinks it would be neat, so we'll let you take him. I'll have someone follow in a car." Because clearly it is a priveledge for us to take your old-enough-to-know-better son and yourself to the hospital, just to take you to the waiting room (because both the adult ED and the peds ED are full) and listen to you complain that the wait will be too long.
-the 20-something year old woman who was complaining of lower back and flank pain on one side. Had no desire to go to the hospital, just wanted to know if she had a kidney infection. I almost hugged my Lt when he told her (with a straight face) that the ambulance's portable x-ray machine was broken and she would have to either go to the hospital or to her PCP. She didn't get it.
-if you cut yourself, and pass out at the sight of your own blood, and then call 911, don't get mad at me when I ask where the cut it. If I can't see it, it probably doesn't warrent a trip to the ED. Now, while I am not made sick at the sight of blood (my own, or anyone else's), I can understand that cutting yourself with a sharp knife is very painful and that some people have that reaction. I really am trying to be understanding and put your mind at ease. Your vitals are all fine, and the headache you feel is probably left over from the adrenaline rush which caused you to get all weak and wobbly anyway, and most likely is NOT from bumping your head on the cabinet as you slid to the floor. Oh, and having your wife constantly question me isn't helping...Man up, dude.
-Note to nursing home staff. I know it's hard to work in a nursing home, and I know the pay is crap. I know you have to pass a ridiculous amount of tests and audits and that you get treated like criminals every time a patient dies. Trust me, I've worked there....I know. But here's a few things I'd like you to think about....Just because the doc told you to ship the patient out to the ED because you woke him up at 2am because patient A has a cough doesn't mean you have to call 911. There are transport services around that can do the same job. The only difference between them and me is that I come in 5 minutes, after putting my own and other's lives in danger by running hot, and I don't charge a fee, unlike the transport service, that, depending on call volume, may get there in an hour or so, and will charge you.
Also, calling for the 'unconscious person' because you checked on them at 8 when you cleaned up their dinner tray and then didn't check on them again until midnight shift change won't go over well with me OR the medics when it turns out the patient was merely sleeping, and took out their hearing aides. Looking at me wide-eyed with astonishment when I was able to magically wake them up won't win you any points either. Obviously the patient is stone-deaf, and can't hear you whispering for them to wake up at the doorway.
As I said before, I've worked in nursing homes and such. I know the nurse to CNA ratio is low, and patient to carer ratio is extremely high. However, I made it a point to know my patients (and I was in a rehab place, so it was quick turn-around) so that if 911 did have to be called, I would know what was going on with them. Calling me for anything and having the CNA meet me, and tell me they don't know what's wrong with the patient is not helping you, me and most of all the patient. This is especially true for when you call me for a fall. If the patient falls, and you suspect something is wrong, PLEASE do not pick them up and put them back in bed, and then wait till the next shift comes in so that they have to call. Make them comfy on the floor and call and wait. I hate hearing the patient ask me not to hurt them again when I have to move them. It breaks my heart, and since it's been hypothesized that I don't have much a heart anyway, that is no mean feat.
And while I have several other beefs (especially with nursing homes), my last one is this. Many people go to a nursing home because they cannot be cared for at home. The vast majority of the time, these people are just waiting to die. Sorry to be blunt, but that's how it is. If I am old and sick, the LAST thing I want is to be moved from my bed and my belongings and sent to a cold, impersonal hospital to die. I have a DNR-B for a reason, and that reason is that I WANT TO DIE PEACEFULLY!!! I don't want to die with the sounds of a hospital ED being the last things I hear. So calling an ambulance for the 99 year old person with end-stage lung cancer and Alzhiemer's Disease who has a DNR-B, and at midnight shift change had a blood pressure of 50/10, a heart rate of 20, and a respiratory rate of 4-6 (and it's now 0130 because you HAD to finish shift change rounds) is probably not the best practice. Yes, I know you get investigated by the state every time a patient dies on grounds, but really? And yes, the doc told you to ship them out, (which I hate, because the patient is NOT a package to be 'shipped') but when you wake a doctor up at 1am and tell him the patient's vitals and not much else, what else do you think he's going to say? I really dislike transporting what is essentially a corpse to the hospital because you don't feel like doing the paperwork.
