1630 hrs. Called to a tenement house for a man with flu-like symptoms on the third floor. Found said man under a stack of blankets sweating profusely and coughing uncontrollably. Chief complaints:

Coughing blood, no appetite, fever and sweating, irregular heartbeat, sore throat with trouble swallowing and shortness of breath.

Once inside the incubation chamber otherwise known as Rescue 1 I find my patient just returned from a lengthy stay in Cuba.

I’m doomed.

Symptoms of active TB may include:

Ongoing cough that brings up thick, cloudy, and sometimes bloody mucus (sputum) from the lungs.
Fatigue and weight loss.
Night sweats and fever.
Rapid heartbeat.
Swelling in the neck (when lymph nodes in the neck are infected).
Shortness of breath and chest pain (in rare cases).

*Update 30 Jun 08 0630 hrs.

Tonsilitis. Yay.

0700

“Rescue 1, respond to 465 Baker Street for a maternity, water has broken, eighth pregnancy.”

That’ll get you moving. Chances of a stretcher delivery increase exponentially after the fifth. Baker Street is approximately three miles from Woman and Infant’s Hospital over some of the bumpiest terrain in Providence. Starting my day with a bundle of joy is not on my list of things to do.

“Speed is of the essence,” I said to my driver, Steve. Steve was on hour twenty-four, I was fresh, only fifteen hours in.

“Roger that.”

Our patient waited on her porch. When she saw us come over the hill she charged the rescue.

“Not a minute to spare,” I told Steve and we were on our way.

“I’m sorry, I soaked your stretcher,” said my patient, a lovely thirty year old woman.

“Don’t worry, the last guy shit in a bucket,” I said, flashing back to our previous call.

Through the bumpy streets we sped, delivery imminent. She held on, a real trooper. We delivered her to the hospital, she delivered shortly thereafter.

I love a happy ending.

Somewhere in the back of our minds lies the fact that any call could be our last. The thought lies dormant for the most part until something tragic occurs. A big reason we are able to keep these thoughts at bay is the faith we have in our colleagues.

Rest in Peace, Stephanie Callaway, and also the patient who died while under your care.

from: Larry Rock
Date: June 23, 2008 1:26:18 AM EDT
To: aliems@yahoogroups.com
Subject: [ALIEMS] LODD
Reply-To: ALIEMS@yahoogroups.com

I can’t recall how many times I’ve read about fatal ambulances crashes; while all are tragic there is a considerable distance when “reading” about them. On Tuesday morning, my phone rang two hours too early, my official notification that Stephanie Callaway, a close friend and coworker, had been “killed.” Less than 24 hours earlier, I had been sitting to breakfast with her and other members of our association. It did not sink in right away; waking from a sound sleep, it just did not make sense.

The following days revealed the full scope of our tragedy. Her partner and another of our medic units with a student, and a supervisor unit, were dispatched to the crash and wound up coding a friend and fellow medic. Along with ambulances from the district in which the accident occurred, an additional ambulance was dispatched from the station of the involved ambulance.

The following days also revealed how tight our community is in times of tragedy. Fire and EMS agencies across the state provided two days of coverage for the Mid-Sussex Rescue Squad. On Saturday, most of our eight medic units were staffed by paramedics from the other counties (they are donating the pay they’ll receive to a trust fund). Along with many former employees, countless brothers and sisters from in state, North Carolina, Massachusetts, Maryland,Virginia, and New Jersey (perhaps more) came to pay tribute in the full honor ceremonies.

I don’t think a single one of us have ever felt more proud of being in EMS, nor have we ever been so humbled. As difficult as this week has been for the family, the crews, and our organization; we have been comforted by the overwhelming support.

Please keep her family in prayer; she is survived by her husband and two young children, her parents, brother and two sisters.

I included the press article from JEMS and a link to the article covering Saturday’s ceremonies.

