Alerts

We're called for a stabbing. The teenage girl says she doesn't want to go to the hospital, just give her a band-aid. The firefighter tells her she might need some stiches. She doesn't want to go. I look at the wound. There is a 1" puncture/incision wound under her left shoulder blade. The bleeding has stopped. I ask her what she was stabbed with. She doesn't know. She said she was just sitting there and some girls came over and then was a fight. She doesn't know anything. If she does she isn't telling.

We lead her to the stretcher anyway telling her she needs to go. I have no idea how deep the wound is. When I try to lay her down on the stretcher, she screams. Her rib hurts. I have my partner go on a priority. Her lungs are clear and equal, but she is breathing shallowly. I give her some oxygen and put in an IV, while my partner calls the hospital. She is sweating now and getting more short of breath. She is crying. I'm starting to get a little worried about her.

In the trauma room, they give her the workover. When they lay her down her heart rate goes up to 140. They sit her back up, it goes back to 112.

Later, they list her in stable condition.

***

There are basically three places patients go when they are taken to an ER. They get an alert, they get a bed -- either in a room/alcove or the hallway, or they go to the waiting room. An alert is either the trauma room, a code room, or just a doctor and a bunch of staff piling in the room to see what is up with the patient. If I think someone needs an alert, I call the hospital and notify them. There is a general feeling that if you call an alert, the patient should merit one. You don't want to cry wolf, but you want to be a good advocate for your patient. Sometimes, like with the stabbing, we just lay out the facts and let the hospital call the alert. Other times we request the trauma room or a stroke alert, etc.

The stabbing you just don't know. You can never tell. Some calls are obvious. Others -- particuarly traumas -- you do your best, use your best judgement. You head to the hospital as fast as you can and hope they are okay. I've had a lot of traumas where I started on a priority, then came to realize as I did my assessment the patient wasn't really that bad off. This girl, I was starting to worry about her. Our scene time was five minutes. Total call time ten.


***

I had two medical alerts today. One was an asthma from a doctor's office. She was very tight, and hacking up yellow phlegm. I gave her a breathing treatment, some fluid, and called for orders for solumedrol, which they granted me. She was doing better by the time we got to the ER, but she needed attention. She was coughing up a storm so a respiratory therapist gave her some nebulized lidociane and that worked pretty well. I had never heard of that treatment before.

The other call was for a mentally disabled person from a group home not feeling well. She had a history of frequent UTI's, and they said she tended to get hypothermic whenever she got sick. She was in no distress with good vitals. I didn't even tech the call. She didn't even feel that cold. Her core was warm. She had good capillary refill. I drove. We got to triage and because her temp was low, the nurse called a medical alert. I was surprised. The doctors and the staff wanted to know why we were bringing the patient into an alert room. We just looked at the triage nurse, who explained to the others her temperature was 93-something by their stick it in the ear thermometer. Hospital protocol. So they wrapped her in a thermal blanket. I didn't think she needed an alert. But what do I know.

I never found out the final disposition of any of the patients.

My job is to just get them to the hospital.

***

Did three other calls. An elderly man who tripped in the parking lot, and bystanders called 911. His wife was a little Italian lady and she was giving the cops the business. "He's fine. Why are you bothering us. We're law-abbiding citizens. You can't have him. You're not taking him from me. he's okay. leave us alone."

The cop was laughing. "I haven't argued with a bad man as much as I am arguing with you," he told her.

I checked the man out and he was okay. He signed a refusal.

***

Took someone home from diaylsis.

Did another respiratory distress. I gave her a combivent and was calling to get her some Solumedrol too, but I couldn't hear the hospital on the radio. That sometimes happens with one of the hospitals.