Being named the 'Angel of Death' by the ED nurses because 6 out of 10 patients I transported over a 2 day period (all of them nursing home patients with a DNR-B) took their last breath as I moved them over to the hospital bed doesn't make me much happier with you, by the way.
Perhaps this nursing home rant should be it's own post. I think it will be. But the next post I think will be one in which I discuss the times I don't mind being a cab-ulance. Those times include little old ladies or anyone who can't drive themselves for something that they otherwise would have.
At any rate, it's no secret around my dept that I have a deep and utter loathing for people who use the ambulance for their own personal taxi. Granted, there are exceptions to this, and I'm ok with that, and I've been told that other EMT's admire me for my 'outward' politeness to these system abusers (though my partners know full well what is going through my head at the time). I know many other EMT's and medics feel this way, and in fact, had an instructor in my EMT-I class who has been in trouble for taking a 'patient' (and I use the term lightly) to the hospital by telling the person to get in the back, and then getting back into the front seat himself, and dropping the person at the doors to the waiting room.
NOTE: I DO NOT condone this action. I did find it funny as hell when he related it to the class, and I wish to hell I had the cojones to do it, but I fear for my certification.
Here are some instances in which I have had the urge to tell the person calling an EMERGENCY VEHICLE for taxi-transport to F**K OFF!!!!
-the guy who has a history of kidney stones, thinks he's getting it again, and has abdominal pain of 3/10. Lives on a road that barely exists and is full of potholes. Has the energy to pack a suitcase, and wait for us at the end of the driveway, and then walk back up the driveway to the house to call 911 back and complain we aren't there yet, because we are lost. Upon putting his keys into his suitcase, I notice 2 car keys on the ring, and saw at least one car in the driveway when I was playing bellhop and loading up his suitcase into the ambo. Total time: 20 minutes getting to his house. 5 minute drive (no flashy lights or sirens because it's 2am) to the hospital, 15 minutes to put guy in triage and wait to give report to the nurse because the ED is full, 15 minutes back to the station.
-the mother who called 911 because her (old enough to know better) son was jumping on the bed and when the mattress slipped off, he cut his foot on the springs. Granted, the slice was deep, and probably painful, though the kid was remarkably calm, and definately needed stitches. Call comes in around 6pm, just as dinner is getting on the table. Upon arrival to the scene, there were so many cars in the driveway (and on the grass, and in the road) that we had to park one house away and walk everything in. Upon being told by the Lt riding charge that Jr needs stitches and a tetanus shot, but mom (or any one of the 15 adults standing around) can take him herself once we bandage the foot up (because arriving on the big white box with lights that aren't flashing doesn't mean you have to be seen immediately), mom states (and I quote) "Oh that's ok. Jr has never ridden in an ambulance, and thinks it would be neat, so we'll let you take him. I'll have someone follow in a car." Because clearly it is a priveledge for us to take your old-enough-to-know-better son and yourself to the hospital, just to take you to the waiting room (because both the adult ED and the peds ED are full) and listen to you complain that the wait will be too long.
-the 20-something year old woman who was complaining of lower back and flank pain on one side. Had no desire to go to the hospital, just wanted to know if she had a kidney infection. I almost hugged my Lt when he told her (with a straight face) that the ambulance's portable x-ray machine was broken and she would have to either go to the hospital or to her PCP. She didn't get it.
