Check

I recieved a check in the mail today from the company crediting me with an additional $1592.21 in earnings along with a letter explaining it was to make certain all divisions who sent people to work in Mississippi were paid in the same manner. I can only say I was surprised. As I figue it, we are now in fact being paid by our regular rates with overtime for every hour deployed.

Not bad earnings for a day off.

Johnny Carson

In the suburbs for 16 today.

Weakness in the supermarket turns out to be a hypoglycemic.

Medical alarm goes off in apartment building. False alarm for the 100th time at this apartment complex.

Lift assist turns into a transport. 300 pound woman with MS has had her knees buckle. She needs help getting up. She has been using a walker, but its time for a wheelchair.

87 year old man goes to MD's office for a regular appointment. Has no complaint except sometimes his legs get weak when he goes to the mall. Nurse takes his blood pressure. 80 systolic. They call 911. The man has afib, which is normal for him. I take his pressure 130/80. I sit him up 129/74. No change in pulse rate. The guy chats all the way to the hospital. Hospital BP's similar to mine. I'm think maybe the nurse took the blood pressure a little fast and just happened to hit an afib pause when the needle was dropping past 120, 110, 100, 90. When I leave the man is telling jokes to a pretty young nurse like he is Johnny Carson.

Guy at a nursing home with multiple history inclding dementia, multiple CVAs,aspiration pnemonia. Is unresponsive normally. He's congested. They send him out. He's Sating at 100% on a canuala.


***

The new American Heart Association CPR and ECC Guidelines came out this week. Here's the link:

Major Changes in the 2005 AHA Guidelines for CPR and ECC. Reaching the Tipping Point for Change

And a link to all the abstracts:

Circulation Selected Abstracts

The bottom line: "Simply put: rescuers should push hard, push fast, allow full chest recoil, minimize interruptions in compressions, and defibrillate promptly when appropriate."

I'm anxious to read some of the other recommendations in more detail.

Double Medic

Worked double medic today, which I generally don't like doing, but I liked my partner today so that was okay. As usual when working double medic we didn't do much. An old man with diarrhea, a woman with a fever, a diaylsis transfer, an old woman not feeling well, and a drunk. When we got the fever call within the next three minutes three other calls came in -- two cardiac arrests and a motor vehicle that may turn out to be a fatal --the driver was posturing on scene indicating a severe head injury.

My partner wasn't feeling well so she went home early. They had no one for me to work with so I hung out for awhile, then punched out three hours early. I did get to go to the meeting tonight about the Bolivia trip. All systems are go for next May.

Apnea

A 97 year-old-man whith a poor gait falls twice in his apartment in a residential community. He is not hurt, but according to the nurse he is not as spry as he used to be and hasn't been eating as much and, fall once, you get a free pass, fall twice, its a trip to the hospital. We go to a distant hospital because that's where his doctor is, not that his doctor is going to come in and see him on a Sunday.

A nursing home calls a commercial service to transport a patient not as responsive as usual, which usually isn't much. The commercial call-taker hears the word "unresponsive" and passes the call to us -- the local 911. Our dispatcher sends two police cars lights and sirens, in addition to us, who are coming, from the distant hospital. The cops skid into the curb, run inside and find no nurses or aides. They find a patient "not breathing" and put her on oxygen and she immediately starts breathing. They finally find a nurse and what develops is a heated arguement about elder abuse, complete with "I want you name" and "I want your name."

That's when we come in. Now I have often been to this home and found patients in dire straights with no nurses anywhere to be found to give me a report, and the nurse who is here today is one of the worst offenders, but when I enter the room, the woman seems fine. She does have periods of apnea, but I have taken her in before and that is normal for her. The patient has every diagnosis possible: CVA, Dementia, diaylsis, MI, CHF, NIDDM, Alzheimers, HTN, Seizure, etc. Her BP is 90/60. I guess the officers came in during one of the apnea periods.

The officers should never have been sent in the first place. And of course they were never told it was an commercial pass.

I love being a medic and like working on the regional committee. But somedays I wish I was in charge of the whole shebang with unlimited power, then I could fix some of these things. Fix the apnea in the system. Maybe.

Checked Out

Cold -- two days after the snow fall and the snow is still on the ground.

