101 Things the Fire Department wishes you knew



Thursday, March 12

Treating Trauma with Mr. Bill

Trying to think of a "learning moment" recently, I remembered a single call I went on that taught me almost as much as I have learned since then. Some Medics are book smart, some are street smart and a rare few straddle both easily.

Early on I got a job with a local Federal Department that mainly ran an ambulance and water tender to cover a population of about 3000. It was there that I learned the basis of what it means to be a good care provider.

My mentor there, I'll call him Bill, was a relaxed Paramedic who always talked about everything but the job. You know the type. Sports, family, anything, but when the bells rang he was all business and I soaked it up like a sponge.

Bill was the one who taught me that driving an ambulance isn't a race, but instead a challenge to see how little you can make the box move from side to side. He instructed me to drive with my back slightly forward from the seat back to better feel the motions of the box I was dragging along. One night when we had 2 trauma patients in the back alone with Bill, one near death and the other considering it, I slammed down the accelerator hoping to cut down the 35 minute drive to the trauma center. Bill calmly came to the pass through and said, "Can you just do my a favor and take it easy up there, you're driving, not playing paramedic pinball." As smooth as if he was asking a waitress for extra napkins.
I now tell my patients not to panic until I panic, just like he did.

I listened in to his radio reports, always trying to learn something new. On this call, even after starting IVs on both patients and asking me to call and see if we could get an intercept to take the more critical patient the rest of the way (there was none available) his radio report sounded like a magazine review of a new restaurant. I recall parts of it all these years later:
"Medic 99 to base, we will be arriving at your front door, ETA 15 minutes, with 2 trauma patients. Standby for patient one. Patient one 25 year old female, restrained driver small sedan rear ended at high speed, positive loss of consciousness, GCS 8, head, neck and left shoulder trauma, full C-spine precautions, (vital signs I can't recall), and high flow O2, without questions standby for patient 2. Patient 2, approximately 40 year old male, unrestrained driver of truck which struck stopped vehicle at speed, unconscious, unresponsive, Multi-systems trauma - he meets all criteria, BP 90, full c-spine precautions and high flow O2. Unless you have questions base, we'll see you in about 10-15, 99 clear."
Even typing this again I can picture the part of highway we were on and I was wondering why he wasn't in panic mode. I was in panic mode and I was only driving.
I still keep my reports to the MVIT format and try to make the person on the other side of the radio understand what is going on before I arrive.

Then we hit the ER.
Because he called so early, they were able to clear out both of the trauma rooms and have all necessary personnel waiting in the parking area. As I parked the Doctors opened the doors and asked a question I later realized Bill had prepared for.
"We'll take the unresponsive first. Which one?"
"He's on the cot, take him right away."
Bill knew the man was more serious and would be taken out first.

Later we moved the woman onto a hospital stretcher and into the second trauma room. He answered questions from both rooms without referencing his charts, which were both partially completed and without a drop of blood on them I might add. I cleaned that rig, it was a disaster area, but he and everything he touched was clean. I, again, later discover how he did that.

He wore two pairs of gloves the whole time. One pair always remained on and he worked on his patients with a second set pulled over them. When it was time to use the radio or make notes, he removed the outer gloves and completed his task with clean gloves, but still protected his hands. I had never thought of that and people who see me using the same technique today say the same thing.

Then, on the drive back to the single wide mobile home that served as our station he literally picked up our conversation where it had left off when the bells rang.

"How do you do it so easily?" I remember asking him.
"Do what?" He replied with a smile. I worked a great many shifts with Bill and learned a great many tricks of the trade, but none had such an impact as that single call did.

I will never forget the look in my interns' eyes when they see me do something Bill taught me and say, "Where did you learn that?" and I feel Bill's smile on my face.

3 comments:

Dispatcher X said...

It's always interesting reading these posts and seeing the other side of emergency care (post p.d. and otherwise). My nephew is an EMT and starting paramedic school and I don't get to talk to him often enough to get the goods on this field, so it's nice to see how things work. :-)

Anonymous said...

Very cool HM.
' nuff sed
Capt. Tom

The Happy Medic said...

Hey Capt Tom, can you drop me a line at thehappymedic@gmail.com when you get a chance?