Please take care and hug the ones you love,

Larry

2 Die in Delaware Ambulance Crash
2008 Jun 17
ANGOLA, Del. — Two people are dead after an ambulance accident on Route 24 near the Lewes/Rehoboth Fire Company substation in Angola.

State Police say the Mid-Sussex Rescue Squad Ambulance was the only vehicle involved.

The crash occurred about 2:30 a.m. Tuesday.

Police say the crash killed a patient who was being transported to Beebe Medical Center and killed a paramedic who was ejected from the ambulance.

A special note from JEMS Editor-in-Chief, A.J. Heightman:The JEMS family mourns the loss of Sussex County paramedic Stephanie L. Callaway, 31, of Lewes, Del., who died at 2:40 a.m. Tuesday, June 17, when the ambulance she was riding in struck a tree while avoiding a deer in the roadway.

Sussex County EMS (SCEMS) is part of Delaware’s state-wide paramedic program and provides ALS support to fire department-based BLS services, volunteer ambulance services, local hospitals, and state and local police agencies throughout a 964-square-mile region via eight specially designed ALS rapid-response, non-transport vehicles

SCEMS employs a staff of more than 100 paramedics and support personnel, serves a year-round population of 163,000 and a summer population that increases to 500,000 when tourists and visitors travel to the Delaware shores.

Stephanie was providing care to a patient in the back of a Mid-Sussex Rescue Squad ambulance from Long Neck, DE when the accident occurred. Her patient was ejected and also died in the crash. The Mid-Sussex Rescue Squad crew was also injured, with one crewmember ejected from the patient compartment..

Stephanie worked with the county since July 14, 2003 and served as a member of the Sussex County EMS Honor Guard, one of the department’s public information officers, a training officer and as president of the Sussex County Paramedic Association.

A dedicated EMS professional, Stephanie was also the mother of two children. We mourn her loss to her family and the EMS community.

http://www.delawareonline.com/apps/pbcs.dll/article?AID=/20080622/NEWS/806220342/1006

He was laying in his girlfriends bed and refused to move. When I entered the room he blew his nose on the sheets then spit onto the pillow.

“What are you doing?” I asked.

He mumbled something and rolled onto his back.

“Why are we here?” I asked.

“He won’t leave,” said one of the police officers that had responded.

“What’s your name?” I asked the man in the bed. Nothing.

“Do you know what day of the week it is?” Nothing.

“Do you know where you are?” Nothing. 0-3. So much for my plan to call it a police matter and back out.

“Is he taking any medications?” I asked a woman who I assumed to be his girlfriend. She took a healthy drag from her cigarette, looked in my direction but not at me and said,

“He’s supposed to but he’s not.”

Great.

How to get a three hundred pound spitting, snot throwing, underwear clad sweaty bear from his lair into my rescue and to the hospital with the least resistance possible?

Force? Too hard.

Guile? I’m not that clever.

Trickery? You bet.

I leaned over the bed, shook the patient firmly and told him we had to go to the hospital, there is an emergency.

He looked at me with bleary eyes, not comprehending.

“Let’s go, we have to go now!” I said, more urgency in my voice. “Something’s wrong with you and we can’t figure out what.”

We helped him to his feet, put some clothes on him and walked him through the rain to the rescue.

Too easy.

En route, the patient realized there was no real emergency. He tried to communicate with me but I couldn’t understand him. As we sped down Rt. 95 toward Rhode Island Hospital, he became more and more agitated. From the rear windows I noted familiar landmarks. Three minutes away he spit on my stretcher.

“If you spit in here again I’m going to have you arrested.”

Two minutes out he started fumbling for the seat belt latch. When he couldn’t figure out how to free himself he twisted his 1″ thick gold necklace in his hands until it tightened around his neck, then he pulled the chain violently up, trying to hang himself.

“You’re going to break your chain,” I said. The chain miraculously broke in his hands, relieved the pressure to his bulging eyes and letting the blood drain from his beet red face.

