Finally, a funny story...

So, we're standing around the ER, finishing up paperwork and generally bullshitting.

My partner takes off his glasses and makes some comment about it being hard to write out his patient report.

Somebody else says, "You think that's hard? Wait till you're wearing bi-focals!" That person turns to the ER doctor and says, "Right, Doc?"

He very seriously replies, "Yeah, they're a real pain," demonstrating how he peers over the top of his glasses. He continues, without realizing what he is saying, "Especially when intubating... or doing a pelvic exam!" He's leaning forward, still demonstrating the head tilt and peering over the glasses.

The room goes quiet. Furtive glances are exchanged. Smiles start to break out.

The doctor looks around, "What!?" Then he realizes what he said and turns beet red. The room breaks out in laughter. Then we leave to go get another patient...

One that went well

It was dispatched as an unconscious patient. They almost always regain consciousness while we are on the way. The common phrase is "syncopal episode" - a fainting spell. So when the notes on the MDT were updated while in route with "PATIENT STILL UNCONSCIOUS," we knew it was probably serious.

We were on our way to sit point for area coverage, so our response time was faster than normal. As we pulled up, a sheriff's deputy car was outside the house, with the sheriff inside. We grabbed all our gear and loaded up the cot.

The sheriff met us at the door and said, "He's in the bathroom. He's still breathing."

My partner led the way and took one look at him - an elderly man on the floor, leaning against the tub. He was gray and dusty in color. "He's not breathing right. He's breathing like a fish out of water. Let's get him out of the bathroom."

We dragged him out and, suddenly, the training kicked in, and it was all asses and elbows, equipment flying everywhere.

While my partner prepared to intubate, I started pulling out everything we needed from the Lifepak monitor: blood pressure cuff, oxygen/pulse fingertip clip, heart monitor leads, etc.

While I was getting him hooked up, my partner successfully tubed him and started bagging him with the bag-valve mask (BVM). At this point, the fire fighters arrived and since the call was in my fire department's area, I knew them both.

"What do you need?" they asked. I tossed Jim the BP cuff and told Cupcake (Dave) to go get the backboard and straps from our ambulance.

By now, the patient had regained some consciousness and was looking at us, obviously unhappy about the tube down the throat.

"Sir! Don't fight the tube. It's helping you breath. I had to put a tube in your throat to help you breathe," my partner loudly told the patient, and surprisingly, he understood her and stopped fighting. She said to me, "I'm gonna give him some medication to help him tolerate the tube."

Once we got him stabilized, we slipped the backboard underneath, strapped him down, and lifted him to the cot. We found out from his girlfriend that he had COPD (chronic obstructive pulmonary disorder) and had not taken his breathing treatment that day.

In the ambulance, my partner asked fire to drive as she wanted me to help on the way. With lights flashing and sirens blaring, we took off down the road, things looking good.

Suddenly, he made a noise. We looked at each other, and it happened. He vomited. What looked like recently eaten chicken noodle soup came welling up, past the tube, running down his face, into his nose and eyes. I grabbed towels and started wiping, while my partner grabbed the suction and started suctioning. The guy was understandably freaking out and reaching for the tube.

"Sir! Sir! It's OK! You can breathe through the tube. Don't worry about vomiting!" Again, surprisingly, he understood us and stopped reaching for the tube. He crossed his hands on his chest and just looked at us.

At the hospital, we hustled the patient into the ER, and the staff burst into action. We quickly transferred him to the hospital bed and thankfully handed him off to the nurses and doctor.

It took us quite awhile to clean up the cot and the back of the ambulance, reviewing the call and what went right and wrong. While it had been stressful and physically demanding, it had gone well, and we felt we had been able to use our skills to truly help someone.

This was the type of call that make up for all the ones that are less than satisfying...

Third Time's The Charm

Black ice all over the county. Car crashes happening everywhere. Over the radio, dispatch sent probably 30 ambulances in 30 minutes to accidents - lots of rollovers.

Then we got one. Lights and sirens down icy roads. Luckily we got canceled by PD (police) - no injuries. Back to the station to catch breakfast. Radio pager goes off again, and we get dispatched to the same road, same intersection. "Probably the same car in the ditch, and the caller didn't bother to stop," my partner said knowingly. Yep, about five minutes down the road, we get canceled again.

