101 Things the Fire Department wishes you knew



Friday, February 27

You Make the Call...C-Spine Precautions

This call was one of the ones I look back on as a perfect example of why a blanket C-Spine protocol is never a good idea. Paramedics need the training and authority to "clear" C-Spine in the field based on proven assessment techniques.


I'm assigned to an ALS ambulance dispatched to a PD eval late on a Saturday night to a nightclub famous for trouble.
On scene PD advises that they responded to a call for a fight, but the defending party fled the scene 30 minutes ago, then suddenly returned.

Our patient is in his late 20's, conscious and alert, no alcohol or elicit drug use admitted or evidenced on assessment. He states the bouncer came at him with a "baseball bat" which the bouncer denies.
The patient has a small, non suturable laceration, approx 2 cm to his right parietal skull, bleeding controlled, and there is some blood in his long unkempt hair.

He is initially refusing treatment, but after talking him into the back of the ambulance where there is better light he decides to go with us simply to escape the situation.

He has no pain, no complaint and makes no indications that the laceration is bothering him. He also states he does not recall the bat hitting him and that he may have scraped his head on a wall as he ducked out of the way of the bat.

From my experience, and the fact I had to talk him into the ambulance, if I break out a cervical collar this guy will freak and fight, twisting his neck this way and that to avoid my cervical immobilization device.

My protocol states that full C-Spine precautions are to be taken on any person with trauma noted above the clavicles.

Do I C-spine this patient? Just collar? Based on your protocols...You make the call.

The Handover - Edition 1

The Pre Hospital and ER/A&E Blog Carnival "The Handover" has gone live!

Our host, Medicblog999 a UK Medic and nurse mentioned more than a few times here at HM HQ, has chosen a great group of posts for the first category of "Your most memorable post."

Go have a read, you'll be glad you did.

HM

PSA #1

And now a PSA (Personal Silly Annoyances) notice,

When did it become acceptable to wear pajamas out during daytime hours? There are a number of borderline adults as well as many teenage girls who are wandering the stores in pajama pants, slippers, sweatshirts and large sunglasses.
When did this become the "in" thing to do? Their grandparents would have been scolded for not wearing a hat out of the house in their day and now these folks are in line at the Target dressed like they're still in bed?
I find it offensive and clearly lazy. Sure it's a free country and they can wear whatever they want, but they're idiots. Lazy idiots.

Ahhhhh, that feels better.

Speaking of being in line at the Target, why are there 28 checkout lines but only 3 of them are open?
When they built this Target, and the 18 catrillion others, they apparently expected to have more high school kids working there because it seems every store I go to has at least a dozen registers, but only a handful open. What a waste!

And especially when I have to stand in line with the kid, behind the teenagers in the pajamas wondering why we don't hire the folks in the PJs to open a few more registers.

I'm just sayin'...

Thursday, February 26

...for a knock at my door?

Years ago, while the Angry Captain was visiting, a neighbor girl came screaming to our door that her house was on fire. We peaked around her and sure enough light smoke was beginning to show. We quickly searched the house, found a pot of oil burning on the stove and took it outside. By the time the first engine arrived the fire was out and the smoke gone.
Mrs Happy Medic was at work for this excitement.

Today the excitement caught up with her.

THE EMERGENCY
A young mother has rung our doorbell telling Mrs Happy Medic that her 3 month old is not responsive.

THE ACTION
Oh, did I mention I'm at the store when this happened?
Mrs HM called for a priority pediatric response, or help, and went back outside to help the mother with what seemed to be an alert, breathing child.

As she did that, I happened to be pulling into the garage.
"Happy, I need you here please," she said in a strict tone. The one usually reserved for emergencies in mixed company. I also noticed she did not use my BS call name "Steph."

I grab the baby and start doing my assessment and asked Mrs HM to grab a stethoscope from inside.
Everything seemed fine except baby wasn't annoyed to be in my arms, wasn't crying and was drooling. While gathering what history I could I heard the quick yelp of a police siren around the block. PD are the only ones to do that quick "Get the F$%& out of my way NOW" siren yelp.

The officer is half in the street and gets out of the car.
I give a quick report and state I'm a Paramedic to which he replies, "so am I, just not here."
He reports to his dispatch that the baby is conscious and breathing and we hear a motor unit pull up as well. They indeed sent the cavalry.
Baby is doing well as the engine company pulls up and I give another report and turn over care.
They've got baby on O2, but he still isn't perking up and getting annoyed, but the ambulance soon arrives and baby is taken into the back for a full assessment and later transport.

As one of my little ones was waving as the engine pulled away I took a quick look at the scene in front of my house.
Police cruiser half in my driveway, half in the street, a motor unit in front of the house, an ambulance in front of the house near the cruiser and a fire engine pulling away.

I'm glad I didn't come back 5 minutes later and see that on my street and panic knowing HM Jr was home at the time.

Wouldn't it worry you coming home to this?

Wednesday, February 25

Medic 99 to be decommissioned


It should be obvious by now that I'm one of those rare Firefighter Paramedics that doesn't mind working a transport unit.
That's how I started, so that was my norm.

When I finished college I went looking for a Department that still did their own transporting. I wanted to keep that aspect of what we do fresh in my mind since continuity of care is an important thing in my book.
I found a Department in the midst of a change from 2 tier to single tier and it was exciting. I was brought in just near the end of a brutal confrontation between the "Box Jockeys" and the "Hose Monkeys." Everything was settling down when the powers that be decided to shake things up.

The details have been omitted to protect my sort of secret identity, but they went back to a 2 tier system but kept a few 24 hour cars simply to keep some Engines BLS. Seems retarded, I know, and it was.

Now the bean counters figured out those 4 dual Paramedic transport units were costing them way more than a 12 hour car staffed by a Paramedic and EMT.

So now the official word is that my second home in the Fire Department, Medic "99" will be decommissioned by July. That means 100% of my days will be spent on a Fire Engine. Great, I guess.

Remember, I'm not all that bothered by an ambulance day here and there. The way dispatch is so screwy (The lawyers calling the shots anyway) we were running BS calls all night and it ruined my sleep schedule, but there was still that part of me that liked getting Erma all the way to the ER and making sure the staff knew what I wanted to emphasize about her.

Will I leave? Certainly not. I'm not going to chase my misery around, but I am a little bummed thinking about not having that extra chance to do right by my customers who need me. Those would be most of the people I meet yet you never hear about. That's a whole different kind of blog.

So in the end I guess I'm OK with it.

More to follow.

the Happy Medic (Soon to be your Happ E. Medic, E for Engine.)

Tuesday, February 24

A look at how they do it over there


As you know your Happy Medic is now active over at Fire Fighter Nation as well as EMS United, what appears to be their sister site, but I'm now informed it is not.

Buried in all the photos of volunteers doing the standard two hoseline gas leak shutdown drill are various members of the site from around the world.

One that came to my attention was this Firefighter from St Petersburg...Russia.

He has quite the interesting photos in his slide show and instead of grabbing my favorites (the list kept growing) I chose to embed his slide show here.
I am especially impressed with the large range of vehicle types he shows, from ladder trucks on snow tracks to large foam laying rigs and what appears to be a few riot trucks (Oh I wish I had those!)
Take a look and to enjoy glorious trucks of fire.

Find more photos like this on Firefighter Nation

Fire Truck, forcible entry tools, protective clothing

Used fire truck for sale? What about the newest in forcible entry tools? Used fire gear? The fire store!

...for the cut finger...


We're expected to run red light and siren to a cut finger? Seriously? Dispatch has additional information for us that reads "Not getting any information on callback. Caller keeps hanging up."
Great.

THE EMERGENCY

Some one at a local market has cut their finger.

THE ACTION

We arrived at the busy ethnic market and wander in asking people where the hurt person is. No one will talk to us and I'm getting frustrated.
"Who here speaks English?!" I shout over the steady hum of shoppers.

No one even makes eye contact. My EMT has gone towards the meat area and signals she thinks she found someone.
The fellow is standing back in 1/2 inch of questionable water and meat juice near the back of the market. He's not in distress and is holding a band aid on his finger.
Wondering who called us I see a middle aged woman with a clip board and a phone to her ear.
"Hi there, are you in charge here?" My words go unnoticed and she pushed past on a mission somewhere else.
Suddenly she turns, screaming at the finger guy and pointing at the meat counter. Apparently he needs to get back to work. I gently touch the paper on her clipboard and she jumps.
"Do you speak English?"
"No I don't" she says to me and goes back to talking on the phone.
"Hey Captain, block the door, no one in or out."
"Why would you do that?" She spins around.
"Now that we have your attention, this man needs to go to a doctor and have his finger looked at. Ask him if he wants an Ambulance." She just looks at me.
My supervisor, nearing retirement, grabs the phone from her ear and says into it, "She'll call you back." and snapped it shut.
She shouted a few words at band aid boy and they exchanged points towards the meat counter.
"No, I'll take him later." And the phone is back open.
"You'll take him now." The Captain has grabbed the guy by the arm and pushed him in front of the Manager.
"He's leaving, you're leaving and we're leaving."