One minute out. He tried to break free of the seat belt by force. I sat three feet away looking for possible weapons. The portable should do the trick if I hit him between the eyes, but what if I missed? The familiar bumps in the road were a welcome relief as we turned onto Dudley street, one-hundred yards from the entrance to Rhode Island Hospital.

Security helped me get him out of the rescue onto one of their stretchers and into the CDU, (Clinical Decision Unit) Rhode Island Hospital Emergency Room’s psych ward.

The restraints held. This time.

Using the technologically advanced 2003 Verizon “Flip Phone,” famed nature photographer Micheal Morse captured this magnificent shot of the elusive Backyard Hummingbird.

“I had to stake out the position,: explains Morse, “right next to the refrigerator and food closet.”

When asked if all of the waiting was worth it, Morse explains,

“Look at the shot. The exquisite Backtyard Hummingbird is the most elusive of all backyard birds. To the naked eye the green blur next to the red feeder looks like, well, an ordinary blur.”

The rest of us can only enjoy the shot and bask in Morse’s brilliance.

I took the last bite from my apple and threw the core out the window. Maybe there will be an apple tree on the spot long after I’m gone. The police had found a woman unconscious in her car near the Temple to Music at Roger Williams Park and called for a medical assist. Engine 11 arrived first, Rescue 1 right behind them.
“Watch out,” said Renato, now a member of Engine 11, “she’s covered with vomit.”
Rob and Seth got the stretcher from the back of the rescue, Renato did a quick assessment of the girl while I picked pill bottles and a suicide note from the floor of the car. The stretcher arrived, we got the girl onto it and into the rescue and went to work.
“You guys know what to do,” I said, trying to make sense out of the mess of belongings I had gathered from her car. I got her name from one of the pill bottles, it matched with the registration. No other ID. I glanced at the suicide notes, there were a few, the first neatly written on an envelope, the others scratched on whatever was available, court summonses, unpaid parking tickets and pieces of scrap paper. I gave the notes to the cops.
“18 gauge in her left hand, ekg rolling,” said Renato.
“Pulsox 78%, I’ve got her on 10 liters,” said Rob.
I noticed her respiration’s were down to 12, her heart rate 180.
“Get some Narcan going.”
Rob drew 2mg and pushed it through the IV.
“Miles, I need a driver and a guy in back, we have to go.
Seth drove the rescue, Miles followed in the Engine and Renato, Rob and me stayed in back trying to revive our patient.
“Bag her.”
Rob got the bag-valve device ready, placed the oral airway and started bagging.
A lightning bolt lit the sky as we passed the Temple, thunder close behind. The brilliant light was gone before the thunder roared, plunging the park back into darkness.
“I picked up the cell phone and watched Rob and Renato work on the girl. Rob assisted ventilation’s while Renato reassessed vitals and checked the girls pupils.
“Rhode Island ER,” came the voice on the other end of the phone.
“Providence Rescue 1, I’ve got a twenty-five year old female, unconscious, suicide attempt, multiple pills and a note nearby, assisting ventilation’s, BP 124/68, pulsox 78% on room air, glucose 253, two minutes out.”
“Thank you Rescue 1, see you in two.”

Seth backed the rescue into the bay , we brought her in. The trauma team took over, me and Renato stayed for a while, assisting ventilation’s and telling the story again.
I was certain she would die. The trauma team wasn’t as certain. A few hours later I looked into the room, surprised to see her alive with stable vital signs. She was still unconscious and intubated, but it looks like she will survive. The Providence Police deserve credit, she had minutes to live before they found her.

I wonder went through her mind in those last desperate minutes as she sat alone in her car in the deserted park during a thunder storm, writing goodbye notes and swallowing pills. If she ever reads her words, will they make sense? Will her situation seem as desperate? Will she try again?