Dispatch, not known for making jokes, sent us a text message on the MDT (the computer system in the ambulance that provides most of the call information), "Perhaps I should just stage you in the area." We have a good laugh and head back to finish breakfast.

After eating, I'm just about to finish some station duties when we get another call. Same road, same intersection. "Oh, come on..." we said as we started down the road, "Not again!"

My partner picked up the radio to ask dispatch if this is, yet again, the same accident. She glanced at the MDT and read the notes. "NOT THE SAME ACCIDENT. THIS IS A SEPARATE ACCIDENT!"

Whoa! So off we went to save the day. Lady lost control on the same stretch of ice, spun out, and hit a tree. Probable broken wrist. Lucky.

We had to backboard her and carry her out of the woods to the stretcher on the side of the road.

Be careful out there when you drive. Icy roads can be very deceptive and really dangerous.

The Old Timers were right

When I first joined the fire department, I was all geeked up about running out there and saving lives. Who doesn't want to rush in and save the day?

And then the classes and training, all geared towards these worse case scenarios: mass casualty incidents, gun shot wounds, motorcycle versus deer. It gets you all fired up for the big one.

We'd get a call that sounded good. Alright, here's the chance to practice everything we'd trained for!

And we get there, and it's nothing. A mere flesh wound. A "oh help, I've fallen, and I can't get up," kind of thing... Or worse, we get canceled mid-route. That is so insulting... The old timers would say, "Those are the best kind of calls."

I would be disappointed if we didn't get to do something. I mean, really, we train and train and train, and we get called out for this?

Then we got a real one. I don't remember if my first real emergency was a car crash or a cardiac arrest or something else. Whatever it was - it sucked. It sucked big time. It was not fun. And it was definitely not cool. The young girl screaming as we struggled to pull her shattered feet and ankles out from under the crumpled dashboard. The guy gurgling in his own vomit as we preformed chest compressions and tried to ventilate him.

It is not a good time in that situation. You feel sick. You feel like you could cry. You wish you were somewhere else. You wish the ambulance would get here quicker. You wish the paramedic would take over and be responsible. But you can't, and you don't, and you won't. You do the best you can and hope for the best.

When it was all over, it feels exhilarating, and we discuss it in detail. What did we do right? What did we do wrong? Did you see it when...?

And now I realize that the old timers were right.

Another day, another garage fire

Towards the end of my 12-hour shift on the ambulance yesterday, a local fire department got a call for a garage fire - fully involved, flames showing - building not attached to home.

It happens. Lawn mowers put away hot. Wood stoves left unattended. Oily rags self-igniting in the trash can. Who knows?

In the station, we listened to all the radio chatter. Another fire department was called for tanker and manpower assist. Then another called for a RIT team (rapid intervention team - a group of four firefighters whose only responsibility is to stand by and be prepared for an emergency rescue of an injured or trapped firefighter).

It all seemed a bit much for a garage fire. Then they called us for rehab, where we stage at the fire scene and are responsible for assessing and monitoring firefighters that might overexert themselves or some other medical problem. #1 killer of firefighters is a heart attack.

We could see the smoke column as we got closer and then saw the flames. Ahh... A large, story and a half pole barn - the new 'garage' for rural America. The guy wasn't a farmer, but he needed space for his lawn tractor, snowmobiles, trailers - man toys.

So we sat in the cab of the rig, watching the snow fall and the building fall down in flames. Occasionally a firefighter would be ordered by the incident commander to come over and get hooked up to the monitor to check his blood pressure and pulse.

Then it was done, and we went back to the station. Another exciting day as an EMT!

Near Miss in California

Lying in bed this morning, we heard this piece on firefighters who got trapped by flames.

Enlarge the first photo and check it out.

http://www.npr.org/templates/story/story.php?storyId=15864703&ft=1&f=1008

True Halloween Nightmare

Halloween Night.

Mid conversation, Joan says, "Is that the siren?" I cock my head and listen. You can faintly hear the fire station siren from inside our house, although it often blends in with other noises and music.

I grab my pager to see if it had tripped - dammit, it had been turned off.

"I'll see you in a bit," I tell her and give her a kiss, "It's probably another bullshit call, but you never know..."

Driving down the dark, dirt road, rain on the windshield, I hold my pager aloft so it gets better reception. Finally, the tones go off, and it vibrates in my hand.

Jim answers dispatch, "7-0 Central, from Station 9-0."