Did a call at a nursing home for a fifty-year old woman with a TBI whose trach got pulled out. She was stable. We just needed to take her in so they could put a new metal piece in the hole in her neck. I guess she was hit by a car in September and suffered very severe injuries. She couldn't talk, and only looked to one side, and could only move one arm. I think it was with that arm that she grabbed her trach and pulled it out. I tried looking up the accident on the internet to see if I could learn more about who she was but I wasn't able to come up with anything.

Did an old man who fell, wasn't hurt, but had such poor balance, we had to take him in to get checked out. He had tried walking back up the stairs to show me he was okay, but I had to stop him beacuse he was about to fall over backwards. I ended up picking him up and carrying him out to the stretcher. He was heavier than he looked and I had to str4uggle with him. I think part of it was I haven't been as regular in the gymn as I was and am not as strong as I was.

Last call was for a pregnant woman in a minor motor vehicle. She wasn't hurt, but was very upset and just wanted to get checked anyway. We left her in the waiting room in a wheel chair.

Circle of Life

Got sent for a nursing home "dsypnea/unresponsive." Found the patient on a mask at 6 liters, which as anyone in EMS knows is like putting a plastic bag over someone's head. I explain the problem to the nurse and she nodds and thanks me. She says something interesting -- she says in the hospital she always turns it all the way up, but the machine at the nursing home goes only to six. So the problem may not be completely the nurse not knowing, but the doctor ordering a mask on the phone, but not knowing the standard nursing home 02 only goes to 6.

This is a problem that has been around ever since I have been in EMS -- 17 years now, and probably long before that. A paramedic of ours who is going to nursing school was doing a clinical at a nursing home and was told to put the patient on a mask. She refused because the machine only went to 6. The senior nurse told her to stop thinking like a paramedic -- she was a nursing student now. The medic still refused, and then went and found the home's 02 policies and showed it to the nurse that any mask needed at least 10 liters and by a proper oxygen canister. The nurse said really, whose policies are these. The medic said "Yours!"

Anyway the patient was the same patient I transported earlier this month -- the one with "tachysniffles." The facial tic the woman has makes her appear to be having trouble breathing when she really is very stable. As far as the unresponsiveness, she basically isn't much more responsive than having her eyes open and watching you. She doesn't talk and I guess sometimes doesn't follow commands. She has been back and forth between the nursing home and the hospital several times this month. A new nurse comes in, puts her on a plastic bag, her SAT understandably goes down. The ambulance puts her on a cannula, the SAT comes back up. The hospital evaluates her and sends her back.

I don't think this is what's meant by "The Circle of Life."

**

Did a refusal on a dog bite.

***

A doctor's office for a patient with ECG changes.

***

Last call was an OD. Pretty young girl took all her psych meds at the same time because she was depressed. She had a heavy drug history. I noticed some track marks on her arms. I asked her where they got IVs in her.

"Between my toes."

No, she didn't really say that. But she contorted her wrist, and said, if you turn it just this way and wap it a couple times, a little one might pop up. I found a vein I could put a 24 in in her forearm and filled four blood tubes. Maybe she'll invite me to shoot her and her pals up at their next abandoned house party.

But then she told me how her ex-roomate poured boiling water on her one night when she was sleeping, and said, "You're not so pretty now, are you dearie." Not the kind of friends I would want to hang around with. It was amazing she wasn't scared more badly.

Hard life.

Really Bad

Woke up to snow this morning. Not happy about that. Even on Thanksgiving.

First call came in as a patient with a recent heart transplant, seizing and making funny noises. I thought for certain it would be a code. We found the man postictal, tackycardic at 120 and hypertensive 180/120. He's had the transplant just this month. His girlfriend said he had no history of seizures. He gradually started to come around till he was almost fully coherent. Then just after we took him out of the ambulance at the hospital, and had started wheeling him to the ER door, his girlfriend said, "What's happening to him?" He was back seizing, a violent full body seizure. It stopped just as we got him into his room. I haven't been back yet to see if they found out anything. I'm guessing maybe his CAT scan might show a bleed.

**

Later we did rollover(skidded on ice, flipped over into a snowbank), but the patient is up and talking, denying any injury, see to be upset that he spilled his just purchased Starbucks coffee, than that he'd totalled his new SUV.

**

Late in the day we get called for an 80-year old man unresponsive in an exclusive area of town. We wind our way through the house to find the man on the carpet, with cool, grey skin, but alert. He says he felt a stomach ache, then tried to get to the bathroom. His family says he then passed out. His pulse is 60. He says he has to go really bad. I ask my crew to bring the stretcher over, and with one partner, stand the man up to see how he does. He is still alert, though slightly wobbly. He is insistent on using the bathroom. It is just a few steps up. I have the sense that he is about to explode with diarrhea, so on my initiave, we help him into the bathroom. I get his pants down and sit him on the toilet.