And then we left, never knowing who called.

Monday, February 23

You Make the Call...Dogwalker...What Happened

As usual, start with the run down HERE.

It just so happens that after 20 minutes of trying to find a solution for these dogs our dog tag phone call spree paid off. I was able to get in touch with a woman who was not at home, but had the information for the owner of the dog walking company.

I gathered that information and discovered the dog walking office/kennel was only a few blocks away. We elected to have the patient ride in the front seat, remembering he was stable and simply needed an eval for possible first time seizure, while my partner, the EMT, walked the dogs back.

It was less than 10 minutes and we drew stares from folks in the touristy area with a firefighter walking half a dozen dogs and an ambulance following closely, red lights flashing.

On arrival at the kennel we grabbed a few business cards and stuffed them into our patient's pocket for next time.
The owner was less than pleased that her walker was going into the hospital and made repeated attempts to get us to leave him behind to tend the dogs.
"Sorry, not your call." I said as we left.
"Feeling OK buddy?" My friend was looking at me from under his worn baseball cap.
"OK, OK" he said, and there were no complications.

If you said secure the dogs and transport, you made the right call.

If you said call a Police K9 unit, ask in at your local K9 officer and get that earful now, before you're hot and tired. They handle their dog, and their dog only.

Sunday, February 22

The Way Things Work?

I've been hearing a lot about the perils of "socialized" healthcare not only with the election of the new President, but with private insurance so expensive and so clumsy.

But then I read stories about "socialized" systems missing people, ambulances getting lost and caretakers completely inept.
Granted every crazy French medic has an American counterpart doing something just as stupid, but those stories aren't covered with the same furvor.
What is really going on over there?

From the front seat of the ambulance for profit healthcare is failing and expensively. Many folks are foregoing private insurance for the state endorsed program which requires the private firms to increase premiums to the remaining clients. Then those people can't afford it, and so on and so on.

As I've said in the past, illegal immigrants are not a drain on my system, not as much as legal residents who find themselves "deserving" of immediate healthcare by ambulance and ER instead of prevention and a visit to the doctor.

The trouble is in the overlapping bureauocracy. There has to be a better way, right?
Maybe yes, maybe no.

But when it comes to emergency care, no matter your income, race, gender, ethnicity or even level of sincerity, you are guaranteed by law, by the people, by the government, access to a medical professional. Be it EMT, Paramedic, Nurse, NP or MD, the law is if you are hurt, you get one regardless of your ability to pay. The insurance companies say you are covered in case of an emergency, but they reimburse at a rate quite lower than the actual cost of care.

Why does my insurance company have to raise my premiums and copays after buying naming rights to a professional sports stadium? Wouldn't that money be better spent on preventative health screenings and public education or is there no profit there?

I'd ask anyone from a different system to chime in and let me know what kind of relationship their service has with federal/state agencies or regulation and any for profit healthcare models.
Am I wrong about for profit healthcare?

Canada, South America, UK, Europe, Asia...anyone?

Why did you change your logo?

That was the first line of an email I got over at thehappymedic at gmail.com. The writer was asking why it seems I keep making changes all the time.

So you've noticed some changes around here? So have I.

When I started my therapy (blog) I had no idea what I was doing.
Now I have an idea what I want to be doing and am slowly learning how to make it happen.

Aside from the obvious banner change, I've added the Angry Captain as a blog team member to enlighten us all with the tales of his 30+ years in the fire service. He dropped a quick hello HERE and I for one am looking forward to hearing more about where we used to be as a profession.

In addition to content I'm trying to make your time here useful. I hate when sites I visit are poorly set up so I'm trying to accommodate you quick visitors. At the top of the right column is now a tabbed section to take you from recent posts to recent comments, to call type. This should make it easy to read the newest post, check for new comments, click an ad and be on your way.

The volume of posts may be deceasing as the Brass is toying with the idea of closing Medic 99.
"Don't do it!" you say, but we're in a state of flux from 24 hour cars to 10 and 12 hour cars and the future is unclear. Rest assured we'll still have the same ridiculous folks calling 911, just less contact with them throughout their EMS experience.

So hang in there, gentle visitors, I'm learning as I go and I do appreciate you stopping by to have a look around.

Stay safe,
the Happy Medic

Closing time at the clinic


The idea of rotating general practitioner physicians through emergency rooms and neighborhood clinics seems like a neat concept but falls flat somewhere near where the patients need appropriate care.

I am not a physician. I do not claim to be a physician. I specialize in the acute, the emergent, the unknown.
I took the same anatomy and physiology, biology and chemistry the physicians did before medical school so I like to think we have the same base education and they chose to specialize in medicine while I chose emergency care.

The old joke of a podiatrist trying to run a recuscitation without an IV is a classic example.
The sad story of a Paramedic diagnosing toe fungus is even worse.

Point being some Doctors don't belong on the front lines the same way I don't belong upstairs at the hospital.

The clinic near the local firehouse I worked at recently is notorious for calling for code 3 transfers for runny noses, broken fingers and the like. The Doctors in for the day know that no ER physician will accept a transfer of these non emergent patients, so the Docs simply call 911. When we're activated the MD knows we have to follow his treatment orders, within our protocols, regardless of our own impressions and assessments.
The most aggravating is when we get called there just after 5 PM, closing time.

This day it was for the "chest pain code 3 transfer."
This is our 3rd time there since 8 AM.

The doctor's hands are shaking as he's describing the condition of the patient. His notes are scattered as well as his verbal report, jumping from lab results to muscle tone definition and everywhere in between. He describes the patient's O2 as "TKO."
He's left out the two things I want to know: Her name and her chief complaint.

When I ask those of our MD friend his face turns to the chart and he's flipping pages, not realizing that the name will be on every page, near the top along with the records number.
While he's searching I walk around him to the patient who is sitting, smiling in the hospital exam chair.
"Is anything the matter?" She asks me.
"You tell me." I responded a little confused.

She explains she's been feeling a vague chest pressure for a few days but wanted to get her blood pressure checked here at the clinic just to be sure everything was OK.

That was just after lunchtime.

5 hours later, the pressure is the same, elevated, but here we are on a code 3 chest pain transfer.
The MD has gathered his thoughts and tells us the patient is a rule out STEMI (the new pre-hospital catchphrase) and hands me a 12-lead EKG. I'm no expert but I see no ST changes in any leads, clean R wave progression anterior, heck not even a first degree block or hint of a-fib.
The computer agreed when it wrote on the paper, in clean black ink,

***Normal EKG***.

I take a deep breath, assuming there must be something I'm missing that he learned in the extra 2 years of medical schooling he took when he let's it out:

"I'm just not sure what to do with her, I was hoping you guys could keep an eye on her on the way to the ER. All my staff is leaving."

"You don't have to go home but you can't stay here." Is what he should have said.
In the parking lot, loading the patient, I was eying the nice BMW and just hoping he would go running to the car to leave, but he waited 'till we were gone.

Friday, February 20

...for the unresponsive...


There are apparently many different definitions of "unresponsive." To me it means a person does not respond. To our new friend it means, "Grandma won't take her medicine."

THE EMERGENCY

A man called 911 saying his grandmother is on oxygen and is unresponsive.

THE ACTION

Dispatch must, of course, stop asking questions there and get us on the road ASAP. It isn't until we arrive at the scene with the ladder truck (It is assumed we will need additional man power) that we receive the additional information that the patient is alert.
OK, change of gears then.
Into the rundown apartment we go.

The carpet isn't urine soaked so much as simply hasn't been cleaned or vacuumed in maybe 20 years and since then a good deal of urine has fallen on it. The walls have a smoke demarcation line upstairs from decades of cigarette smoke. The furniture and decorations are straight out of an episode of Madmen, except they are completely ignored on cleaning day, which looks like tomorrow.
At the top of the stairs is our do-gooder, mid 20's, stylish clothes, new shoes and a fancy cell phone in his hands.

