I sat with him in the back of the rescue, two old friends having a chat.

“You know you have to stop drinking.”

“What do you know?”

“I know I had to stop drinking.”

“It’s easy for you, you’ve got it made.”

“I do now.”

“I got nothing.”

“Neither did I.”

He looked at me, then dropped his head, and deflated.

“I’m a good auto body man, I’ve even got a job. They don’t let me work when I’m like this.”

“You’ve been like this for years.”

“Not always. Sometimes I get better, but it never lasts.”

“Why?”

“Cuz I got nothing to live for.”

“There’s always something, David.”

I dropped him off at the hospital, thinking I may have made a difference. I thought I’d try harder the next time I saw him. Thought I might even get him to a meeting.

They found him a few days later, frozen to death in an old truck that needed some body work.

PUBLIC SERVICE ANNOUNCEMENT!!!!!

Currently, the blogosphere is under a voodoo curse perpetrated by an evil priest disguised as one “Ambulance Driver.”

This is the real “Ambulance Driver.”

http://ambulancedriverfiles.com/

Please do not be fooled by impostors.

If you feel a strange urge to vote for Ambulance Driver,

http://firecritic.com/contests/fire-ems-blog-of-the-year-2010/finalists-and-voting/

run toward the nearest body of water and fully submerge yourself. Showers won’t do, full submersion is necessary to lift the curse.

When through with the cleansing process, vote for Rescuing Providence!

He was in the back of the police cruiser, glaring at me. The cops wanted him transported to the hospital for a psych evaluation because he had been threatening some of the residents at his group home. I’ve been down this road with the police a number of times, this patient is considered by their, and our higher ups a medical transport situation for a change of mental status. I spend a lot of time in the streets with the cops, and know and like them, and understand they do as much running around as we do.

Common sense would dictate that the police transport the guy, but I have given up on that a long time ago.

His name was Theodore.

“Theodore, I’m taking you to the hospital.”

“Why! They’re lying!”

The staff of the group home stood outside with the police; two ladies in their forties. They watched the proceedings from a safe distance.

One of the cops let him out of the safety of the caged back seat of the cruiser and into the unsafetey of the back of Rescue 1, where I lost my partner last week when a deranged Afghanistan Veteran attacked him during a transport for a change of mental status.

Theodore sat on the bench seat, and waited. The police asked if we should tie him to the stretcher.

“Can’t. He hasn’t done anything.”

Theodore gave me a smile, and relaxed. Kind of like the Afghanistan Vet did last week. We put a seat belt on him and got ready to roll. Rhode Island Hospital was two minutes away.

“He goes to Roger Williams,” said one of the social workers.

“Not today, he’s going to the closest hospital,” I said. Roget Williams is a fifteen minute ride from where we were.

“Our protocols say to take him to Roger Williams!”

“I don’t care what your protocols say.”

“Wait here,” she ordered, and dialed her phone. I have to admit I was rather amused by all of this and wanted to see how it panned out. She talked for a while, then handed the phone to me.

“The supervisor wants to talk to you,” she said smugly.

“Too bad.”

Theodore undid the seat belt and ran from the truck, screaming, “I want to go to Roger Williams!”

He doesn’t know where that is, somebody gave him an excuse to go off the deep end and he did.

We got him back, put him back in his seat, and made him promise to stay put. He was a likable enough guy, about six two and two-fifty. He also moved remarkably fast. I should have had a police officer accompany me during transport, but didn’t. I can be my own worst enemy. I think that somewhere deep down, in a place I don’t like to look, I wanted him to attack me. The primal instinct needed for survival would take over, and I would prevail, and get the adrenaline going, and feel like a real man. Sick, I know, but that’s what happens when you spend too much time dealing with these things.

The police followed us to the closest appropriate medical facility. The staff at the group home is compiling a full report and complaint that they will forward to the proper authorities.

It can’t make it back to me soon enough. I’ve got a lot on my mind.

“I’m in more pain than when you picked me up!”

“Me too.”

It’s bad enough in the Captain’s seat, I can’t imagine how it feels on a backboard.