Yes, that's what I did. Do'oh.

He says he is all right. I turn to see where the stretcher is. I see it is stuck in the kitchen blocked by a a kitchen island. I tell my partner to help our newest crew member maneuver the stretcher around it, then I turn back to the man, and he is out cold, still sitting on the toilet, urinating a fountain of pee onto the floor. I shout for help, and give him a sternal run to no avail. The stretcher is still in the kitchen, so my partner and I have to pick the man up and carry him into the kitchen. I am worried that he is coding as we carry him.

It takes him awhile, but he finally comes around. We want to take him to the closest hospital, but the family is insistent that we take him to their hospital, which is a bit further. The man's pressure is 83/50 and he is still complaining of belly pain, but I relent and agree to go there.

I dump a half liter of fluid in, and get his pressure up to 95/60, though he is still cool and clammy. He still has the pain. I don't feel any pulsing masses.

I'm not crazy about going to this one hospital because they tend to converge on you ER style -- they are not very busy -- and with so many people asking questions at the same time while others remark what took us so long, it is a little hard to maintain a coherent report. I had given an ETA of 5 and it was more like 10. Sorry. Here's the story (if you care to listen).

While I write up my paperwork, the entire family from the house is there in the ER hallway, rehashing the call. I hear everything from they wanted to go to the other hospital to they put him in the bathroom, they couldn't get the stretcher in. They are talking like this even though I am standing near them, writing a report against a counter. It's like I am invisible.

When I get back in the ambulance, I say to my partner, "So maybe I shouldn't have sat him down on the toilet."

What can I say?

You do what you do.

Teenagers

Quiet day. Few cars on the roads. Doesn’t sound like many transfers going out. I was expecting to get hammered today, but it already has the feel of a holiday. People off work, staying home or if they are going anywhere -- going to the grocery store.

We do a couple calls. An elderly Hispanic woman with a high blood sugar and an elderly nun with a case of sudden dementia. I speak Spanish on the first call, and because the hospitals are slow, I get lots of time to have Spanish conversations with my professors and professoras – the techs and clerks at the hospital who are Hispanic, and who are often to busy to talk to me at length.

For lunch I go to El Mercado, where I am planning to get roast pork, but my friend there tells me they have “pavo” -- turkey today so I get pavo and morro, which is the Dominican yellow rice with peas. It’s very good.

We do a call for a 14-year-old girl in a suburban psychiatrist's office who has been spitting at her mother and the doctor and threatening violence. There are three cops there. “I’m not going,” she says. She swears at her mother a couple times, but when the cop explains how it is, she ends up going. Once she is in the ambulance, she just curls into a fetal position and cries.

Next call is for a 14-year-old girl in a housing project. She has been kicking out windows and threatening her mother and the mental health workers with a knife. There are eight cops there. She doesn’t want to go to the hospital and swears at them. They explain how it’s going to be. She’s not buying it. She continues to resist. I end up giving her 2 of Ativan and 5 of Haldol. She keeps fighting and kicking, so we have to restrain her as well. But once she is in the ambulance, she calms down and drifts off to sleep.

Teenagers.

Last call is to a distant town for a lady in a nursing home with a broken hip, fell a couple days ago, confirmed by X-Ray. While the nurse is leading us up to the room in the elevator, she castigates a teenage nurse's aide. "So you've gone and gotten Mrs. Sindlinger into a tizzy. You're supposed to let her win when you play BINGO. It's in her care plan."

The aide looks like a teen being scolded unfairly by her mother. She looks down at the floor and rolls her eyes.

"Next time let her win!"

"So the fix is in," I say, knowingly.

When we leave the elevator, I see the aide stick her tongue out at the older nurse's back.

The Door

It’s raining. We’re sitting in area 9 in the parking lot of a chain drug store. On the radio a crew is asking what floor they are supposed to take their patient to. They are doing a hospice run. They picked up some lady from an elderly apartment community and have taken her in to the hospital where she will die in a matter of days. Her last ride. I’ve taken a number of people on these rides. The worst are the young mothers dying of cancer.