"What's the trouble?" asks my partner as we send the ladder truck back on their way.
"It's grandma, she won't respond to me."
"THE HELL I WON'T!" I had to grab the hand rail mid stairway she screamed so loud.
"She won't take her medicine, I have to go." And away he went. As I gave chase verbally, he turned sideways to pass me on the stairs.
"Slow down there, Speed Racer," he gives a blank look, "We need you to help us take care of your grandma. You can't just call us and leave."
"No, it's OK, my auntie lives a few blocks away, she'll go to the hospital later today." And away he went without a look back.
In the movie version of my story I, played by Matt Damon, have a really great monologue about caring for our families in a time of moral decay which convinces the boy to come back and do the right thing.

Me? I just blinked and he just walked away.

Back upstairs we learn that grandma has been feeling poorly the last few days and just needs someone to come by and make her lunch every now and again and that her, "no good grandson" gives her a coca-cola and leaves.
She refuses to take her medicine today because she's simply had enough and wants to "get away from it all."

Back out in the fresh air I don't blame her. All she needs is someone to pay attention.
And I get paid to pay attention.

...for the man down...


I have a question about fate, karma, purpose, God or whatever it is that you believe makes people do things. Specifically, the reason each person is on the planet Earth and when can we tell we have achieved our purpose.
I bring this up because I think a man was born, grew to adulthood, started smoking, had trouble sleeping, took a walk in the rain in the middle of the night...and saved a stranger's life.

THE EMERGENCY

A man has called stating a man is down on the sidewalk and has a bruise on his arm.

THE ACTION

Driving through the rain we imagine the usual reason for this kind of call in this kind of weather, a homeless person sleeping in a doorway. The police won't move them since it's not a police issue, so who moves folks around? We do!
Arriving on scene in the rain we see this is no doorstep call, this man is lying on the sidewalk in nothing but shorts and one shoe.
We go into work mode and find his skin cold and muscles rigid, but he is mumbling and breathing quite well.
"I couldn't sleep so I went for a smoke. Then I went for a walk. Is he OK?"
Blood pressure and blood sugar check out. We're taking C-spine precautions since we're not sure what's causing his altered mental status. Rolled over and onto a waiting dry blanket between him and the board I note quite the odor of alcohol.

Into the ambulance with hot packs to the chest and pits, he's wrapped and away they go.

I share this event not because of the oddness of who would be referred to at shift change as the "human popsicle," but because of the odd circumstances that led to strangers meeting in such a way.

What was it that made this man wake in the early hours of the morning and go for a walk in the pouring rain only to find a man who would have been dead by morning?

Anyone?

Thursday, February 19

You Make the Call...Dog Walker

I'm assigned to an ALS ambulance in the business district. We are sent code 2 to the eval and arrive on a warm summer day to a local tourist area. We find people who have witnessed what they describe as a seizure.
The patient is a middle aged man who speaks little english and a language no one around seems to understand or even recognize.
His vitals are a little elevated, but he certainly fits my model for an ER evaluation.

Here's the trouble spot. He's a professional dog walker and has with him, on an elaborate leash system, half a dozen dogs. He has no car keys, so there is no chance of finding a car for the dogs to hide in for a short while.
He has no ID and no business cards for himself or an agency.

It's not an emergency situation, but we can't take six dogs in the ambulance let alone the ER.
I tried checking the dog's tags for owner phone numbers but each number goes to the home, not the cell phone and we're only leaving messages to call my cell phone.

He needs to be evaluated, I need to get rid of these dogs. The ETA for animal control is 2-3 hours.

What should I try next? You make the call.

Wednesday, February 18

Make a difference without filling the boot

It's a bit early for my annual rant about the misleading "Not for profit" MDA telethon and fund raising efforts, but the local hardware store just tried to guilt me into donating to the MDA Shamrock Fund.
"Do you want to help cure sick children?" She asked.
"I'm a Paramedic, I already do."

I was sent a link by an old Probie about a local effort to help a local kid.

St Baldrick's is a foundation that was established to aid in cancer research. Not unlike other charities they spend close to 20% of their income on management and fund raising. This particular fund drive is looking to raise $1000 for a local cause.

Don't want to donate? Money a little tight? I understand not everyone can donate money.

Even better than a donation, organize a dinner for a family in need. Grab your tools and spend a day off helping your neighbors with home repairs. Volunteer at a local clinic or organization that helps a cause you believe in.
Your time is more valuable than a $1 piece of paper on a wall in a store or 80 cents on the dollar to some researcher in some lab and 20 cents to the "Love Network."

I'll rant more about the MDA "Fill the Boot" debacle later in the year as Labor Day approaches.

Stay safe everyone,

Happy

Tuesday, February 17

...for the respiratory distress...


Rarely is a call a twofer. I have only, in half a dozen cases, gone from thinking "I hate this crap" to "Wow, I'm glad I paid attention in class." This one was indeed a twofer.

THE EMERGENCY

A caretaker has called stating that one of her Erma's (See Glossary of Terms) is having trouble breathing.

THE ACTION

I'm new to this area of town and the crew is moving slowly to the engine.
"Come on guys, someone could be dying!" I shout out sarcastically.
En route they begin to share with me the stories of Bubba, who we're apparently going to see.
Bubba is in the neighborhood of 350 pounds, rarely wears pants and has not been sober in recorded history. He is able to accomplish these feats since he is a Bubba and lives with Erma, who does everything for him.
Bubba has always called 911 saying his mom is sick but they've never even seen her sick. Not tired, nor upset, she often just stands there, arms crossed while Bubba begs for a ride to the hospital.

As we arrive, I see him on the front landing in all his pantsless glory. His belly sticks out from under a T-shirt that might have fit him 15 years ago and the tiny underpants are almost comically funny, but they were sad funny in real life.

As he spits unknown food particles from his mouth while yelling for us to hurry everyone is slowly gathering their things. Then it occurs to me. He's yelling for us to follow him, not help him.

We tried to hurry upstairs to the source of the audible wheezing but Bubba is quite slow on the uphill and decides to stay in the room when we get there.

Erma is SIck. Capital S, Capital I. And she's considering the capital C.

Tripoding position on the edge of the bed, pale skin, look on her face of impending doom and an expiratory wheeze that could have hailed a cab in another part of town.
She's unable to speak more than one word at a time and she doesn't speak clear english so we have to treat what we see.
Getting a blood pressure, even though I knew she would be hypertensive, proved difficult as Bubba decides to become a rescuer as well and is rifling through my kit looking for God knows what.
She's remarkably hypertensive for a frail 90 something year old woman and as the EMT places the oxygen mask the officer tries to convince Bubba to let us work.
The monitor shows her in a narrow complex tach in the 160s and she is starting to have an extended inspiratory phase.
Her level of compensation is dropping, her little heart can't take much more of this stress.
A bit of relief from some NTG and her pale look of death softens to more of an off white look of panic.

Suddenly, she lays back straight onto the bed, still.

Monitor shows no changes and I'm up at her side in a flash to intervene and she's got a small smile on her face.
"I breath" 2-3 deep breaths, the deepest yet.
"better."

We sit her up and then onto the floor so she can rest against the side of the bed. Her color continues to improve as I get an IV going and we hear ambulance sirens. The crew chooses to have the CPAP ready in case her difficulty worsens, but carrying her out there was no regression to what we had seen earlier.

Bubba was in hysterics. Usually he's the one getting taken away. He's asking us who will cook for him and wash his clothes.
"Your mother is very sick, she needs rest. Have you ever lived alone?"
He has not. In his 50 something years, he has never left his mother's house. Maybe because he has no pants.

Crusty indeed


New responder on the Mutual Aid Board:

Crusty Ambulance Driver

One of the drawbacks of Twitter is it makes me follow things I might never have found. But I did find Crusty and as a result, I'm paying more attention when all of you alert on a good blog.

Crusty follows along all the wacky junk we see in the streets and gives it like a log book of runs for the day. Quick, easy to read and not bogged down over analyzing medical cases, just telling it like it is.
I often groan like Crusty does in the Simpson's show when I'm frustrated. Those in the know give a smile and those who are not miss it completely.

Wander on over a give Crusty a read, you'll be glad you did.

Monday, February 16

You Make the Call...Training Drill...What Happened

Get up to speed HERE

Unfortunately for me on this day, this officer is one who refuses to listen to those below them. Or above them, I learned.

As we went to make entry, me on air and the officer losing air quickly, I made every effort to point out what I perceived as a safety issue, but was pushed ahead by both the officer and the instructors. With no fire and no inhalation hazard, I chose to continue the drill, hoping the situation will be remedied immediately following the drill.