-if you cut yourself, and pass out at the sight of your own blood, and then call 911, don't get mad at me when I ask where the cut it. If I can't see it, it probably doesn't warrent a trip to the ED. Now, while I am not made sick at the sight of blood (my own, or anyone else's), I can understand that cutting yourself with a sharp knife is very painful and that some people have that reaction. I really am trying to be understanding and put your mind at ease. Your vitals are all fine, and the headache you feel is probably left over from the adrenaline rush which caused you to get all weak and wobbly anyway, and most likely is NOT from bumping your head on the cabinet as you slid to the floor. Oh, and having your wife constantly question me isn't helping...Man up, dude.
-Note to nursing home staff. I know it's hard to work in a nursing home, and I know the pay is crap. I know you have to pass a ridiculous amount of tests and audits and that you get treated like criminals every time a patient dies. Trust me, I've worked there....I know. But here's a few things I'd like you to think about....Just because the doc told you to ship the patient out to the ED because you woke him up at 2am because patient A has a cough doesn't mean you have to call 911. There are transport services around that can do the same job. The only difference between them and me is that I come in 5 minutes, after putting my own and other's lives in danger by running hot, and I don't charge a fee, unlike the transport service, that, depending on call volume, may get there in an hour or so, and will charge you.
Also, calling for the 'unconscious person' because you checked on them at 8 when you cleaned up their dinner tray and then didn't check on them again until midnight shift change won't go over well with me OR the medics when it turns out the patient was merely sleeping, and took out their hearing aides. Looking at me wide-eyed with astonishment when I was able to magically wake them up won't win you any points either. Obviously the patient is stone-deaf, and can't hear you whispering for them to wake up at the doorway.
As I said before, I've worked in nursing homes and such. I know the nurse to CNA ratio is low, and patient to carer ratio is extremely high. However, I made it a point to know my patients (and I was in a rehab place, so it was quick turn-around) so that if 911 did have to be called, I would know what was going on with them. Calling me for anything and having the CNA meet me, and tell me they don't know what's wrong with the patient is not helping you, me and most of all the patient. This is especially true for when you call me for a fall. If the patient falls, and you suspect something is wrong, PLEASE do not pick them up and put them back in bed, and then wait till the next shift comes in so that they have to call. Make them comfy on the floor and call and wait. I hate hearing the patient ask me not to hurt them again when I have to move them. It breaks my heart, and since it's been hypothesized that I don't have much a heart anyway, that is no mean feat.
And while I have several other beefs (especially with nursing homes), my last one is this. Many people go to a nursing home because they cannot be cared for at home. The vast majority of the time, these people are just waiting to die. Sorry to be blunt, but that's how it is. If I am old and sick, the LAST thing I want is to be moved from my bed and my belongings and sent to a cold, impersonal hospital to die. I have a DNR-B for a reason, and that reason is that I WANT TO DIE PEACEFULLY!!! I don't want to die with the sounds of a hospital ED being the last things I hear. So calling an ambulance for the 99 year old person with end-stage lung cancer and Alzhiemer's Disease who has a DNR-B, and at midnight shift change had a blood pressure of 50/10, a heart rate of 20, and a respiratory rate of 4-6 (and it's now 0130 because you HAD to finish shift change rounds) is probably not the best practice. Yes, I know you get investigated by the state every time a patient dies on grounds, but really? And yes, the doc told you to ship them out, (which I hate, because the patient is NOT a package to be 'shipped') but when you wake a doctor up at 1am and tell him the patient's vitals and not much else, what else do you think he's going to say? I really dislike transporting what is essentially a corpse to the hospital because you don't feel like doing the paperwork.
Being named the 'Angel of Death' by the ED nurses because 6 out of 10 patients I transported over a 2 day period (all of them nursing home patients with a DNR-B) took their last breath as I moved them over to the hospital bed doesn't make me much happier with you, by the way.
Perhaps this nursing home rant should be it's own post. I think it will be. But the next post I think will be one in which I discuss the times I don't mind being a cab-ulance. Those times include little old ladies or anyone who can't drive themselves for something that they otherwise would have.
Thursday, October 16, 2008
You always remember your first...