Yesterday a thirty-year-old female cop in one of the suburban towns was murdered by her ex-boyfriend, a state cop. We had two cars on standby while they looked for the shooter. They found him a couple hours later, also dead. The paper said he parked his car at a park, and then walked over to her house so she wouldn’t see him. He was supposed to turn himself into court today on a police charge, but instead he called his lawyer and said there was a change in plans. Her new boyfriend -- another cop -- came home and found her. Details are sketchy.

I knew her by face, not by name. I’d been on calls with her a few times over the years. She never had much to say to us. She was a good-looking woman, who I noticed had recently started wearing more makeup around her eyes. Like I said, I didn't know her well at all, but she seemed to have a tough air to her. If she pulled you over, I don't think you'd want to sweet talk her.

The state trooper looked vaguely familiar. I can’t help but think about the incident I wrote about a week ago, the car pulling in front of me, and out of nowhere the driver giving me an angry finger. While he was not in an issue vehicle, he looked like a state cop. I remember thinking that guy must be mad about something in his life. Was it him? I don’t know. It occurred within a half-mile of the eventual murder scene.

The paper in the news rack had a headline “A Cop’s Fury.” It had pictures of the two dead on the front. It made me think, you are here on day, and the next people are walking by the news rack with your picture on it, only you aren’t one of the people walking by to see it.

**

We did a call in her town this morning, and said our condolences to the two cops who were there. They had black bands over their badges. The call was for an old woman who said she had taken a handful of painkillers. She said she did it because she was stupid. She said her ex-husband and her doctor would be mad. I got the feeling from the cops they were at this house all the time for similar vague complaints of taking too many pills. “I don’t need this today,” one cop said to me.

The woman complained as we carried her out in the stair chair in the rain. "I'm getting wet," she cried, "Oh, its cold!"

“It’s pouring rain, there’s nothing we can do," I said, “Look at us, we’re all soaked.”

In the ambulance, she complained she hadn’t had time to fix her hair. "I look just awful," she said. "I can't go out like this."

“Next time you take a handful of pills,” I said, “wait until it is sunny out and you have first done your hair.”

She looked at me with one eye cocked.

“I’m just making a suggestion,” I said.

“I just wanted someone to talk to,” she said.

***

We did a long distance transfer, and then a couple motor vehicles. Raining all day long.

**

A maternity, woman bleeding at 21 weeks, feeling pressure, a kid with a broken ankle and a couple more transfers.

**

I find myself in idle moments thinking about the dead policewoman. They say on the radio she was shot in the chest and head.

I guess she probably never figured her death was coming that day, the door opening, and in coming that angry man. At what point did she realize she was going to die?

When do heart attack victims get that sense that right now what is happening -- this sudden pain in their chest -- might be their end? And car crash victims – they start to loose control and see the tree or the truck careening toward them?

I don’t mean to be morbid.

I used to be worried about dying. I’ve lived awhile now and feel lucky to have made it as long as I have. If the deal was when I was born, I agreed to come out of the womb, but in return I would only have these 47 years, I'd take them.

I have many, many years ahead I hope. But if I were to die today I wouldn’t have been cheated. I am as excited about life and its possibilities as I ever have been, excited not in the wild way I was as a youth, but in the more realistic sense that I can enjoy the moments now and not just the thought of the goal.

I want to live fully and feel, for the most part, I have been. I work a lot, but I like my job and the money I make will help me keep doing what I love – being a paramedic, writing, going to foreign countries to help the poor, getting good seats to a Red Sox game every year, living in my house which I feel comfortable in, being able to eat a good steak, and drink a cold beer when I want without having to count nickels on the liquor store counter.

I hope I continue to live a full life and that the door doesn’t open for me any time soon.

Please not any time soon.

I don't want my picture on the newsrack, my obit posted on some bulletin board, people, thinking, yeah, I knew that guy. I used to see him around.

Beast of Burden

As soon as we signed on this morning, the dispatcher said, "I hate to do this to you, but we need to to take 385 out. We've got a run for you."

385 is the bariatric ambulance. Wide load stretcher, rated for up to 850 pounds.

We take a 500 pound lady to a rehab hospital. After we leave her off, my partner, who teched the call, says, "She told me she was a registered dietician for 20 years."

"What! What happened?"

"She retired."

So she's a dietician for 20 years, then she retires and its like, "Wow, I'm not a dietician anymore, I can eat chocolate pie!"