We know where the potholes are, and usually avoid them, these latest apparitions have descended like the plague on the streets of Providence. The trucks suspension is getting a workout, equipment lands on the floor, and if not for the safety belts, so would the patients.

Can’t wait for the snow and ice to melt, it’s a minefield out there. And it’s damn cold.

Vote for Rescuing Providence, and all of your dreams will come true!

http://firecritic.com/contests/fire-ems-blog-of-the-year-2010/finalists-and-voting/

I’m looking like a roadie from the winter leg of The Monsters of Rock Tour, 1985, black combat boots, clipped gloves and an old knit cap on my melon, my partner looks like he stepped out of an Eminem video with his hoodie covering his head and three or four layers keeping him warm, and we’re standing on a doorway in South Providence at two a.m. It’s four degrees below zero, factor in the wind chill and it’s -30. The door is locked, and there are no lights on. The person who called for abdominal pain must be in bed, under the covers, waiting for rescue.

A mini van approaches, a guy in his thirties gets out, shivers a little, walks through the clouds of steam from our breathing and unlocks the door.

“She’s upstairs,” he says, and starts climbing. We follow. Mike can’t see, once he entered the warm hallway his glasses fogged up.

The man walks into the apartment. A girl in her early twenties is lying on the couch, all smiles.

“You called!”

“I take care of you, no?”

“I love you!”

“You too!”

We’re standing in the doorway watching “Love Story” at 0200.

“Why are we here?” I ask.

“She has belly pain and it hurts bad,” he says. She glows and smiles.

“I can’t believe you called the ambulance men!”

“You are sick!” he says. I’m getting sicker by the minute.

“Lets go.” says the man to her. “Take her to the hospital,” he says to me.

“Have you lost your mind?” I ask. “The hospital is across the street, your van is running, YOU take her to the hospital, we have emergencies to respond to!”

On cue, the radio comes to life.

“Rescue 4, respond to 234 Moore Street for an emotional female”

“See!

I key the mike.

“Rescue 1 to fire alarm, needless here, we’ll respond to Moore Street.”

The man is shocked. His plan of rescue will need readjustment. We go back into the cold night air and head toward a real emergency. Moore Street is only a minute away.

We stand on the porch, in the freezing cold. The door is locked. It’s four degrees below zero. Nobody answers, there are no lights on.

A car pulls in front of the house, a woman gets out.

“I have the key….

Screw it, I need the votes.

http://firecritic.com/contests/fire-ems-blog-of-the-year-2010/finalists-and-voting/

Thanks, Jonesie!

I caused a little stir with a post a few months ago concerning a diabetic and my treatment of him. I could just go about my day and treat people and take them to the hospital and go home, but I have found that this blog of mine helps me do the job better, and other people get a lot out of it, so I write about my experiences.

Every now and then somebody reads something I wrote and feels the need to state for the record that I am an idiot. That may be true, however, my treatment of my patients is always within state protocol, and in their best interests. The stories may be a little colorful now and then, but I’ve been honest for a reason, so people, myself included,  read this stuff, and get better not only at what they do, but how they treat others.

I ran into the guy that started this particular imbroglio during a call last week for somebody else. He went out of his way to approach me, and say thank you for doing the right thing, and his medication had been “tweaked,” and he feels 100% better.

I’ll take 100% all day long. So tell that to your students, Mr Paramedic-instructor.

http://rescuingprovidence.com/2010/11/02/diabetics-and-firefighters/

Response from a reader:

“Are you FREAKING KIDDING ME???

You’d delay treatment of a perfectly correctable medical condition in order to remove the possibility that the patient might exercise his rights? You used the word “kidnap” in there, which is ASTOUNDING to me.

What if he puts up a fight and hurts himself, or somebody in your crew? As a paramedic student I watched a terrible fire based EMS crew wrestle a guy down, causing a fractured wrist…oh and they also missed the freaking IV, and the “superior” fire/medic got his OOMPH into it and managed to get half an amp of D50 into the guys elbow before the student managed to get the confidence to say something.

I understand he’s a PITA, and needs evaluation…but he also has rights, and one of those is to be an idiot.