7-0 Central answers - I've heard her voice hundreds of time but have no idea what she looks like - "Station 9-0, have a report of a PI crash, car versus horse." PI stands for personal injury. I have no idea why they call it that.

"Oh no," I mutter to myself, "this one doesn't sound good."

Deer can really damage a car. Horses do a lot of damage to a car. Joan and I were driving into Ann Arbor one foggy morning and saw flashing lights ahead. Near a farm, still in it's lane, was a car with a dead horse lying in front of it. It looked like the Hand of God had karate chopped the front of the vehicle, with a perfected centered, horse-sized dent from the front of the hood, up the windshield, to the roof. I read in the paper later that the driver walked away with only bruises.

I didn't make the engine out of the station, so I suited up and sat in the driver's seat of the rescue, waiting for the next guy. Kevin rolls up, and we take off. Over the radio, our assistant chief, on the scene, tells everybody to slow it down to priority two, which implies that things are basically ok.

By the time we get there, the driver of the car is being loaded into the ambulance. He only had a laceration to the side of his head. He had thought it was a deer, had a second to realize it was a horse, and just enough time to lean to the left as the horse came through the windshield and peeled off the roof (see photo of actual car). No blood - just some horse poop on the hood and on the inside of the rear window. Some obvious jokes were made. My pathetic attempt involved the headless horseman.

The consensus was that the horse had gotten loose from a local farm and was just wandering around in the dark.

This raises a good point that people should know.

It is (usually) better to hit the animal than swerve, especially at high speeds. We see a lot more seriously injured people who try to avoid the deer, lose control, roll the car, and/or hit a tree.

In fact, my sister, while trying to avoid hitting a fawn, at low speeds, rolled her car down a steep slope and totaled it in the mountains of Northern California.

Just remember, there's a lot more wildlife out there but only one of you.

P.S. I saw the car at a local junk yard recently and took the photo.

Musings on Mortality

We transported a 94 year-old woman today from a nursing home to the hospital, priority five, just a transfer. She had a possible lower leg fracture and needed an x-ray to confirm it.

She mewled in pain like a kitten when we sheet lifted her from the bed to the cot. She gazed blankly at us – the lights were on, but nobody was home. It was like that for the whole transfer to and from the hospital. I had to leave the room when the staff moved her leg to get the x-ray plate in position. I couldn't take the sounds. It made me want to cry. Lots of things in this job make me want to cry.

She kept trying to put things in her mouth and gum them, like a newborn. The cot strap buckle, the edge of the velour blanket, my hand. I sat there, watching her as the ambulance bounced and swayed down the road. Thoughts running through my head.

We wouldn't do this to our pets. We wouldn't let them suffer like this. Why do we insist on keeping people alive when there is nothing left? When all that is left is pain and suffering...

This is just one version of what is going to happen to all of us. I just hope to God it doesn't happen to me.

It reminds me of an old joke: “I want to die in my sleep, like my grandfather. Not screaming in fear like his passengers.”

Where did it all start?

Where did it all start?

It could have been when I was a little kid, burning little paths of dried grass on the sidewalk and crisping ants with a magnifying glass with that kid that lived over on Morningstar Drive.

It could have been when I set fire to a margarine tub full of gasoline, and when the flames started to die down, I grabbed the can and poured some more gas into the tub. There was beauty in the flames that climbed back up the arch of falling liquid, right into the can I was holding. I was in high school then.

It could have been when Uncle Bob and I were burning brush in the middle of a five-acre grass field four years ago. With winds of 15 to 20 miles an hour, we assured each other it wouldn't get away from us and the mowed trail would stop it if it did. The roaring front of flame was glorious. Uncle Bob ran to call 911, and I watched the field fire run towards the woods. That was also the day that got me recruited by the fire department.

It could have been the workshop on using controlled burns as an land management technique, invigorating natives plants with fire, and suppressing invasives. Learning how to create firebreaks, use the wind, and control the fire was fascinating – although control can be elusive and quickly lost.

Or maybe it was the first day I got paid to put on a Nomex jumpsuit, strap on a five-gallon water pack, pick up a drip torch, and set fire to a prairie grass field. It went up like a bomb, with flame fronts tens of feet high, roaring like locomotives, and sending a column of smoke thousands of feet into the sky.

Maybe I've always been a bit of a fire bug.