...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.