If THIS is an example of the “nothing beats it” system in Providence, you are truly the most deluded guy in the fire service. I wonder if anybody from your crew of from your service…or your medical director will have the sense to remove your practice privileges and turn you in to the state board before you get somebody hurt or sued?

I’m not entirely sure how one might get more legally in jeopardy than going on the internet and use the word “kidnap” and the phrase “…taking the option of a lucid refusal away from him”, despite the ethical issues.

Anyhoo, at the very least its provided my students with a real-world example of the precise wrong thing to do.

You realize the patient has a FANTASTIC case against you and the department, right?”

FF/Paramedic
Houston

http://ambulancedriverfiles.com/2011/01/when-you-vote-for-ems-blog-of-the-year/

I’ve been thinking for an hour or two about some witty, slightly off color remarks in response to Ambulance Driver’s post, but figured the truth is probably the better way to go.

Four years ago, somebody suggested I start a blog to promote a book that was going to be published.

“What’s a blog?” I asked myself. I googled EMS blogs and “A Day in the Life of an Ambulance Driver” appeared.

“I’ll just do what he does.”

I do it about half as well, which is why A Day in the Life of an Ambulance Driver has twice the votes.

http://firecritic.com/contests/fire-ems-blog-of-the-year-2010/finalists-and-voting/

Nevertheless, everybody roots for the underdog, and Rescuing Providence is no exception! The 2001 Patriots, The 2004 Red Sox, The 1969 Bruins-all come from behind champions. They did it with grit, and determination, character and guts. Considering I have none of these things, I’ll do it with this:

Vote for Rescuing Providence, and all of your dreams will come true!

“Engine 3 to Rescue 1, code 99.”

“Rescue 1, received.”

Three years old. Pedi code. Two minutes out. Racking my brain, dosages, kilos to pounds, airway, rhythms, joules, access.

The baby lived on the third floor of a pediatric nursing home, “The Cabbage Patch,” I’ve heard it referred to, and I myself have called it that. Saying it isn’t disrespectful, or mean, or callous, it’s just one of the many ways we cope with the things we see. I don’t think the name is funny, and neither does anybody else, ironic maybe, or even appropriate, it doesn’t matter.

Most people have no idea places like this exist, or if they do know, they keep that knowledge tucked away somewhere. Children with severe birth defects live and die here, cared for by people trained to provide the best care possible when the family cannot.

Joshua lived on a ventilator. Three years had passed since he entered this existence, and for three years artificial means kept him alive. He grew, and ate, and smiled, and felt. His parents came every day and took him home on the weekends. His room was full of toys, and notes and cards.

Now it was full of firefighters, EMT’s nurses, a respiratory therapist, and others trying to help, and one of us did compressions on his little chest, and another bagged him, and  I looked into his eyes to see, and I saw, 4mm, fixed and unresponsive. I honestly thought he would look back at me, and smile, and say, “what’s all the fuss?”

He didn’t. We loaded him up, and brought him to Hasbro Children’s Hospital where I gave my report, and the nurse signed the papers, and we left as his parents rushed in. He’s gone, now, at rest.

It was the last call of a long tour, one that I am glad is over. The good calls, the monotonous calls, violence, excitement and heartbreak all meld into one big package that I put away as soon as I leave the station, and return to the real world.

http://rescuingprovidence.com/2007/03/22/seventh-floor/

I had already lost my partner, battled a raging lunatic, took a few old ladies to the hospital and treated a diabetic.  Lunch waited at the station, I just couldn’t seem to get there. At two-thirty the clouds parted, and a little sun shone through. A turkey and goat cheddar wrap with fresh salsa and an avocado sat in front of me, waiting to be devoured. I lifted the masterpiece…

“Rescue 1, respond to Ohio Avenue for a thirty-one year old male complaining of flu-like symptoms.”

“*%@#$!”

Chris from Engine 13 offered to take the run, I handed the radio over, and returned to my feast. I would take his spot on the engine should a call come in, but what were the chances of that happening?

“Attention Engines 13, 10, 11, Ladders 5 and 2, Special Hazards and Division 1, a still box.”