I took EMT-B class in NorthEastern PA (yes, it deserves being capitalized) during my sophomore year of college, between 1997 and '98.. I had wanted to ride an ambulance since I first started seeing them on the sidelines of the high school football games, while I was playing drums in the band. How cool, to be in those orange jumpsuits, driving around town lights and sirens to save people's lives!
I already had plans to go to medical school after college and then working in an ER or as a trauma surgeon (hey...I had dreams...), so when the opportunity came to take an EMT class, I figured, why not? By becoming an EMT and working car wreck scenes and heart attacks, I learn if I can hack the pressure and stress that comes with working in emergency situations, right?
So I took EMT class, and excelled, I'd like to think. My instructors made sure we could think our way out of a problem, because honestly, the way EMS was in PA at that time, you may very well find yourself on a trip to the trauma center an hour away with one medic in the back with you and the driver in the front. There was no helo on every corner, and the local Level II trauma center only took people with their particular insurance. And if you wanted to go to a specific hospital, you better either call when you're on the doorstep, or call before leaving scene, because the doc taking your call could very well refuse your patient, sending you to another hospital. We didn't do a lot of rendevous with the medics, because they were hospital based in a delta truck (van) and we had to respond to the station and then get to the scene, because the ambulances were housed in the city council building, along with the fire dept and the police, and the local jail. There was a room upstairs with the computers to do your reports and a couple of couches, but you weren't allowed to sleep there. Therefore, there was a lot of being woken up in the middle of hte night and calling in to dispatch and driving to the station to get the ambulance out. Dispatch, who was contacted by the county (who received the 911 calls) would tone out whatever was needed. You got 3 tone outs, 2 minutes apart, before mutual aid was activated. If you called in as the aide, or EMT, you would head to the station, but if they didn't raise a driver, it would go to mutual aid and you just drove across town at 3am for nothing. I can't say that I got a lot of experience there, but I learned a lot from the medics who beat us to the scene and treated the patients while they waited for transport. Our dept didn't have a lot of money, so I learned to improvise a lot of things, and I learned that if shit goes downhill, you can't freak out. You have to suck it up and deal and learn from what is going on so you don't let it happen again. A partner of mine had to once ride with a 300lb pt in the back of the secondary ambo, with a stretcher that wouldn't go down all the way and therefore wouldn't fit in the brackets. The patient was critical, and for once they had beaten the medics to the scene and set up a rendevous. I remember him relaying the story to me, him a new EMT on his second call, terrified that the medic would open the back and see him holding the broken stretcher against the brackets with his feet and have kittens. You can say that I learned early in my career the importance of 'Improvise, Adapt and Overcome.'
I got my certification in January of 1998. In NEPA, winters tend to be a bit rough, and one night, about 2 weeks after getting my card in the mail, our tones dropped for an injured child after sledding. It had been snowing and sleeting all day, and we hadn't had classes. So my partner and I piled into his truck and headed over to the station. We made it just as the ambo was pulling out and jumped on. We got on scene, and the medics, rescue chief, assistant rescue chief, and half the dept had already gotten there (lots of people responded in the POV's from home if they heard the ambo had a crew). We got there just in time to help put the backboard on the Reeves and slip and slide down the icey road to the ambo.
Everyone piled on. The rescue chief, the paramedic, myself, and my partner. A firefighter drove, and the patient's little brother sat in the front seat. The patient was a tall kid, somewhere in his early teens (I can't remember his exact age), who had been sledding down the street at night with his brother. The parents were out, maybe shopping, maybe working, I don't remember. The patient hit a tree after jumping the curb, and had been found by the first people on scene under a car.
I don't remember much about the trip to the hospital, or the patient's treatment. I remember that he didn't have a mark on him, save for a stripe of grease on his forehead, obviously from sliding under the car. I remember being given trauma shears by the medic and being told to cut his pants. I remember that it was a long-assed ride, with the on-spot chains down, slowly driving up the highway in the snow, the emergency lights reflecting off the flakes. I remember that we couldn't call for a helo because of the weather.