Just as we got the line to the back of the drill prop, the officer's low air alarm went off. Thinking I had lost track of time I checked my gauge: 3000psi. The air leak is worse than I thought. As I turned to assist the officer out, since we were alone, they were gone. I followed the line back and out and wasn't far behind.

"My airpack is malfunctioning" the officer said.
I raised my issues and explained I was trying to stop the evolution based on what I had seen and was told I didn't see what I said I saw. It was explained to me that the airpack was clearly faulty and that the officer was obviously properly dressed or they wouldn't be an officer.
When I asked the instructors if they had also seen the safety issues, they answered in the affirmative and simply told me there was nothing they could do. The officer was untouchable and never listened to anyone.

Great. Now I have to hold my supervisor's hand if we get a fire.

If you said do everything you can to keep your crew safe, you make the right call.

Sunday, February 15

Way to go Walgreens


A tip of the helmet to the folks over at Walgreen's corner Drug Stores. I'm not usually one to applaud corporate actions, but some folks just do the right thing sometimes.
While driving around on errands yesterday I passed a Walgreen's with one of those giant red signs out front.
Usually the sign shows me I can get 2 gallons of milk for $3.95 or that Vioxx is on special. But imagine my surprise when I glanced over and saw, "AMBER ALERT!" followed by vehicle, child and suspect information.
After returning home I learned that this has been Walgreen's policy for most stores since the late 1990s.
Recently, in September of 2008, they added severe weather notifications to their policy of helping to find abducted children.

For the rest of my errands, as the banks reminded me of their high yield savings accounts, I wondered why every screen in the abduction area wasn't automatically used to help find missing children. A huge undertaking, I'm sure, but if it can save 1 life, it's worth it in my mind.

So a tip of the helmet to Walgreen's and their Amber Alert sign policy.

That is all.

Saturday, February 14

The Angry Captain is on scene

This is not a cartoon. This is an actual photo of the Angry Captain.

The Angry Captain got his nickname from his fellow workers when he was in charge of reconciling FEMA grants for his department’s Urban Search and Rescue responses to nationwide emergencies. The paper trail required to receive reimbursement was finite in FEMA’s eyes as well as requiring receipts for all purchases. These are foreign to the rescuers trying to get the job done in stormy weather and lack of any initial support at the scene. Simple things that we use every day get lost when power is out as well as cell sites, land lines, and stores and banks are closed; credit cards mean nothing. Sorting out these items later creates great stress on the person trying to get the money back. Hence the “Angry Captain” moniker.


The call 1 a.m. Saturday…cell phone call from passerby of smoke in the area of an industrial complex, no specific address.
This is a single engine response to investigate. We get many calls in the same area due to the nature of the businesses in this area and the proximity to a major road. As usual, we cruise by the buildings that have night shifts finding nothing. We continue, as my eye catches something from the corner of a building that appears to be smoke but dissipates immediately at the roofline.

We walk around the building not seeing anything except in the one corner above a rollup door that is closed. I remember this business from an inspection I did in the last year. It specialized in drying and preserving plants for use in household decorations. They had a special room inside (not unlike an auto spray booth) for drying the plants with a foul smelling preservative. I suspected that this might be something that was a normal part of the operation. However, to have something coming from the rollup door instead of the roof where the booth would normally vent was odd.

We called dispatch to contact a responsible party. They responded “no response” from the number on file. Now, with no means of visualizing the warehouse area from the outside and continued wisps coming from the top of the door, I elect to force entry to a man-door next to the roll up. No heat on the doors, but I just was not comfortable leaving (unlike the responsible party who choose not to answer the phone). We opened the door and found a haze from the top 6-8 feet of the warehouse. I called for a full structure response as we continued in (better to have them on the road and turn them around if not needed).

No heat, just the haze; as we inspected the drying unit, it was shut down and closed up. It was clear inside. We continued into the office areas, which were clear. Other units started arriving and the truck was sent to check the roof. We opened the other doors to ventilate and clear the haze. The rest of the units were released except for the Truck and the BC who hung out just to see what the deal was. Finally, dispatch received a call from the owner who said he would be there in 30 minutes.

About an hour passed until he arrived. He stated that a fumigation company had been there Friday to fumigate the warehouse. No signs were posted on the doors to warn us of any hazards. We placed all the units exposed out of service until their turnouts could be bagged and replaced. Luckily, everyone wore SCBA until the building was clear, but the unknowns of the fumigation process created mountains of paperwork and exposure reports, as well as activating our service center to replace 18 sets of turnouts for all companies at 3 a.m. The paperwork and documentation took me well past my normal relief time of 8 a.m. It took 2 weeks to find out what the fumigation company used due to “trade secrets.” The chemicals were then listed on all the exposure reports.

Lesson Learned - Expect the unexpected, always, no matter what you think you know about the situation.

Memories

Some of you know, and many of you may have read in an earlier post, that I am a second generation Firefighter. I've asked my father, who retired just a few years ago, to think of some of the better tales from his 30+ years of service and share them with us new kids in the business.
No way to know where you're going unless you know where you've been, right?

Funny thing about my dad is that he had a silly nickname when he worked too. Any guesses?

The Angry Captain.

I'm not kidding. Your Happy Medic's dad was the Angry Captain. I think that's why he laughs more at my name here at work than most others.

But hidden somewhere in our history of silly names and lame jokes is where a spark in me said, "I want to be like him. I want to do what he does."

There are a few memories I wanted to share, maybe sparking the memories of other second generation folks and what it was like to more or less grow up in a fire house.


The Crown Climbing the Hill


For a number of my formative years, dad worked at a Ladder Truck Company in the area we lived. His was the first due truck in our neighborhood which meant he was able to come by the house if needed, and if his Captain approved of course. Yup, I was the coolest kid in town when my dad pulled into the small cul de sac driving that 100' Crown Tiller.
We could also hear him responding from quite a distance. Not just because of the sirens, but because when that Crown started up a nearby hill there was no mistaking her.

The hill in question stood maybe a half mile, not more, from my bedroom window and on a summer night you could hear the sirens die down and that Crown go into low gear. That low rumbling was unmistakable. It was Dad. And just to let us know he was thinking about us, just as they crested that hill he would carefully give 2 half pulls on the air horn before that Crown would take a break and head down the other side of the hill, sirens blaring again.
As a kid, I was relieved to know that dad was OK. I know now that he was on his way to work and that the siren sound should have made me nervous, kept me up, not put me back into a gentle sleep like it did.
I'm sure mom was in the next room getting the opposite effect from those honks. As if Dad was saying, "I love you," in case he never got another chance.

Friday, February 13

You Make the Call...Training drill

I'm at a training exercise with a number of other companies. As part of the evolution we are to lead a line into a single residence for simulated initial fire attack. As I flake the line and prepare for entry, donning my mask, then hood, I re-affix my helmet and look to the officer doing the same.

The officer has placed the SCBA mask on their face over eyeglasses causing the mask to not seal properly and the air is escaping rapidly. It is then that I notice the officer has placed their mask OVER their flash hood, causing even more complications. Trying to point out these issues brings only shouts from the instructors to advance the line. With the mask on my issues are not heard. Touching the problem areas leads only to swats from the officer's arm and a push towards the door. There is no live fire and no real inhalation hazard.

Should I continue with the drill and address the issue before leaving training?
Is it more appropriate to bring such glaring issues to light immediately?
Do I keep my mouth shut and talk with the officer later?
What should I do? You make the call.

...to investigate the smoke alarm...


The following tale is told not because we are reminded to always leave the engine with a tool; Not because we were the only ones to bring water to the fire; Not because you need to be careful when extinguishing burning wax, but because of how determined the owner was to "let us in."

THE EMERGENCY
A caller states, "Smoke alarm downstairs is beeping and the unit feels like smoke." Not smells, but "feels."

THE ACTION

We are second due in the first alarm compliment. It is early evening on a calm winter night, no wind. First engine reports smoke showing from a garage, no fire noted. We kick it up a gear. Our assignment as second in is to supply the first in engine so we pull past them and to the hydrant, it's a short pull.
The first in engine is at the garage door, peering in, we see no smoke. I grab my airpack, buckle the hip belt (like so many forget) and BAM! axe holster. Noting a heavy fuel load and no pre-connected line stretched yet, I reach for the pump can and away we go. Since our job is to back up the first line, and there is no first line, we're searching for the seat of the fire.
In this shotgun style house, the garage and attached area reaches back maybe 60 feet, on average, and can be dotted with small closets and in most cases small illegal apartments. As we pass the halfway point the smoke has forced us to our knees and we have yet to find the fire. Smoke is mostly light, grey, but no heat.