I was up from the table and down the pole in seconds, scrambling for gear. I ended up with Chris’s helmet, bunkers and boots, Mike’s coat, and Ryan’s mask and gloves. It would have to do. We rolled out of the station, a minute or so later Captain Healey reported a smoke condition. A few seconds after that came the battle cry of The Providence Fire Department:

“Engine 13 to Fire Alarm, Code Red!”

Ryan drove fifty feet past the fire building, I left the jump seat with my Scott pack ready and joined Fernando at the rear of the truck. We stretched a 200′ 1 3/4 attack line into a side door and into complete darkness. I turned in my pack, put on the mask and went further in. Fernando had the pipe, Ryan pumped and the Captain stretched some more line into the building. Fire rolled overhead, Fernando hit it with a strait stream, then stopped. His pack malfunctioned, he was without air. He handed the pipe to me and backed out.

I felt the heat and had to crouch down, then kneel, then crawl forward, dragging the charged line with me. I knew there was heavy fire in the rear room, but had no idea what was hanging me up. Dining room chairs, when tipped on their side in a smoke filled room are not the comfortable seats they were designed to be. They become obstacles, unknown things that just might be your undoing. There was about three feet of bearable space between the floor the obstacles, and heat above me. The sound of fire freely burning in the distance consumed me, and I got past the chairs somehow and kept moving forward. Captain Healey joined me, then Fernando, and freed up some more line, and made it easier to get closer to the source of the heat, Hotter now, almost unbearable, total darkness, but strangely peaceful once I got moving.

More fire was above us, and beside us, and underneath us for all I knew. I opened the nozzle and hit the fire, just as Ladder 5 opened the roof. A square of light showed up, at first seeming miles away, but as the smoke and heat cleared and we got ahead of the fire it seemed to get closer. The vibra-alert went off, I was nearly out of air but had some more fire in the ceiling. I thought the light I saw was another door, and figured I could make it out, so I finished the job. Turns out I was in a bedroom, and tangled up in the springs from a destroyed mattress, and the light was a window. I got free again, crawled over the mattress, and opened the nozzle, this time in a fog pattern and directed the stream out the window, taking a lot of smoke with it.

The fire in the house was out.

“You can take the boy out of the fire, but you will never take the fire out of the boy.”

It had been nearly ten years since I was first in and on the pipe. I guess some things you never forget.

Later, while packing hose, probably the last time I will ever be on top of a fire engine, tired and dirty, cold and satisfied, the enormity of a twenty year career and the latter part of it hit me. Not many people have the opportunity to do a job they love, and know it will be for the last time, and to be able to go out on top, and there is nothing better than being on top of a fire engine in Providence, packing hose, carrying on and enjoying the camaraderie that only those in the fire service could understand. It was a private moment, and kind of overwhelming, but it ended quickly when Ryan asked if I planned on packing hose or taking up space on top of the truck. Captain, Schmaptain, we’re all equals, and that is what I love most about all of this.

The homeowners arrived on scene. An elderly lady, her daughter and an eight year old slowly walked up the icy driveway, holding on to each other. I couldn’t look away. The Red Cross had arrived, and helped them look into their home. The elderly lady was overcome with grief, and collapsed . The little girl broke down, and the mom, and daughter tried to hold it all together, while dealing with her own loss. I heard the radio call for a rescue for an emotional female.

I needed to get off the truck, and do my job, but somebody else was in my seat. I packed some more hose and looked away.

Later, back at the station, while washing the soot from my hands and face, another call came in, this one for a female on Prarie Avenue with flu-like symptoms. I found my radio.

“Rescue 1 is in service, we’ll handle.”

And handle it we did, soot and all. The patient didn’t notice, and will never know that the medic taking care of her got a taste of his old life, and it was sweet while it lasted, but was now exactly where he needed to be.