The cookout took a turn for the worse when a five-year old girl fell up the stairs. Nothing life threatening but enough to put a damper on the festivities. She sat in her mother’s arms crying softly when we arrived. A big bump and 1/2 inch laceration decorated her forehead. Little kids just don’t look right laying on a stretcher. Thankfully, my little patient was a perfect angel and might not even need a stitch. her mother and two family members came with us to the hospital, the young girls translating for the mom. One of the girls told me she wants to write this summer, maybe become a novelist. Never one to miss an opportunity to tell somebody about my own writing exploits I chimed right in with the story of Rescuing Providence. The other girl in the rescue said she knew me, her class has a reading club and they might read my book! How do you like them apples!

Rhode Island Hospital ER, 0230 hrs:

Overdoses, stabbings, a man covered in blood and toothpaste (the blood was an offering to Jesus, the toothpaste protection from terrorists)drunks covered in vomit, people on backboards with cervical collars around their necks, a screaming man “four pointed” face down on a stretcher, another guy trying to smash his head against the wall from his stretcher, a depressed man with stubs for feet sitting in a wheelchair crying, a sexual assault victim sobbing off to the side, sitting in the EMS break room talking to the police and a little old lady who felt “faint” sitting in the middle of it all.

Alida, one of the two triage nurses held it together with amazing grace but was about to lose it when the mother of a seventeen year old girl who had taken ten unknown pills demanded to be seen immediately started acting up.

Things were about to hit the breaking point when two cars, followed by a trail of cops sped into the ambulance bay and dumped a couple of gunshot victims onto the pavement. That quieted things down for a while while we got the victims onto stretchers and into the trauma rooms. My patient had a single GSW to his lower back, possibly shattering lower spine. He was diaphoretic, hypotensive and losing a lot of blood. The other victim ended up in another trauma room, a couple of bullet holes in him. I think the two were shooting at each other in a crowded nightclub parking lot.

I somehow got myself involved with the trauma team, along with Denny, a twenty-two year old “new guy” from Rescue 3. We started IV’s, helped intubate, restrain, cut off clothes and basically got bossed around by the trauma nurses and doctors. All hands on deck ruled the ER, too many patients, not enough hands.

An hour later we managed to extricate ourselves from the madness. Denny has been on rescue only two months but has already seen more than a lot of people will see for their entire career. If we can keep him humble we might let him stay in the rescue division.

Rhode Island Hospital ER 0930 hrs.

New day, new hospital. The cops are gone, so are the maniacs. The trauma rooms are now full of elderly people, some with trouble breathing, others with chest pain, more with injuries from falls or MVA’s. Last night’s controlled chaos has been replaced with cool efficiency as tests are ordered, x-rays taken and patients treated. the gunshot victims made it to the operating room, I think they will survive. What a difference a few hours makes.

*Providence Journal

2 men shot outside Providence club

01:00 AM EDT on Sunday, June 15, 2008

PROVIDENCE — Two 22-year-old men were seriously injured yesterday in an early morning shooting and brawl outside a Poe Street club, the police said.

The two men were shot around 2 a.m. in the parking lot of the just-closed Platforms Dance Club. There are two clubs in the area, the police said.

“There was a large disturbance in the parking lot and several shots rang out,” said Sgt. James Marsland. “It was a good-sized fight.”

Injured were Derrick Knighton, of 139 Burnett St., Providence, and Derrick Clarke-Heath, address unknown. They were driven to Rhode Island Hospital by residents. Knighton was shot in the torso. Other patrons injured in the fight –– but not shot –– were also driven to the hospital for treatment, Marsland said.

Two patrolmen found .380-caliber shell casings in the parking lot. The police towed three cars believed to be involved in the fight: a 1994 Oldsmobile, a 1995 Chevy Lumina and a 1997 Nissan Maxima. No arrests have been made. The case is under investigation, Marsland said.

81 Degrees, sunny skies, low humidity, perfect day. I refuse to let the Providence’s minions get me down, even though we’re off to a shaky start.