We have good communications, no one is panicing, a plan has been made and is clear. As I'm reaching past some debris to see how deep the closet is I feel a touch on my shoulder from behind.

It's a civilian. "I need to get to my unit and let you in" he mumbles as he begins to push past me into the closet. This guy is clearly altered and where on earth did he come from? He's got keys in his leading hand and before I can react he suddenly disappears into the closet, gone. My officer and I decide to give chase in the most unusual search and rescue I've been involved in in some time. Turns out what we thought was a closet was simply a jog in the hallway with heavy painter's canvas leaning in all directions. As I pass through, axe and pump can in tow, I see the occupant near another door near what must now be the back of the garage. Smoke is thicker and warmer here.
The man is trying to unlock the door when the officer reaches him first and pushes him forcefully out the back door, immediately ventilating the small, cramped hallway.
It also introduced fresh air to the fire area because the heat intensified behind the slightly open basement apartment door.

We found the fire.

The team now behind me started calling back for a line to be charged.
"We got it! Hand in a nozzle! We need a line in here."
My officer sticks his head in from outside and screams, "Did no one think to bring water to the fire?"
"I got this Cap'n" already footing the door open and peaking in I see what used to be a candle on what is still mostly a dresser, all standing beneath what might have been a curtain.
Not 30 seconds of quick bursts and the fire was out. Well before the line made it in.
When I hit the dresser the first time, I knew the wax would scatter, but I had no idea how neat it would look. It was similar to throwing water on a grease fire, only the wax cooled as it flew.

I tried to help overhaul but the man in the back yard needed my particular attentions at that time.
Turns out he ws fine, mentally sound, simply wanted to make sure we opened the door instead of breaking down the door. Not sure why, exactly, since the landlord now will have to explain why this guy was paying rent on a tiny little illegal bedroom in the back of a garage.
At the end of it all I didn't have a single drop of candle wax or water on my gear. The folks cleaning up were covered in it as it was still dripping from everywhere I had spread it.


Before you all start commenting about "You weren't on air?" and "No charged line?" We were on our knees to maintain clear visibility due to all the junk in this garage. On a similar note, dragging a charged attack line around a crowded area can prove dangerous. There should have been someone assigned to bring it in, and there may have been, but I never heard if there was.

I mention this incident here because it was hilarious to hear the Captain the next night tell the story of a man just wandering into a closet and disappearing, "And me and my medic say, let's see where it goes! Sure as hell it goes to the fire!"

Wednesday, February 11

...for the abdominal pain...


Another vague description of a complaint. These abdominal pain calls really drive me buts, especially when called in by a third party at a local donut shop in a questionable part of town.

THE EMERGENCY
A shop keeper called stating a man has come in asking for an ambulance for stomach pains.

THE ACTION
We were nearing the end of the shift, 4 hours to go, when this run came in. For whatever reason a call at 2:45 AM makes me fume from the ears, but 3:15 AM and I don't mind so much. I think that's where my internal clock resets to "tomorrow."
So back to the call at hand.
We arrive at the donut shop just after they opened. We've had this call 100 times before. Someone spends the night on the street and it isn't as glamorous as they thought and now they want shelter. The first places to open are the donut shops.

I get out while my driver is getting his jacket on, slowly. It's cold and these calls usually end with me walking someone to the back and him driving off.
I approach the man doubled over at a table by the window and ask my signature line and we're gone in 7 minutes.

I know it was 7 minutes because 18 minutes later, in the trauma room, the doctors asked me how long we were on scene and I confirmed it with dispatch.

He tells me his stomach hurts and he needs to get to a hospital.
"Where does it hurt?" I ask glancing through the selection of fresh donuts. The place smelled great.
"Here and here" he rubs his dirty hands over his abdomen and around is lower back, not stopping anywhere in particular.
"How long has it been bothering you?" Again, the smell is nice. I make a note to come back around this time each morning we're out.
"About 10 minutes." Is his reply.
And as with every patient, whether real or imagined, I always ask, "What were you doing when it started to hurt?"
"Getting robbed. I got shot OK?!" He shouts and sits up, for the first time showing his face to me. He's been crying.
"Show me." I respond, forgetting the smell and noticing my partner is still not inside yet.
He lifts his shirt and there it is, clear as the sprinkles on the old fashioned donuts nearby, a small caliber bullet entry wound, not bleeding. Which worries me. You see, if blood isn't spilling out, it's spilling in. That's Bad. Capital B.

"Let's go!" I grab him by the arm and head for the ambulance.
"Medic 99 control, I have a shooting at my location, I need PD code 3." I shout into the radio as my partner stumbles out of the rig.
"Where to?" he asks yawning.
"Trauma center, code 3, this guy's been shot." Then it occurs to me, "Where were you when you got shot?"
"Around the corner, sleeping." Great, an unsafe scene with someone around who likes to shoot sleeping people.
I hear sirens approaching and tell my driver that the first cop who gets out comes with us and we're leaving.

With the sweatshirt off, I apply the bandages to both anterior and posterior, noting very little bleeding. High flow O2 is on and I'm spiking a line when the first officer approaches, gun drawn and peers into the ambulance.
"I need you with me officer, we are leaving with your witness right now."
He climbs in and begins to question the patient about the shooter and relays the information to his colleagues.

Pulling into the trauma center, he has no radial pulses, despite 500ccs fluid challenge and states he has the urge to have a bowel movement. Those weren't his exact words, nor was poop the reason his abdomen felt the way it did.

The trauma Doc told us our patient was bleeding internally, quite extensively, and that time from injury to intervention was crucial. That's when I looked back at the call log to check the times.
10 minutes patient reported from incident to Ambulance arrival.
7 minutes at scene.
11 minutes to trauma center.
12 minutes in trauma room before moving towards surgery.
39 minutes from time of insult to intervention. Not bad at all.

They say we should spend no more than 10 minutes at the scene of a trauma victim and I agree. So does our patient who was seen a few weeks later, wandering the same streets where he was almost killed.

Complacency kills, friends, don't get caught looking for horses when zebras are around. Always follow your assessment model. Always.

Tuesday, February 10

...for the severe shortness of breath...



I love having raised voice arguments with citizens who claim to be having trouble breathing. More times than I can count I've had to tell people to calm down, stop talking and tell me more about their trouble breathing, at which point they usually start breathing irregularly, as if I don't know what breathing distress looks like.

THE EMERGENCY
A man has called stating he can not breathe.

THE ACTION
Our screen in the fire engine says the following:
"The caller states the patient is unable to breathe.
The caller states the patient is/was unconscious.
This is a first party caller."

So the caller is the patient, and can not breathe. I love it.
As we arrive, first thing in the morning, he is standing in his driveway, waving. He's dressed, shoes on, hat and sunglasses.
When we stopped and I arranged my bag to exit the cab he disappeared. A blessing? Did he see the err of his ways and go back inside?

No.

He's sitting on the tailboard of the engine, jacket sleeve pulled up, clearly proving he has done this before.
"Did you report..."
"I can't breathe." He interrupts my opening line. No one interrupts my opening line. He's off on the wrong foot already.
"Tell me more about your trouble breathing."
He goes into a lengthy explanation of his long night and morning of not being able to breathe while I'm reading his oxygen saturation in the high 90's and clear breath sounds. As he's talking the odor of alcohol is tough to ignore. I may have tested positive had I been tested right there and then.

When he stops talking he begins to do a strange, irregular breathing cycle that causes me to step back and restart my assessment.
"What are you doing? Why are you breathing like that?"
"I can't breathe. I told you. Do you understand English? I want my ambulance and I want it now. I need my dialysis." He pulls the other sleeve up to show me his shunt.
"Let me guess. The van driver won't take you to dialysis when you smell like you've been drinking right?" He's starting to squirm.
"No, I get it. Kidneys on the fritz, I'd look for an outlet for the stress too, but we're not your personal taxi service. What is the chance you'll take a cab to your dialysis?"
Sirens from the ambulance are getting louder as he looks me straight in the face and shakes his head "Nope."

Sigh.

My only smile on this one was when the ambulance Medic recognized him and walked him straight to the rig telling him, "Stop the act, we're already here."

Monday, February 9

How many does it take?

All these guys are coming with us to the hospital?




A joke an old supervisor used to tell:

How many firefighters does it take to change a light bulb?
10. 2 to make entry, 2 to stand by outside in case of emergency, 2 to staff the ambulance in case of injury, 2 to vent the roof and 2 to supervise.