The most memorable thing though, was this. The rescue chief, also a medic, called the closest hospital, General Hospital, to give report. The doctor on the other end of the radio, after learning that the patient was a minor and the parents had not been contacted yet, refused the patient, instructing us to take him to We'll Take Anyone Hospital. Neither one was a trauma center, but the local level II trauma center didn't like to be bothered at night with patients who didn't have the right insurance. WTAH was 20 minutes up a major interstate on a good day. Tonight was not a good day.
Cursing a blue streak, the rescue chief told the driver to head for the highway. 45 minutes later, we were at the hospital. I don't remember much more than what I've written, perhaps because while cleaning up the ambo I slipped while going out the side door and fell, hitting my head on the floor. Don't know if I had a concussion, but I certainly had a headache for the ride back. And I do remember that 2 days later the news reported that the patient had died of a closed head injury.
Being in Maryland now, I tell that story, and people are incredulous. Perhaps I got some details wrong, being a newly minted EMT with ZERO experience with the hospitals and doctors and things of that nature. But I do remember having a box on the back of our run forms where the patient had to put their insurance info, or sign if they didn't have any. And I do remember the hospital, specifically General Hospital, being VERY interested in which box was signed. And I distinctly remember the rescue chief cursing the doctor at GH as we drove slowly to WTAH, impuning his degree and the questionable tactics of allowing a hospital to turf what could be a critical patient to a hospital father away on a horrid night to be out driving because insurance coverage couldn't be confirmed.
Whether the law in PA had changed by then to allow uninsured people payment options or not, I don't know. I didn't know much about the law in PA at that time. But when I tell that story to my EMT students, they don't believe it. Not the part about the hospital turfing the patient, or the part where the next closest hospital was more than 10 minutes away.
I already had plans to go to medical school after college and then working in an ER or as a trauma surgeon (hey...I had dreams...), so when the opportunity came to take an EMT class, I figured, why not? By becoming an EMT and working car wreck scenes and heart attacks, I learn if I can hack the pressure and stress that comes with working in emergency situations, right?
So I took EMT class, and excelled, I'd like to think. My instructors made sure we could think our way out of a problem, because honestly, the way EMS was in PA at that time, you may very well find yourself on a trip to the trauma center an hour away with one medic in the back with you and the driver in the front. There was no helo on every corner, and the local Level II trauma center only took people with their particular insurance. And if you wanted to go to a specific hospital, you better either call when you're on the doorstep, or call before leaving scene, because the doc taking your call could very well refuse your patient, sending you to another hospital. We didn't do a lot of rendevous with the medics, because they were hospital based in a delta truck (van) and we had to respond to the station and then get to the scene, because the ambulances were housed in the city council building, along with the fire dept and the police, and the local jail. There was a room upstairs with the computers to do your reports and a couple of couches, but you weren't allowed to sleep there. Therefore, there was a lot of being woken up in the middle of hte night and calling in to dispatch and driving to the station to get the ambulance out. Dispatch, who was contacted by the county (who received the 911 calls) would tone out whatever was needed. You got 3 tone outs, 2 minutes apart, before mutual aid was activated. If you called in as the aide, or EMT, you would head to the station, but if they didn't raise a driver, it would go to mutual aid and you just drove across town at 3am for nothing. I can't say that I got a lot of experience there, but I learned a lot from the medics who beat us to the scene and treated the patients while they waited for transport. Our dept didn't have a lot of money, so I learned to improvise a lot of things, and I learned that if shit goes downhill, you can't freak out. You have to suck it up and deal and learn from what is going on so you don't let it happen again. A partner of mine had to once ride with a 300lb pt in the back of the secondary ambo, with a stretcher that wouldn't go down all the way and therefore wouldn't fit in the brackets. The patient was critical, and for once they had beaten the medics to the scene and set up a rendevous. I remember him relaying the story to me, him a new EMT on his second call, terrified that the medic would open the back and see him holding the broken stretcher against the brackets with his feet and have kittens. You can say that I learned early in my career the importance of 'Improvise, Adapt and Overcome.'