Back in the Captain’s seat in back of Rescue 1.

http://bigdogfirephotos.smugmug.com/2011-Fire-Incidents/Working-fire-Providence-RI-109/15546796_LBNdz#1164558131_jje4D

Brian had him in the back, doing vitals when I looked in. When the pulsox monitor went on his finger, he started to rock. Then he swung his arms back and forth and started to growl. Then his head began rocking, harder and harder until he was smashing it against the wall above the bench seat. Brian told him to stop, the patient growled louder. I had one foot in the side door when he attacked. It was quick, in an instant he was on his feet, charging. Brian got in close to avoid the punches, I attacked from behind. Thirty seconds later is was over, the guys from Engine 11 joined in, it took five of his to subdue him, and keep him subdued. We called for police back-up, and kept him down. He put up a heck of a fight, there was an incredible amount of rage built up that manifested itself in the back of Rescue 1.

Brian ruined his hand during the struggle and I called for an additional rescue for him. The patient continued to growl and seemed to gain strength. Eventually the police arrived, cuffed him and helped us restrain him, face down on the stretcher.

It was ugly.

Minutes prior to all of this, he had walked out of the home that he shared with his wife and year old daughter. The wife had called us because he was acting strange, and had been since returning from Afghanistan. The plan was to take him to the VA for a psych evaluation, all that changed now. He’ll be charged with felony assault on a firefighter, his wife and daughter will be without him for a while, and I’ll be without my partner for who knows how long.

There is a war going on, and has been raging for ten years. The fighting is done mostly “over there,” but also finds its way here, at home. Our soldiers are deployed, and do their jobs, and come back, and everything is supposed to be okay. Well, it’s not okay. There is a lot of pain and suffering going on behind closed doors, and closed mouths just waiting to turn outward. I’m sorry my partner was hurt, and the rest of us have our bruises, and we had to manhandle a United States soldier, but I thank god his wife called for help in time.

There were two hunting knives on the kitchen table when we first arrived, and the soldier was eyeballing them. We got him past those, and into the rescue before he snapped.

http://firecritic.com/contests/fire-ems-blog-of-the-year-2010/finalists-and-voting/

I wish I were half as classy and gracious as The Happy Medic,  http://happymedic.com/2011/01/16/blog-of-the-year-2010/ but I’m not. So vote for Rescuing Providence, and all of your dreams will come true!

I put a lot of effort into this blog, and a lot of time making it look somewhat professional and entertaining. I used to wonder why. Now I know.

The response from my Captains test results that I posted a few days ago here and on Facebook made it all worthwhile.

I read every comment posted here, and appreciate them all, knowing there is so much to read out there, and all just a click away. I may not respond to the comments as much as I would like, but without them, this would only be half a blog.

Thanks again. And thanks for stopping by and making my day.

So I did it. Years slaving on Rescue 3, making Lieutenant, then more years slaving on Rescue 1. I stayed out of trouble, learned some things, studied a little and finished second on the Captain’s test. The rank of Captain is as high as we can go here in Providence, before making Chief, but that is a completely different way to go, political mostly, and I have no intentions of following that path.

So now I wait for somebody to make room for the new guy. My friend Woody finished #1, but that was no surprise, he’s a lot smarter than me. He’s Acting Captain already, on Rescue 2. I’ll be moving sometime this year, if all goes according to plan.

One of the best things about promotions and all of that is telling the family about it. Their lives are intricately entwined with ours, life in the fire service is definitely a family affair. So, I told the family.

“Meet the Providence Fire Department’s newest Captain,” I said, expecting great praise and adulation.

Danielle looked at her mom, looked at me, looked back at her mom and said,

“You did a good job cleaning him up.”

And that was that. And she was absolutely correct.

Thanks, Cheryl.

My brother fell through the ice.  He got out, but I don’t think he walked on frozen water again. I remember skating on the pond he fell through, and hearing the cracks, and stopping mid-stride, waiting for the ice to give in, and send me into the freezing water. I heard that there is an inch of air between the ice and the water, I used to imagine myself under the ice, sucking air from that little pocked while watching the people above me follow my progress until I sank.

I’m not afraid of falling through the ice anymore, probably because you couldn’t pay me enough to walk onto a frozen body of water without the proper equipment. What does scare the daylights out of me is having some kid fall through on my watch.

“Hypothermia treatment works in the following way: After the heart stops, blood flow to the vital organs, particularly the brain, ceases completely. Although CPR does restore some flow, it is still only a small fraction of normal flow and very quickly the brain and vital organs are irreversibly damaged. Thus, even if the heart is re-started, the patient may be left with severe brain injury and may never regain consciousness. Lowering body temperature reduces the demand that the brain has for oxygen and protects brain cells.”