How many paramedics does it take to change a light bulb?
We'll find out in 13 minutes, they're responding from a distance.


Almost like reading my mind from across the pond, Medic999 recently posted a question about American EMS response and comparing it to his UK system as I was formulating a similar question to him.
As I was checking blog updates to gather my thoughts, he made a post about reading American blogs that seem to have multiple responders at a scene.

Coming from rural, suburban and now urban systems, I have seen many different ways of providing service.

So let me put out there what all those folks in the stories may actually be doing, 999, as well as inviting others to chime in on their response policies.

In my rural experience, we were 3 men total, all trained as firefighters and EMTs. On some days there was a Paramedic, most not. When a call came in, we rolled both of the 2 ambulances available so all 3 men could assist at the scene. I know now this was a waste of resources, but at the time I was under trained and believed the extra persons could help us.

The sub urban setting had us responding alone in an ambulance while a paramedic responded in a separate vehicle. Local police officers were trained as EMTs and firefighters and would also respond to drive or assist in patient care. At that time I saw the twinklings of a system that could work well and provide quality care while drastically saving money. It did neither. Every time the ambulance from one station went on a call the fire engine housed there was left unstaffed.

Here in my urban digs, we have so many people wandering an emergency scene we could sell tickets. On an average response we have a 4 person fire engine team, one of which will be an EMT or Paramedic. If there is no Paramedic, a second 4 man team will be dispatched, only so a Paramedic can be on scene as soon as possible. Then the 2 man ambulance arrives, always at least one Paramedic and sometimes a Paramedic supervisor.

On critical calls, such as stabbings, they'll add a 5 man Ladder truck team (I still don't know why) and a Fire Chief supervisor since the number of persons responding is now outside the span of control for the engine supervisors.

Long story longer, the American response model is tied to the Fire Department simply because of the "holy cow" status of the Fire Department. Many ambulance and EMS agencies are feeling the squeeze and need to be rolled into a Fire Agency or risk disappearing completely.
The model is hopelessly flawed. On average a $400,000 fire engine is rolled out simply because one of the people on it is a Paramedic. The same training and equipment could be delivered via a small car or motorcycle (UK model) with an ambulance to transport, and fire units if needed for assistance.

The problem is, if you remove the call volume the Paramedics create, the Fire Companies suddenly appear to run little if any runs. There will always be a need for fire suppression, but the bean counters at City Hall don't care about response times, only call volume.

So here I sit in a tiny little single Engine firehouse, who will likely run 6 calls this week, but is kept open solely because of the number of EMS related runs they receive.

Having so many folks at the scene isn't always a help. I'll have the driver stay with the engine, now we're at 3. I'll be performing my assessment and the EMT will try to get a set of vitals. The Engine officer will be misspelling the medications on the run sheet and standing in the hallway, clipboard in hand.

On every run I'll have 6 people respond where 2-3 would be fine. But if we go to a 2-3 person model a lot of resources will be shut down because they simply won't have enough calls to justify the expense. Sad to say, but true.

I invite my readers to view 999's blog and comment here, or there, or both with whatever thoughts you may have on the underlying question: "How many does it take?"
EDIT- 999's post was removed due to technical difficulties. Sorry.
HM

Budget cuts are starting to hit


Here where Happy hangs his helmet, we often talk about how we're immune to drastic budget cuts. Although salaries are often protected by contracts, it's important to remember we can easily be replaced. Remember all those folks that tested with you that didn't get hired? They'd love a crack at your spot now.

But even here at our large size Fire Department, new cut backs that had been rumored are now taking effect.

Anyone else noticing this kind of stuff?

Paper towels are to be used sparingly.

Reduce gas and electric by at least 10%

Here where I'm working today, we'll call it Engine 98, the furnace is broken. There is no heat. We are under orders from the facilities management folks to just use the gas oven and a room fan to heat the common areas. A gas oven. On a cold day. Needless to say I'm typing with my turn out coat on.

Another station lost it's hot water heater and it wasn't repaired for over 2 months. 2 Months at a busy, crowded house (15 FFs) with no hot water for showers, washing or cleaning.

Soon we'll be told to reduce the amount of bandages, nasal cannulas etc to use.

Granted we can be wasteful at times, but some of the cuts are going to hurt. Not in the pocketbook but in the living conditions in the firehouse.

The training staff has also been drastically cut down to barely even a skeleton crew. There were rumors of some new hires this year, but now there is no one to train them.

Local unions focus on what is pensionable, mainly because most on the board are closer to retirement and have those concerns fresh on their minds. I keep having to pause my typing to rub my hands together to stay warm here today. My smile is beginning to crack.

But hey, the heat works in my car out in the lot. Worst case I'll wander out there with a portable radio and just sit in the sunlight.

And looking at the call volume for Engine 98 over the last few days, I should be able to get some work done on the computer.






Speaking of "computer work", I mentioned just a few posts ago about taking time out to watch the fantastic series Firefly. Turns out there is a group of Uberfans who tracked down the ambulance prop used in the episode Ariel and are refurbing it to travel around different fan gatherings.
If you have a moment, look for the new link in the sidebar about the "Ariel Rescue Group" and check out their progress. Looks like a fun, but costly, project. But then again, if that's what it takes to get Jewel Staite (Kaylee) to come visit me, I'll make one too! From scratch.



Everyone stay safe,

the Happy Medic

You make the call...17 year old mother...What happened

First, get up to speed HERE

In this particular situation, where I was working, the mother was not legally allowed to make medical decisions for herself because of the rigid requirements of declaration of an emancipated minor. This has since changed in that jurisdiction, mainly I think because of the increase of teen pregnancy and the situation became more of the rule than the exception.

Oddly enough, even though we were on the phone to have her mother to come and get her, she was legally able to refuse transport on behalf of her biological child. Granted we weren't running her DNA in the street, but you can tell when a mother is the mother of a child and when something doesn't seem right. And this seemed right.

So there you have it, the confused EMS legal statutes of Happy Medic's history.

If you said anything at all that complies with your protocols, you made the right call.

Saturday, February 7

Attention all units in the field


All companies, cars and personnel in the field,

EMS is taking another big step closer to being recognized as a profession rather than a trade. And Medic999 is taking the initiative to get us there.

I too got lost looking for good EMT, EMS and Fire blogs. You can find dozens that link to and follow dozens more and its tough finding the ones you really like and that speak to you directly. I don't expect everyone who reads this blog to follow the ones I do, but often its a good fit.

Medic999 from the aptly titled blog medicblog999 has taken the initiative to start a kind of Blog Carnival. It boils down to a group of bloggers taking turns moderating a forum about blogs. Seems boring, but imagine a group of authors (bad comparison Happy, but keep going) getting together for a book club meeting and you're an author too.

If you ever wanted to start a blog, do it. It's great cheap therapy.

So keep your eyes on this space, or over at Medic999's spot for details as they develop.

Who knows, this may turn into a Firefighter Nation/JEMS Connect/Facebook hybrid cross-trained, turnout pant, stethoscope hanging, 4 AM call running monster of fun and information. Or not.

That is all.

...for the laceration/dangerous...

Can we be any more vague dispatch? Maybe even a quick line about "traumatic/violent/accidental"? Anything else? Little did I expect the Fire Department/Executive Car Service was being summoned again.

THE EMERGENCY
A caller states a woman is suffering from a laceration and that it is severe.

THE ACTION
We were close to the scene and chose to make the entry. Nice part of town (Mercedes on the street so the nice car can be in the garage), not that that precludes them from violence, we expected more of a cut from a wine glass.
Grabbing the trauma bag we're met a the door by Mr Fishbiscuit. This is a rare sighting of a Mr Fishbiscuit, usually Erma lives alone.
I ask him if he has an emergency and he cocks his head to the side and shows his teeth while inhaling slightly.
"No, not exactly, you see my wife needs a blood transfusion."
"Well, super, we happen to have that equipment right here on the fire engine!"
That's what I wanted to say.
What I really said sounded happy and excited to learn more.
Erma's doctor drew some blood this morning, looking for indications that her painful cancer is spreading. Erma is home bound but is in some nice digs with Mr Fishbiscuit and a 24 hour care taker...who speaks clear english. Those of you in the field know that's a big, expensive thing these days.
Turns out Erma's Doctor called a few minutes ago and advised them she would need a blood transfusion tonight or tomorrow and to come into the hospital. When they asked if a van or ambulance from F&B was coming the doctor told them to just call 911, it's quicker.

It's quicker.

