Interns

Ride alongs, some like them, some not so much. What do you think?

The call was for a seventy-two year old male with a history of cancer having difficulty breathing. Upon arrival we found him lying on the floor, on his side, respirations 30/min, heart rate 170 with a blood pressure of 90/44. He was cyanotic, sp02 74%, with 3 liters supplemental oxygen and semi-conscious.

Engine Company 8, from the West End, one of the country's busiest fire crews had arrived first and administered 10 liters 02 through a non-re-breather and helped my partner for the day, Jay, who had been detailed to the rescue for the tour from Ladder Company 1. The five firefighters got the patient onto a stair chair and carried him out of the house while I did a preliminary assessment.

He had  just finished his last chemo treatment, his prognosis was good following a year long battle with lung cancer. His son found him struggling to breathe, upped his oxygen from 2 to 3 liters and called us. He lay his father on the ground, and it helped him breathe. In the rescue we finished the assessment, supplemental oxygen had improved the patient's color and oxygen saturation to 86%. His impaired consciousness was attributed to lack of oxygen and confirmed with a blood glucose test, 167. An EKG was done by Andy from Engine 8 and concluded the patient was in SVT.

At least that's what the printout said, but I distinctly saw P-waves in the printout. We had a little palaver in the back of the rescue, me and five of the best firefighters anywhere, one of whom, had just sunk an impossible IV using a 24 gauge needle in a patient whose veins were shot, another had set up and interpreted a 12 lead EKG, a third monitored vital signs and administered O2 and maintained the airway, and decided the best course of action was to skip the Adenosine due to the patient's fragile condition and proximity to the ER.

Vagal maneuvers were attempted with no improvement in the heart rate, one of the guys drove the rescue, another drove Engine 8, my partner, the doctor and two firefighters rode in back, in case the man coded. He didn't. Twenty minutes later, after Engine 8 had returned to service, and Jay had cleaned and restocked the truck, the man's son went out of his way to thank us, and let us know his dad had improved considerably.

I looked into his room, and saw a different person. His eyes quickly  darted in my direction, and he gave me a grin. I shook the guys son's hand, and walked out of the ER, the intern with me, ready for another one.

The care and professionalism displayed by the firefighters made me proud of my department, my vocation, and the fire service. I'm glad the new doctor was able to see just what it is we do before delivering patients to them. I hope she remembers as the years progress, and the patients add up, and it all becomes a blur. Thanks to Dr. Sullivan for giving us the opportunity to let the interns know just what we do. It is a great opportunity for everybody.

Dr. Francis Sullivan runs the EMS portion of the Brown Medical School Residency Program in Emergency Medicine, and has his first year interns do ride-alongs on Providence's rescues. I enjoy having the doctors along for the ride, it gives them some perspective and hopefully a little understanding of just what we do.*

*Dr. Sullivan "runs' the EMS portion of orientation for the residency and Dr. Williams assists with that and runs the rest of their EMS experience.   Brian Clyne, Jessica Smith, and Robert Tubbs are the residency director and assistant directors respectively and get all the credit for choosing great people and not ruining them.