Three kids fell through the ice near my home ten years ago. One died, one got himself out, one was under water for forty minutes. My niece moved here from North Carolina a few years ago, and among the many friends she made was the guy who drowned, and died, and then lived. The Warwick Fire Department started the efforts that eventually led to his recovery. They got him out of the water, treated him extremely gently, covered him with blankets, and followed state protocols and the AHA guidelines for cold water resuscitation.

http://www.ussartf.org/cold_water_survival.htm

I always find time to read stuff about hypothermia and resuscitation this time of year. It’s part of being a firefighter, EMT. Instead of seeing what most people see, the fun, and excitement and playfulness of the season, we see the other side, and try to remain vigilant should some poor soul end up there.

http://rescuingprovidence.com/2007/02/12/ice-rescue-drill/

Why do I have to be the bad guy? I’m just the last one in line, the one that starts with the uppity-ups, who figured out they could make some money from the EMS division of the fire department by billing for transports, then goes to the medical community who figures it is easier and cheaper in the long run to err on the side of caution and drag anybody who complains about anything into an ER for an evaluation, and winds through the Health and Human Services Department, who encourage the poor to call 911 for anything and everything, then travels into the communications department, where dispatchers are so beaten they barely listen to the person’s problem before sending the troops and then it gets to me.

It’s tough being the bad guy when you are all alone. There’s no cavalry coming over the hill, just you, and the patient that really isn’t even that, more a customer of a service provided by the state. We are the face the public sees. For better or worse.

Nobody says no, everything is smooth sailing until this big galoot in the Providence Fire Department uniform shows up, and instead of carrying you to the red and white taxi decides to interrogate you. There’s always one idiot in the bunch, and here he is, acting like a doctor or something, asking all these questions. It’s none of his business when you started to feel sick, or what medications you are  taking, or what you are allergic too. Just who does he think he is? Drive the ambulance mister, and let the doctors do the doctoring!

No sense being the bad guy. Get in the truck, and giddy-up.

A car skidded into hers, tapping her bumper. She drove home and sat in her driveway, then called 911. She gave us the license plate number of the car that hit her, then said the pain in her neck and back was too much to bear, and she couldn’t walk. We brought the stretcher over to her, and put a collar around her neck, and put a backboard under her, and extricated her from her vehicle. She grunted and groaned and put on quite a show. It didn’t bother me too much, business as usual in the city, if I let little things get to me I’ll be in the nuthouse before long. This is the meat and potatoes of EMS, things we do every day, day after day.

We brought her to the ER. She told the triage nurse she was now having severe abdominal pain. That bought her a trauma room and a full work-up. I’m not being cynical , just honest by telling you there was nothing whatsoever wrong with this woman, she was simply padding her case. In a few years, maybe less she will get a check from her insurance company, or the hit and run  driver if she gets lucky for a few thousand dollars. Not bad for an afternoon’s work.

I wheeled her into the trauma room, left my report on the desk and walked out. I figured it was a fairly simple thing, nothing new, the same thing happens dozens of times a week. Stable vitals, no sign of trauma, no visible damage to the vehicle, just people following protocol, and not a damn thing we can do about it.

A few minutes later somebody told me they wanted a report in the trauma room. I walked in and a roomful of grim faced doctors and nurses waited. I told them the details, they listened politely and got to work. I watched for a few minutes as they did their thing, asked all the questions, ordered all the right tests, cleared her from the board and moved on to the next one.

In the trauma room next to the one I had just brought my patient, a different girl rested now, after the same team of doctors did their thing. This girl was unconscious, and intubated, and had no feeling in the lower half of her body after smashing into a jackknifed tractor trailer on Route 95, and being crushed in half, and her spine stepped, and her cord irreparably damaged. She’s nineteen years old, and the back seat of her car was full of nursing books, and she had a nursing school sticker on her back window, the only one that wasn’t shattered.