Luckily Paramedic Captain 99 heard the call for the laceration, thought the worst, and was enroute to assist in case it was a stabbing or major trauma or something we needed help with.
The ambulance arrived and I explained the situation to the frustrated crew. We got Erma loaded when I told the Captain what was happening.
"I think I'll pop on over to St Closest and remind this doctor we're not his private errand boys."

I want that job soooooo bad.

Friday, February 6

You make the call...17 year old mother...

Many protocols are similar when it comes to when a person can or can not refuse medical care. It often includes such situations as Active Duty military, emancipated minor or the like, but what about when that person is responsible for another little person?

I'm called to an MVA and find a family from the local Air Force Base lost control on the ice and crashed into a parked car. There are minor injuries to the driver, who is in his early twenties, and is refusing treatment, which we agree is appropriate. The female is 17 and is experiencing lower abdominal pain where the seat belt was. Not entirely uncommon, but we advise that, because of her young age, there may be something the doctors can make sure doesn't become a problem in the future. She is refusing care as well. She is not married to the gentleman in the car, nor is he the father of the child.
The 6 month old, properly secured to her car seat, is smiling and doesn't appear to have even noticed the car is stopped.

My question to all of you, keeping in mind protocols vary by jurisdiction, is this:
Based on your local protocols can the 17 year old unwed mother make her own medical decisions and refuse treatment?

If your answer is no, as the biological mother of the minor child, can she make medical decisions for that child?

You make the call.

...for the sick eval...

Just like being intoxicated, somewhere along the line having the flu became an emergency worthy of a call to the ambulance. It seems folks have forgotten that each year little tiny organisms wander the earth, making us sick (to expel the foreign organism). I'd have to say 95% of my "sick eval" patients fall into two categories:
"I need antibiotics"
and
"It can't be the flu, I got a flu shot"
The other 5% fall into both categories. This drives me so nuts, I can't even give this category of patient a medic unit icon for the post. Just can't do it.

I will walk you through the standard call.

THE EMERGENCY
Never really is. Its often a point, late at night or early in the morning, a person "gives up" on trying to help themselves and calls 911 because they are sick.

THE ACTION
He or she will be in bed, buried in blankets, eyes red and overplaying symptoms. They'll be writhing around under the blankets, refusing to allow us to take an assessment, asking that we just take them in already.

He'll mention something about a report on the local news about an outbreak of something serious like e-coli and infer, never claim, they may be infected.
When asked what medicine they have been taking, they'll say, "none" or tylenol, but never a cough supressant, expectorant or anything else useful.
When asked what they want to do they'll give an almost roll of the eyes and say they need a doctor to give them antibiotics.
When folks self prescribe, I enjoy testing their medical knowledge.
"So you think this is a viral infection?"
"Oh yes, it's horrible!"
"Good, antibiotics don't work on viruses, so you can go to the store, get some medicine and feel better by morning."

Or they'll try the flu shot line.
"It's not the flu, I got a flu shot."
"Well, good for you. Bad news is the flu shot is only a mixture of what the drug company thinks the next flu might be and they haven't gotten it right yet."
"Well, its not the flu. Can't be."
"Well if you won't listen to reason and do the responsible thing, I guess we're going to the hospital. I need your billing information before we go."

If only I could make these folks see the err in their ways. They rely on us, not for our opinion, but for our no cash up front service.

I long for the days when we can charge a "non-emergency" premium to people who abuse the service. Abuse is the wrong word there...misuse is better, but abused is how I feel taking $150,000 of equipment and two Paramedics to someone who refuses to help themselves and demands we literally wipe their nose for them.

FLU does not equal EMERGENCY. There, someone finally put it in writing. Now if only they'd put it in the evening news, I'd be all set.

Wednesday, February 4

...for the chemical burn following a bizarre horseback riding accident...


MedicBlog999 had a great post bringing up the topic of pre-hospital pain control. I had made a comment that I used to be conservative in administering pain meds since a Doctor in the ER told me he was unable to assess a patient's knee injury.
We all know it's not about him, but the patient. But still, that kind of thing has a way of skewing your perspectives on pain.

Pain is indeed relative. We use that stupid 1-10 scale to get a number. We just love to qualify and quantify. I understand it is to trend the treatments, but isn't it more about comfort? I recall a gentleman with a broken hip telling me it still hurt like a 12 out of 10, but he didn't care as much about it after morphine. And that's what it boils down to is making the patient more comfortable for that bumpy ride to the ER.

Also impacting our judgment to administer medications is our own experiences. I often ask women who tell me their pain is a 10 if they have children. Then I ask them to reevaluate the pain using childbirth as a 10 and wouldn't you know that number comes down as the smile on their face goes up.

I think practitioners who have experienced real agonizing pain are quicker to get meds on board, if for no other reason than to not see someone suffer what they went through. It was just such an experience that changed my views on pre-hospital pain control.


OK 999, here is your explanation of what I called "chemical burns following a bizarre horseback riding accident."

Personally, I never experienced true pain until soon after I got married. Sounds like a joke, but true story.
We were on a cruise, it was a Wednesday. Just your average everyday Wednesday, September 12th, 2001.
We were in Mexico going on a horseback riding excursion and it was hot, so we're in shorts and t-shirts. Lathered in sunblock and bug repellent we went on a fantastic group ride through the forest and along the beach. The mosquitoes down there were the size of school children and some of them held down regular jobs at local markets. When one landed on your leg, you felt your whole body shift under the added weight. I noticed the local guides picking wild limes, biting into them and rubbing them on their skin. I asked one of the guides why they did that and she replied, "It keep the mosquitoes away, they hate the lime."
Well, I was being eaten alive so I did what they were doing and, sure enough, no more mosquitoes around me.
It was the next day, while snorkeling, that I began to feel the beginnings of the worst pain I've ever felt.

Describing the sensation is difficult, but it was similar to when you have really badly chapped lips and smile accidentally, that tearing sensation and the sudden, sharp pain. I had begun feeling that, but there was no outward sign of any injury. No discoloration, no increased pain on palpation, nothing. The sensation reached from my knees up to the tan line of my shorts on the entire anterior aspect of both legs. Pretty much everything that was exposed to the sun on the horseback trip.
It was the next day, friday, when the first blisters appeared.

We were on a cruise ship in open water off the coast of Mexico steaming back towards Long Beach Harbor when the blisters began to throb and ache. Simply wearing shorts and walking into the wind was difficult and hurt more than anything in my life up to that point. Had you assessed me then, that would be my 10.
We had concluded that it was a combination of the sun block, bug spray and lime juice that had combined to burn my legs from the inside out and decided to call the on board Doctor.
Down into the bowels of the ship we went, where the floors are linoleum and the lights a clinical fluorescent white. The Doctor was off duty, but on-call, and we could call him in...for $300. We decided to stick with just the nurse at that point, realizing that whatever he said, she would act on, so we just went with her recommendations.
About an hour later my legs were caked in silver nitrate and covered with sterile bandages. It was watching her bandage the legs that made me realize that when those blisters grew tighter I would be in real trouble.

Our ship mates made jokes about the newlywed having sea legs when I nearly cried each time I had to gently move the pant legs off my legs just to sit down and eat.
But I couldn't just sit in the room and cry. The news of September 11th was everywhere and on every channel of the shipboard TV. We wanted to sit on the deck, take dancing lessons, do what we could to make the trip a positive memory on account of all the negatives already happening.
We finally made it into port and I was having trouble keeping myself together. Add the extra hours needed to search the ship for terrorists and I was nearly ready to jump off the boat just to get into an ambulance.
My father in law met us on the dock and we relayed our situation. The decision was made to go straight to the ER, after everyone got a bite to eat.
In the ER the staff chose to medicate me before removing the bandages. Thank goodness they did. After quite a bit of Demerol the first nurse to touch my legs almost got punched square in the face I jumped in pain so fast. "We'll give him some more I think," he said and the rest of the visit is fuzzy.

What is in my memory is the weeks of physical therapy, sitting in the Whirlpool tanks and having my bandages changed every day. I remember having to stretch my legs constantly so that the healing skin didn't grow back too small, stunting my mobility right there and then.

Whenever I see someone in pain, I remember my horseback riding trip and wish I had someone on the boat that could dose me up, and fast. And each time I hear someone say their pain is a 10 out of 10, I ask them what the worst pain they ever experienced really is. I don't pass judgment, I just want to make an honest comparison.

So there you go, my experience that changed the way I interpret pain pre-hospital and why any and every burn patient I encounter gets an immediate call to open the reserve doses, just in case.

