Day Four - Oh Well/Mississippi?

I heard someone say the other night that while there are some regional differences, a paramedic is basically a paramedic and the practice is pretty much the same everywhere. I agree, but also part of being a paramedic is being comfortable with your equipment, with your setting, with your routine. A good paramedic can improvise, but it does help to have a certain underpinning like a captain who knows his boat and his area of the sea.

First call is for an unknown. The fire department arrives at the church before us and we find them grabbing a skinny woman who is screaming "Its a lie! Its a lie! I didn't kill myself. I didn't kill myself!" She is out of her mind. I hear someone say she has been smoking the stuff. The firefighters who are both big men, walk her out to us. She is fighting and now starting to spit. They throw her down face first on our stretcher. I announce that I want to sedate her. One of the firefightres says we are close to the hospital. Maybe ten minutes away. The woman is creaming spiting and trying to bite. "Let's get her in the ambulance and I'll sedate her," I say.

Under my protocols, I would give her injections of Ativan and Haldol and in two minutes she would be snoring. The gear in Mississippi doesn't have Ativan of Haldol. All I carry here is Valium. The problem with Valium is I can't give it IM, I have to give it IV. An additional problem is they don't carry saline locks, so if I want to give the patient Valium, I have to hang a bag of Saline. Whiule my partner spikes the bag, I put an IV in the back of her arm while the fire guys hold her down as she continues to buck and shout and spit and try to bite. He hands me the line, and I try to take it down -- they have no Veneguards. The poatient is diaphoretic, the tape sticks to my gloves. I finally get it taped down. I draw up the Valium, put it through the rubber port, then open up the line. It won't run. I know my line is good, but I can't get the fluid to run. I examine the drip set -- it is foeigh nto me. The roller clamp is above the drip chamber. I try to trouble shoot, but can't get it to run. I then have to find a syring, drwa up some saline and flush the the Valium in through the rubber port. It flushes fine, but still the line won't run. The next thing I know the IV has been ripped out in the patient's flayling and the Valium I did get in doesn't seem to have made any impact. We finally get to the hospital where they give her Ativan and Haldol and there she is sleeping like a Baby. I examine my Valium and discover I only gave her 2 milligrams instead of 4. I was expecting to give up to 10 depending on how she reacted. My mistake comes from the fact the Valium is stored in a syringe similar identical to the morphine we catrry back home and here in Mississippi. Execept the morphine is 10 milligrams in 1 cc, the Valium in 10 milligrams in 2 ccs. In the heart of the battle, I thought I was drawing up 4 mg, but in fact I was only drawing up 2. Not enought bay any means to sedate a person.

Oh, well.

At the hospital I beg the nurses to give me some saline locks and they are happy to oblidge. I want to ask for some ativan and haldol, but don't think I will get anywhere with that request.

We do a chest pain, which I think is just an anxiety -- a local business owner under stress. He thanks us for helping him. His ECG looks good, his skin is warm and dry, good vitals. He has had similar pain and be told by his doctors it is stress. Two nitro don't help. I work him up, give him some aspirin, some 02, but stop the nitro after two.

We do a psych -- an 18 year old who has been told to move out by his adoptive father. The cop tells me there are some 10-80s in the family. I think he means some of the family died in the storm, but I am told later that 10-80 is local slag for an AIDS patient. Eighty. AIDy.

The last call is a fall at the airport. A man who has been obviously drinking has taken a tumble down about ten stairs. The fire department has a c-collar on him. We board him and get him out to the ambulance. The man has no idea why he is in Mississippi. He claims no knowledge of the hurricane. I look at his license and the photo there is one a bearded madman. One eye closed, the other cocked wide. He looks like he has just beat his wife, kicked the dog, downed a fifth of jack Daniels and walked into a pool hall ready to fight.

I don't know if he has a concussion or is just completely hammered, but I work him up. He knows his name, social security number and home addresses, but he has no clue why he is in Mississippi. "Mississippi?" he says. "What am I doing in Mississippi?"

***

It takes forever for us to get from the hospital back to the base. The traffic jams are horrendous with so many roads closed. In the passenger seat, it seems like I fall asleep, open my eyes, and we're only ten yards down the road. I fall asleep again, open my eyes and we are still not through the light.

***

At dinner we talk about the new hurricane, Hurricane Rita that is headed into the Gulf. One of the local guys, who lost everything in Katrina says he hopes it hits us. "Everything is already destroyed here. No one should go through that."