0720 hrs. “Rescue 1, respond to Veazie street for a person with possible strep throat.”

911 for strep throat? Hmm. Could be an elderly person, high fever. Might be an infant. Could have breathing difficulties associated with the “possible strep throat.” I kept an open mind during the response. The morning rush was on, traffic making the response twice as long. All Providence rescues are on other calls, rescue 1 is sixth due to Veazie, on the “other” side of Providence. Lights and sirens all the way, some people go to great lengths to make room for the rescue, others are completely unaware of anything but themselves.

0732 hrs. “Rescue 1 on scene.”

The apartment building is a disaster, kids toys left haphazardly in the parking lot, trash bags ripped open by stray dogs, bottles broken, litter flying around, greasy fingermarks smeared all over the doorbells. An empty coffee can held the door open a couple of inches, I kicked it in and walked up to the apartment. I knocked and waited. Knocked again and waited. Banged on the door with my radio. A thirtyish lady finally answered, bewildered expression on her face,.

“Did you call for a rescue?”
“A rescue?”
“A rescue.”
“I didn’t call for no rescue.”
“Somebody did.”
“Hold on.” She shut the door in my face. A few minutes later she came back.

“My son called from his room. You took him last night for a sore throat. I got to wait to get his medicine until eight o’clock but he’s in pain.”

“So am I.”

82 degrees, sunny skies, low humidity, nearly perfect day. I probably won’t let Providence’s minions get to me.

It was his fourth attempt that I’m aware of, two by hanging, one by a wrist slashing. This time he jumped thirty feet from a highway overpass onto the pavement. Rescue 1 was dispatched as a special signal and directed to respond to the highway below the overpass using a silent approach. The highway was jammed, traffic had been stopped on both sides for ten minutes before we were dispatched. Stephanie, my chauffeur for the evening got us as close as possible before things got too tight to move forward. Rather than use the sirens we waited about a quarter mile away from the incident and hoped for the best. After ten minutes the call came in from Ladder 1; the jumper had jumped. I took us a while to get to him, by the time we did the fire companies on scene had an IV established, cervical collar in place and an EKG done. They had cut his clothes exposing two fracture legs, a broken arm, broken ribs and assorted scrapes and bruises. A carnival atmosphere had developed, crowds of people, some horrified but more than a few highly entertained by the spectacle.

We got him to the ER where last I heard he had no feeling in his legs. I guess he’s lucky to be alive but I’m really not sure if he thinks so.

Houston may have a good idea here. Click on the title to read more

I wondered what all the limo’s were doing downtown; rows of them lined up near the Westin, in front of the Biltmore and parked around Kennedy Plaza. I thought some dignitaries from an oil rich Arab country were in town or something similar. These weren’t “economy” limousines, they were brand new, bright white Cadillac’s, Lincoln’s, Hummers-somebody even had a stretch pick-up truck. There were dozens of them. Turns out a high school was holding their senior prom at a downtown hotel.

Later, we responded to a popular nightclub for a possible overdose. An eighteen year old girl was found lying on her back in an alley next to the club, her tiny black dress covered with vomit. Her friends were concerned. They had graduated from a private high school that afternoon and were out celebrating. Hundreds of bleary-eyed kids swarmed the rescue, taking pictures with their camera phones, laughing, shouting, partying full speed ahead. I asked the friends what happened, they said they didn’t know. The unconscious girl was in the VIP room at the club and ended up in the alley. We got her to the ER where she threw up again, this time on one of the ER Technicians.

I wonder if a prom in the high school gym and a graduation party in the backyard ever occurred to these folks. Life isn’t always glamorous. Truly special occasions lose their luster when every little milestone is celebrated as if it were a glorious achievement. A little humility early in life leaves something to look forward to later on. Everybody wants to be a rock star, most of us won’t be.

I’m not quite sure what to make of the editorial in yesterday’s Providence Journal. Click on the title and it should link to the page.