The scars are mostly gone and I'm still smiling,
Happy Medic

I know what my next shift will be full of

I'm here at home listening to the kids battle over a book on the couch with the morning news on in the background and there's a story about women and heart disease.

A great topic, one which every woman in my family should know about, but they just went down the list of symptoms to watch out for and call 911 if they experience any of the following:
Chest Discomfort
Shortness of Breath
Fatigue
Nausea

Great...they're recommending folks call 911 in case of fatigue and nausea during stomach flu season. That combined with the peanut butter scare (I've had 2 of those calls already) should make for a full day tomorrow.

It always amazes me that we can tell what's been in the news by what the old ladies are scared they have.

Tuesday, February 3

...for the fall...


We were told she had fallen. What was left out was the dog, the nurse and the car ride home. Stop me if you've heard this one.

THE EMERGENCY
An elderly woman has called stating her "Hip has popped out."

THE ACTION
Not sure what to make of the information provided, we're surprised to see a woman standing in the front doorway, in a robe, clearly favoring her right leg.
We helped her the way every EMS crew should and noted no trauma, did the eval thing and found little. It was the response to my last question that got a whole new line of questions started.
"Would you like to go to the hospital today?" I asked.
"Yes, I want to go back. You see the nurse gave me a ride home and said to call an ambulance in the morning."

Stop the presses. He said WHAT?!

I shook my head and asked her to repeat what she had just told me and she did, every word the same.

Enroute to St Farthest Hospital she fills me in on the details of her last 24 hours:
She was having lunch with a friend, reached over to get a fallen napkin and her hip "popped out." Not being one to bother the local Firemen, she had her elderly friend help her to the car and off to the hospital.
After an evaluation, the physician ordered tests and scans and x-rays and then told her she would need to stay the night until they discover the cause of her pain.
She insisted on arranging boarding for her dog at home. Her friend had long since left and lives out of town. So the Doc did what any doctor with an elderly patient who can't walk would do. Got a nurse to drive her home.
She was given instructions to find a boarder for the dog, then call 911 to "arrange a ride" back to the ER for admittance.

I was dumbfounded. We were literally being used as a car service. Back to the ER we go when the staff doesn't recognize her at all. Shift change. So we have to explain, the patient and I, the entire situation and they seem not to notice the blaring misuse of ambulance resources and questionable practice of sending elderly fall victims home with an RN escort.

In the end she got the care she needed and got the dog taken care of, but what a horrible night she must have had trying to sleep on what could have been a badly injured hip.

On a side note, I was apparently a little too heavy on the conversation on this one. From time to time I can get chatty when I get frustrated. As we left the ER I asked my driver where he wanted to go for coffee, he said, "Anywhere you like Eddie Haskel." I smiled.

Monday, February 2

Where's my flying ambulance?

Your Happy Medic has a nerdy side. Gee what Paramedic doesn't, right?

One of my particular joys after a long day in the 6x8 foot office is watching an episode of Firefly.

Firefly was a short lived sci-fi TV series written by Joss Whedon of Buffy the Vampire fame. No vampires in this series, but plenty of great characters and dialogue. The show took on a cult following, mainly appealing to two unique groups - space buffs and western buffs. And, like many great programs before it, was canceled prematurely.

A particular episode stands out as appropriate for this crowd as it has a neat look into the future of pre-hospital care. At least as envisioned by sci-fi writers.

The video at hulu.com is the whole episode, with only minor breaks and has a great explanation of the series to that point. It's great alone, or with watching the preceding episodes first.

If another person ever tried to get you to watch a fun sci-fi show a few years back, this was it.

Find a few minutes and give it a try. The ambulance and interaction between medics and hospital staff is worth it.

A rough one from the archives


I was asked recently about the call in my career that angered me the most. Maybe because people want to find out what makes Happy into UnHappy. I didn't even need a chance to think about it.

Long ago, your Happy Medic worked in a combination Public Safety system. All the firefighters were firefighter/EMTs or firefighter/paramedics and the police officers were cross trained as medics or firefighters.
Working in such a system allowed for paramedic policemen to perform basic and advanced skills as well as understanding the severity of medical situations.

This is back in my first year of carrying a paramedic license, so confident that I was ready for anything. That's usually when life reminds you of the truth.

It was late in the evening and we received a 911 call from the ER for a welfare check. Not being one to subscribe to the community health aspect of following up on every patient, we agreed to head over there, no lights or sirens. Then we heard on the radio that officers were being sent to the same address, lights and sirens, to take custody of a minor child. The combination of our run and this new police action made my heart jump into my throat. I had a feeling the officers would take custody of a child and place them in my arms. The question was, "Why?"

That question was answered as soon as we walked into the tiny apartment. The stench of urine met us at the door along with piles of trash. Two teenage boys were on the couch, handcuffed by one of the officers. Nearby was a brand new gaming system with 3 or 4 games scattered around. I heard a familiar voice, that of one of the veteran paramedic police officers, call my name from the back room. There was panic in his experienced voice and that made me scared.

The 4 month old child was a shade of brown usually reserved for people who frequent the beaches. She appeared sun tanned, olive skinned. It was easy to see the shade of color since she was barely moving. The young mother, 16 if I recall, was telling a story about how they went to the hospital to get the baby checked out earlier in the week, but left when the boyfriend, not the father, had to go to work.
I noticed the officer had his hand on his baton and was looking for a chance to grab the baby. The officer looked away only briefly, later I learned he was listening to radio traffic in a small earpiece he wears.
"Our Medical Director called this in, she's still technically a patient of his."
That made the baby technically a patient of mine. The officer asked the mother nicely to hand over the child and she agreed. I was just taking her when another girl of maybe 16 turned the corner with another young child. The officer nearly drew his weapon she appeared so quickly. Her infant was the same olive color but moving and acting appropriately.

I processed in my mind the time to transport to the hospital, 30 minutes, and the closest other ambulance, 20 minutes. No time to wait.

I grabbed the baby and made a line for the ambulance. The paramedic officer remained at the scene, taking the mothers into custody and monitoring the other child, which left me alone in the back with the little girl.

We left for the hospital and I began to assess her when I noticed the diaper was dirty. Not dirty only in the 'needs to be changed category', but in the 'filthy on the outside' category.
I removed it and found only dry mustardy bowel I would later learn was a sign of distress in this age of child.
After a change of britches and a quick toweling off with sterile water I learned the olive skin was not hereditary, but dirt. She was in fact white and quite an interesting shade of jaundiced yellow.

I gave her oxygen and she began to squirm a bit, later crying and moving quite well. It was as if she didn't want to breath in the horrible stench around her in that place and found my little world quite a happy change.

She and I arrived in the ER where our medical director, who called initially, was awaiting our arrival along with the Peds team. It turns out mom and the boyfriend took baby from there earlier in the week without permission just before she was about to undergo treatment for her jaundiced condition. It took them that long to figure out where she was.
The 16 year olds were cousins. Children raising children.

That was the first, and last, time I felt like taking matters into my own hands and teaching those girls what it might have been like to be treated the way they treated their own children.

Since then I don't get as bothered by neglectful parents, but now as a parent I see how easy it is to keep children clean and healthy, if you only want to.

And that was the time I was UnHappy.

Sunday, February 1

...for the most disgusting thing I've ever seen...

The wife jogged a horrible memory recently. The memory of the most disgusting thing I have ever seen on the job.

Decapitation? Was gross, but not the worst. Almost fascinating at the time in fact.

Dislocated fingers? While skin cringing, even while typing it, no.

The blood and guts in major MVAs, hangings and jumpers is expected and there is a certain preparation that comes along with it.

Poop and month old urine soaked clothing is indeed repulsive, but alas, nowhere close.

The most disgusting thing I have ever seen is a nose bleed.

True story. Although it was the sink beneath the nose bleed that is still fresh in my mind, even all these years later.

The call came in as a 26A1, minor bleed.
An employee at the local hotel had a nosebleed that wasn't stopping with pressure and relaxation. She had retreated into the restroom to try to stop it and parked herself over a sink. As we entered the restroom there was an odor of metal. It was blood. Her nose was still bleeding and in the sink was approximately 300 mLs of blood, most of which had begun to clot to itself. To this day I have never seen that much blood escape a living person who was talking to me. Then she coughed and brought up another 20-50 mLs of clotted blood to add to the sink. The blood came out shaped like a tongue and flopped into the sink where it didn't blend into the rest at first, but simply floated on the sea of clotted blood.

As we attached the nose clamp and got her to relax, the sink seemed to call out to us as if it was alive.
When I took another look at the sink, the fresh clot had been absorbed into the red sea.

That was gross.