We thought we were clear, then the dispatcher says, "I hate to do this to you but we have another bariatric run." As soon as we cleared that, they hit us again. 500 lbs, 420 lbs, and 350 pounds. At least they were getting lighter. My body felt like I'd done four sets of heavy squats followed by four sets of heavy deadlifts by the time we were done. The stretcher may be rated for heavy people, but you still have to move it up and down. It was usually just me on one end. Even moving it in and out of the ambulance is a strain, just bearing the weight as you pull it out, waiting for the wheels to drop.

We got back in our regular ambulance and banged out another five calls including another 300 pounder. They were for an OD, an Abd pain, a fall, a two transfers.

On the radio Mick Jagger was singing "Beast of Burden." I cranked it up:

I'll never be your beast of burden
My back is broad but it's a hurting
...
I'll tell ya
You can put me out
On the street
Put me out
With no shoes on my feet
But, put me out, put me out
Put me out of misery

I'll never be your beast of burden
I'll never be your beast of burden
Never, never, never, never, never, never, never be

I need no fussing
I need no nursing
Never, never, never, never, never, never, never be
**

One of our calls was for an OD-- a young man took thirty pills. I told the nurse he had a seafood allergy. She says to me, "Well, then why didn't he just go to Big Y and buy a bag or shrimp or go to Red Lobster if he wanted to off himself."

Pay Controversy Revisited

I wrote recently about the controversy surrounding the pay we recieved for the work we did in Mississippi. A union in one state went so far as to call for a Congressional investigation, claiming they were paid less than the prevailing wage, while the company made millions. Here's an excerpt:

They say that while EMS workers are toiling under extreme conditions for wages barely above what a teenager makes at a fast-food restaurant, (the ambulance company) is reaping huge profits.

The release was posted on our union board and everyday I walked by it, it made me madder and madder. I was also angry that a nearby union had filed a grievance against the company. I did not want our union to file a similiar grievance -- at least not without the support of the people who went down to Mississippi, my opposition notwithstanding. When I went in to vote for the new union contract, I told a union rep that I was offended by the release and wished them to take it down, or at least let me post a rebuttal.

I ended up being asked to post a rebuttal, which I believe is up on the board now. I was also later told that the union board member had posted the release as informational and that the union had decided against filing a grievance because no one had come forward to complain, and that because we were paid so much more than the local Mississippi workers, it would have looked bad for us. I have been having an email debate with one member of the board, who remains very concerned about the way we were paid and believes that you must never allow a union contract to be ignored. While I disagree with him on this issue, I respect his view. My arguement was if the contract was not followed to the letter, the fact that we got more than we normally would have if the contract(my interpretation of it) was followed. Instead of "no harm, no foul," "more pay no grievence."

Here is what I posted:

November 11, 2005

To the Union Leadership and Rank and File Members:

It is my hope that the union’s posting of the press release about the pay received by AMR employees who volunteered to be deployed in the Gulf Coast in the aftermath of Hurricane Katrina does not constitute an endorsement of the release’s charges.

If it is the intention of our union to endorse these charges or file a grievance against (the ambulance company) on behalf of all of our employees, I ask the issue be discussed with the union rank and file, particularly those who went to Mississippi, to ensure that there is support for such an action.

For myself, I believe making the claim that our pay was cut by 35% is disingenuous. I was paid $3069 for a seven day work week period in which I worked only 72 hours, which would make my pay $42.62 per hours worked. To make similar pay in Connecticut I would have had to have worked 105 hours or seven days of 15 hour shifts. In addition my transportation costs, all my meals, drinks and laundry were taken care of. I had no expenses for the week.

As to the allegation of (the ambulance compnay) profiting exorbitantly from FEMA contracts, I take no stand on these serious charges because I have no access to AMR’s balance sheets. I do believe the press release’s interpretation of the given figures is naïve.

While I believe in taking on the company when there is just cause, I think claiming victimization for helping those who lost everything while we were paid so well makes us look petty, and pretending our pay was cut, does nothing for our credibility.

I respect the right of any union member to file a grievance on any issue, including this one, when they feel they have been individually wronged. And certainly if anyone was officially told they would be paid their regular rate 24-7, they have a legitimate grievance.

If the consensus of the union is to proceed with a grievance or endorsement, despite my disagreement, I will continue to support the union, and thank them for considering my opinion in the debate.

Respectfully,


(my name), EMT-P
Union Member

Disclosures: I own $2500 in company stock purchased in the recent employee stock offering. I also voted to authorize the union to issue a strike notice in the first contract vote.