In an out of body experience, I saw myself rip my patient off of her backboard, and drag her across the hall, and plant her in front of the kid who will never be a nurse, and tell her that this is what a trauma room is for, and to appreciate the life she was given, and her health and the hope of a future that doesn’t include a wheelchair, and that her puny little lawsuit and the puny little people who go along with the scam, the lawyers, and doctors and physical therapists, and insurance adjusters who look the other way should be ashamed of themselves.

Then I returned to my body and responded to an MVA in a parking lot and put a guy in his twenties complaining of neck and back pain following a minor collision onto a backboard, and put a collar around his neck, and took his vital signs, and brought him to the ER, where he will be treated like a real patient.

I don’t know how they do it. Come to think of it, I don’t know how I do it.

The Welsh Viking is somebody who, rather that complain and whine about “The System” actually did something, and continues to do so. If you get a chance, please follow the link, and read the post, and say thanks.

http://thewelshviking.wordpress.com/2011/01/17/what-is-an-emergency/

Thank you, Heddwch.

“Rescue 1 and Engine 13, respond to The Highrise for an emotional, suicidal female with a knife, stage for police.”

The cops got there first.

“She needs to get those legs looked at,” said one of the three who stood in the corridor outside the patient’s apartment. The patient was in the corridor as well, sitting in a wheelchair. An anklebiter barked non-stop inside the apartment, I peeked in and saw him, inside his cage, protecting his territory the best he could.

“She’s not going to want to go with you guys, I hope you can talk her into it,” said one of the officers.

I walked toward the wheelchair bound person, crouched down and made eye contact. Then I looked over my shoulder at the circus behind me. Three cops, four firefighters and me and Brian. Then I looked back at her, a twenty-four year old lady with little legs, clean clothes, highlights in her shoulder length hair and a half smile on her face.

“Strong work.”

The smile grew.

“What happened?”

“I was frustrated, and arguing with my boyfriend last night. He wouldn’t leave me alone, or leave my place. I don’t know why, but I did this.”

She lifted the bottom of her pants, pulled them over her knee and rolled the material back. First one, then two lacerations stretched from one side of her thigh to the other. They were deep enough to require stitches.

“You have to come with me and have those looked at,” I said, keeping the shock out of my voice, I think.

“Why?”

“Because those are serious wounds, and they’re self inflicted, and you need some help.”

“I manage just fine.”

“What happened to your legs?”

“Spina Bifida.”

“Do you have feeling in them?”

“A little.”

“Did you feel it when you sliced them open?”

“Not really.”

“How about when you stitched them closed?”

“I didn’t do that. My boyfriend did. He wouldn’t leave until I let him.”

“Did it hurt?”

“Oh yeah. It hurt a lot.”

Her boyfriend had taken a needle and thread, and sewed her up. Just like a torn pair of jeans. The pain must have been excruciating. The stitched were red, and would be infected, and who knows where it would lead.

“That leg will get infected, and you might lose it,” I told her. She gave me the strangest look when I mentioned that she might lose a useless leg.

“I’ll go.” She gave me the most genuine smile I’ve seen in a while. We took her to the ER, she told me about her “boyfriend” of six months who stitched her leg and told her not to call anybody, because he would take care of it.

The police are looking for him now, she filed a restraining order and wants to be rid of him, once and for all.

http://www.medpedia.com/search?q=spina+bifida&commit=Go

http://medicalauthorchat.com/2011/01/18/podcast-interview-with-rescuing-providence-author-michael-morse/

http://lifeunderthelights.com/2011/01/assessing-greatness-catching-the-stuff-youre-supposed-to/

Well, Mr. Big-Shot Rescuing Providence all around smart guy read Chris’s excellent post and thought back to the days when he was a rookie and would make mistakes like that. Not checking the glucose level? Ha!

My patient is a forty-four year old dialysis patient, diabetic in respiratory distress, breathing down to 6 respiration’s per minute, Pulsox 62%. She’s paralyzed from the waist down, has fistulas in each arm and is covered with bruises. I barely heard the BP, 86/42. Her heart rate was around 40.

