No Laurels

I did not write fully about my last call last night. My partner and I talked about it this morning as we did last night as soon as we had cleared the hospital. I apologized to her for the way the call went. I was embarrassed by it.

Here’s what happened. An hour before crew change, we get called for a fall. The 930-2130 shift is a ballbuster, but the one grace is we usually get out on time. Starting around eight, the dispatchers protect us if possible, holding us in reserve only if necessary. We were both tired.

The call is in a town where another medic responds in a fly car. He arrived just before us. We found a man laying on the floor. He said his back and hip hurt. The medic poo-pooed it. I tried to ask him questions about how he came to fall and where and how exactly he hurt, but the medic was already trying to get him up. The medic said he hurt because he had been laying on the floor a long time. The patient was elderly and had Parkinson’s and I thought well, maybe he’s right,maybe maybe he just had bad balance, fell and couldn’t get up. Maybe he had a touch of dementia as well as his speech was slow. Without going through everything, I let the other medic have his way instead of insisting on doing it my way. While it was technically his call until he turns the patient over to me for transport, in practical terms, I usually assume control over the patient when I arrive and that is usually fine with the fly car medic. Tonight, though in the back of my mind I want to believe the man is not hurt, that we can get a refusal and I can get out on time and get home, maybe have one beer, check my email, then lay my head on the pillow. So instead of c-spining the man, or at least lifting him gently from the floor, or erring in any way on the side of caution, we stand him up, and when he says he doesn’t feel right, we sit him down in a chair. We call his wife and wait for her to come home from her dinner out, thinking maybe she will say this is his normal and decide not to have us transport. She is a retired nurse who works on one of the floors that is notorious for treating EMS with disrespect. (This is an opportunity to show her what EMS can do, and I can only say I am glad she is not there to watch us bumble). While we wait for her, I take the man’s pulse, except I can’t feel it long enough to count it. The other medic scoffs and tries to take it. He says its sixty and regular. I ask if he is sure. Then he admits he can’t feel it well either. So we put the man on the monitor and he is in an afib at 80-100. Nothing too shocking there, but the man seems a little clammy now and so instead of waiting longer for the wife, we get him on the stretcher. I pick him up under the arms, and the other medic, grabs his legs, but he doesn’t lift high enough for us to put him(the man weighs 250) on the stretcher, which keeps rolling farther from us as we try to step toward it, and the man meanwhile starts complaining again of pain in his hip. We finally get him on the stretcher, his wife comes, says he looks a little pale and agrees to have us transport. When we get him in the back of the ambulance, he tells me he has neck pain. At this point, I don’t really see how I can c-spine him. I am saying to myself, you are an A-hole. While you know the man is unsteady on his feet, you don’t know if he tripped or got dizzy and fell, he could have a hip injury or heaven forbid, although unlikely, a spinal injury. And you call yourself a paramedic.

Anyway, as soon as the call was over I told my partner I should have taken control and done what was right. She said she saw I was trying to do right. I say it is my responsibility to see that right gets done, and I apologize again.

Bottom line I found out today the guy was fine, no broken bones, sent home the same night. Whew!

Calls like these are good only in that they catch you before you let your standards slip again. In EMS you have to prove yourself every call. There is no resting on laurels. I resolve that the next time I disagree with a fly car medic I will simply say, you can do that, but you will be riding in with the patient and I will following in your fly car.

Today I resolve to be a stellar medic.

It’s now five in the afternoon (I have a new used $200 laptop) and we have not really been tested today. An MVA with two patients – I insisted on c-spining one of them who had midline back pain – a woman with weakness, a nursing home patient going in for day surgery of a growth on his neck, a psych patient going to the psych hospital, and a woman blown over by the wind, who suffered a hematoma on the back of her head, but no loss of consciousness. What I have been today is friendly, I’d like to think compasionate, and thorough in the simple tasks, making certain the patient is made as comfortable as possible, doing a full assessment and giving good reports at the hospital, both written and verbal. And of course, clearing in a timely fashion.

*

The one funny moment was when as I was trying to assess the patient’s neck and spine, her son kept saying. “Really, its cold here, can we get her in the ambulance? Can we get her out of the cold now!”

“Just a moment,” I said, “I need to check her neck.”

“Please, please, she’s cold. You must get her out of the cold.”

“Just give me a moment. I have to make certain she doesn’t have a neck injury. It will affect how I treat her.”

“But it’s cold,” he says, then looks up at the sky in exasperation.

She checks out fine, so I have her sit on the stretcher.

“What hospital are you going to take her to?” the son asks.

I tell him the hospital just up the street.

“Can you give me directions?”

“In a moment, we just have to get her in out of the cold.’

“But I’m from out of town. Just tell me how to go.”

“In a moment,” I say. “She’s cold, I want to get her in the ambulance.”

“Will I be able to follow you?”

“Yes,” I say, “I’ll give you the directions, but first we just have to get her in out of the cold.”

*

We do a call for a one year old who has had his arm pulled out of his socket. The police come and question the mother. There are three mothers, six kids and a man in woman’s clothing brushing his hair in the sparse apartment. Two of the kids are slrrping. The one year old is in his aunt’s arms and she says he only crys when you touch his arm, which hangs limply by his side. The officer questions everyone. The story is one of the other children grabbed his arm and pulled, while he resisted. It seems to be a good story. The women all admit they have DCF cases, and they cooperate. They have been through this before. I finally get the kid and lay him gently on the stercher where we pad and secure him. He sleeps all the way to the hospital.

*

Last call is for a man with a CVA history, who can’t keep his balance. He says there is nothing wrong with him, while after sitting him up, we watch him slowly sink backwards until his back is laying flat on the bed.
*

We punch out on time.

Not a bad day. Not too much stress. Steady enough to make the day go by. All the patient’s and their families were nice. No one gave us a hard time, and we gave a hard time to no one.