I got my certification in January of 1998. In NEPA, winters tend to be a bit rough, and one night, about 2 weeks after getting my card in the mail, our tones dropped for an injured child after sledding. It had been snowing and sleeting all day, and we hadn't had classes. So my partner and I piled into his truck and headed over to the station. We made it just as the ambo was pulling out and jumped on. We got on scene, and the medics, rescue chief, assistant rescue chief, and half the dept had already gotten there (lots of people responded in the POV's from home if they heard the ambo had a crew). We got there just in time to help put the backboard on the Reeves and slip and slide down the icey road to the ambo.
Everyone piled on. The rescue chief, the paramedic, myself, and my partner. A firefighter drove, and the patient's little brother sat in the front seat. The patient was a tall kid, somewhere in his early teens (I can't remember his exact age), who had been sledding down the street at night with his brother. The parents were out, maybe shopping, maybe working, I don't remember. The patient hit a tree after jumping the curb, and had been found by the first people on scene under a car.
I don't remember much about the trip to the hospital, or the patient's treatment. I remember that he didn't have a mark on him, save for a stripe of grease on his forehead, obviously from sliding under the car. I remember being given trauma shears by the medic and being told to cut his pants. I remember that it was a long-assed ride, with the on-spot chains down, slowly driving up the highway in the snow, the emergency lights reflecting off the flakes. I remember that we couldn't call for a helo because of the weather.
The most memorable thing though, was this. The rescue chief, also a medic, called the closest hospital, General Hospital, to give report. The doctor on the other end of the radio, after learning that the patient was a minor and the parents had not been contacted yet, refused the patient, instructing us to take him to We'll Take Anyone Hospital. Neither one was a trauma center, but the local level II trauma center didn't like to be bothered at night with patients who didn't have the right insurance. WTAH was 20 minutes up a major interstate on a good day. Tonight was not a good day.
Cursing a blue streak, the rescue chief told the driver to head for the highway. 45 minutes later, we were at the hospital. I don't remember much more than what I've written, perhaps because while cleaning up the ambo I slipped while going out the side door and fell, hitting my head on the floor. Don't know if I had a concussion, but I certainly had a headache for the ride back. And I do remember that 2 days later the news reported that the patient had died of a closed head injury.
Being in Maryland now, I tell that story, and people are incredulous. Perhaps I got some details wrong, being a newly minted EMT with ZERO experience with the hospitals and doctors and things of that nature. But I do remember having a box on the back of our run forms where the patient had to put their insurance info, or sign if they didn't have any. And I do remember the hospital, specifically General Hospital, being VERY interested in which box was signed. And I distinctly remember the rescue chief cursing the doctor at GH as we drove slowly to WTAH, impuning his degree and the questionable tactics of allowing a hospital to turf what could be a critical patient to a hospital father away on a horrid night to be out driving because insurance coverage couldn't be confirmed.
Whether the law in PA had changed by then to allow uninsured people payment options or not, I don't know. I didn't know much about the law in PA at that time. But when I tell that story to my EMT students, they don't believe it. Not the part about the hospital turfing the patient, or the part where the next closest hospital was more than 10 minutes away.
Wednesday, October 15, 2008
Beginning
I'm starting this blog because I didn't want to continue on the Antarctica blog, keeping that one rather special for my Ice time.
But I have so many calls crammed into my head that I need to get them out. So while I'm recovering from surgery and waiting to be cleared to ride again, I figured I'd empty out my brain of 10 years of EMS calls. The good, the bad, and the ugly.
But I have so many calls crammed into my head that I need to get them out. So while I'm recovering from surgery and waiting to be cleared to ride again, I figured I'd empty out my brain of 10 years of EMS calls. The good, the bad, and the ugly.
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