Your quick thinking EMT did a thorough work-up, starting with the glucose reading. That was okay, our bagging was effective, her pulsox climbed to 92% and her heart rate increased to the seventies. Yet she still remained unconscious. We wheeled her out of her third floor apartment in one of the rougher hi-rise projects in the city, through the cement hallway, past the chain-link balconies and into the tiny elevator, bagging all the way.

That was pretty much it, IV access was nearly impossible, and my intubation attempt failed, so we continued to assist ventilation’s en-route to the ER and monitored her condition. When we arrived I gave the report to the medical team in the trauma room.

“Forty-four year old female dialysis patient, history of diabetes and lower paralysis, found by family members this morning in bed and unresponsive…”

“Did you give Narcan?”

Narcan. Freaking idiot. Sure enough her pupils were pinpoint. She had a history of Dilaudid seeking.

Should have paid attention when I was reading Chris’s post.

Thankfully no harm done, but a valuable lesson learned.

Thanks, Chris.

* Dr. Suner found IV access in the patient’s hip. Pretty cool.

Last year Providence’s Rescue 4 did 5,900 runs. The other five were close behind. Is this a number to be proud of? I think not. It is absurd. Most of these runs are little more than rides to an emergency room.

How do we deal with the “beat down” and still rise to the occasion when the occasion actually arises? Responding to the twentieth call for abdominal pain that turns out to be the flu, a hangover or menstrual cramps does not mentally prepare you for the Triple A. The pile up of fender benders with the usual assortment on “neck and back” injuries lulls you into a false sense of nonsense when responding to an MVA with serious injuries. Allergic reaction responses lose their luster when the majority of these are for people whose medicine didn’t do what they wanted,and want a ride to have their medication “checked.” When a patient presents in respiratory distress, with hives on top of hives and a pulsox in the seventies it’s time to perform, and put all of the nonsense away.

People call 911 all the time. Most of the calls could be handled by the people doing the calling. It’s the people who call whose situation is out of their control we have to be ready for. They need help, and that help needs to be crisp, professional and competent, even if it’s the thirty fifth call in the last thirty six, and the previous calls amounted to nothing. 

Some suggestions:

     *Every call is an emergency until you get there and see for yourself

     *Every caller is a person who deserves proper assessment before judgement (and try not to judge)

     *Leave the attitude at the station

     *Repeat after me…the patient is not the enemy…the patient is not the enemy…

     *Don’t let the system beat you down, the only thing you can control is you and your actions

     *Know when to let it all go, preferably at the end of your shift!

     *Just say no to overtime now and then

I’m no EMS genius by any means, and I’ve had a few moments in my twenty years that I’m less than proud of, but if I’ve learned anything it is this:

    * Take care of yourself. People are depending on it, and some of them really do need you.

Overheard in the back of Rescue 1, during a clean-up.

“Piss isn’t too bad.”

“Puke is the worst.”

“Nah, shit’s worse than puke, any day.”

“Blood is easy, it doesn’t stink.”

“That’s why piss isn’t bad, easy clean-up.”

“Old piss is pretty bad.”

“New shit is worse than old shit.”

“It’s still runny.”

“Speaking of runny, snot’s pretty bad.”

“Yeah but you hardly ever wear it. ”

“Yeah, puke wins that one.”

“But shit’s still the worst.”

“Yup. Piss is my favorite. Definitely.”

“I guess.”

I need the half hour before work to get my head together. The ten minutes of twilight between the first alarm blast and the delayed response from the snooze button. The warmth of the shower, then the nearly unbearable heat as I turn it up and let the water run down my back, the only pain free moment all day. Luna waiting impatiently for her morning feast. She won’t let me out of the house until she gets her “Crunchy Bits.”

I enjoy the ride to the station. I’m fortunate to live on the coast, the ride to work simply beautiful. This time of year the sun rises at exactly the same time I straddle Narragansett Bay as I make my way toward the station, and the barrage of calls. But for now, peace rules the day.

Until my cell phone rings, and the person I’m going to relieve in five minutes wants to know if I’m close because somebody has chest pains on Dexter Street. This person just so happens to have relieved me fifteen minutes late yesterday.  It’s ten minutes before my shift begins and they’re already calling.

Looks like I’ll be taking the even more scenic route.

*yes, this is Narragansett Bay