I heard last week the company was issuing an IPO for its stock. Last night I looked it up on the internet and found not only that it was true, but also read financial documents filed on November 14. The documents included the following statement:

Hurricane Katrina and our Gulf Coast Operations

(Ambulance Company) provides ambulance services in Gulfport and
Biloxi, Mississippi and several other Gulf Coast
communities. Although our dispatch center was damaged
by Hurricane Katrina and we had damage to a small
number of vehicles, we were able to maintain
communications through our use of back-up generators
and other emergency supplies. We have worked closely
with FEMA and other federal, state and local agencies
and have deployed additional ambulance transportation
resources where they were most needed, particularly in
the coastal areas of Mississippi, Louisiana and
Alabama. We have deployed more than 100 additional
ambulances and nearly 300 paramedics, EMTs and other
professionals to aid the rescue effort in the Gulf
Coast, including the deployment of additional
resources to aid in the transport of evacuees to
medical facilities in Texas. For the three months
ended September 30, 2005, we recognized revenue of
$4.6 million and expenses of $4.7 million in the
deployment of additional resources in connection with
Hurricane Katrina and other Gulf Coast storms.

(Company) operations were generally unaffected by
Katrina, with only one facility in the affected area.
(Company) deployed additional resources to assist those
operations, and we have experienced a volume increase
in certain facilities in adjacent states where
evacuees were relocated.

We have been able to maintain our normal
operations in areas outside the Gulf Coast,
notwithstanding our transfer of resources to that
area. We expect that, for the foreseeable future, our
(Company) operations in Mississippi will continue to be
negatively affected by the aftermath of Hurricane
Katrina, and that we will continue to provide
additional resources to assist local recovery efforts
throughout the region.

So they weren't making millions. They weren't profiteering. They were just serving the people. For the times I disagree with what the company does, I think they deserve praise for what they have done and continue to do in the Gulf Coast.

I'm Not Getting Out/399

Interesting, but somewhat frustrating call. Comes in as a seizure with paraylsis. We find a 30ish woman in bed, aphasic with right sided weakness. Family says she had a "gran mal seizure" lasting "an hour and a half." When I ask why they didn't call 911 sooner, they said she has them all the time and the doctors have told them to let her ride them out. The only reason they called this time is because of the paraylsis.

I work it up like a stroke and go lights and sirens to the hospital. En route she starts talking some, but her speech is slurred. She can only very weakly grip with her right hand, and can't move the right leg at all.

En route I ask the husband for her name and date of birth along with meds, etc.

When I patch to the hospital, first my radio is breaking up (as it sometimes does--we have a faulty wire that is sometimes jarred by bumps) On the third try I get patched through to the hospital, but I can't hear them I just hear clicking. I go ahead and give the report, hoping they hear me. Different hospitals in the region have different requirements for patches. The one I go to the most likes them short and sweet. "40 year old alert patient, history of frequent seizures, had a seizure lasting an hour and a half according to the family, now has right sided weakness, which has never happened in the past. Stable vitals. We're six minutes out." The other hospital wants to know everything. (Today I give them a longer version of the first report.) You can call in and say the patient is alert and oriented, and they will come back asking for the Glascow Comma Scale. You say vitals are stable, they want to know the vitals, which is the only thing I can hear them say over the radio now. I give them the vitals 140/80, 80 and 18. Pretty unremarkable.

At the hospital, we stop at triage and I give the nurse the patient's name and date of birth. The patient's husband, then says that's not her name, that's his name and date of birth. His first name is a name more commonly used for women than men. I just shake my head. Why would he think I was asking for his name and date of birth?

When we get into the critical care room, I start to give the story when the doctor says, "I think I know this woman, she has pseudoseizures. She's had this right sided weakness before, haven't you?" I just repeat what the family told me, and introduce the husband. Without even questioning him, a nurse asks him to leave the room for a little while until they are ready for him. I say, you might want to get him to describe what happened because his explanation is atypical. They just nodd and go about their business. The doctor lifts up the woman's right arm, it falls flaccid against her chest.

I leave the room and write up my report. I don't know what to make of the woman's condition. At least there were two doctor's in there examining her. I have never heard of a gran mal seizure lasting an hour and a half and I've never heard of a seizure (acute stroke aside) leaving someone paralyzed or with weakness on one side, but I can see how it could happen.

I followed my treatment plan and did everything I was supposed to. I was just left feeling somewhat frustrated.

**

Slow day. I'm tired because I stayed up way too late last night watching the final episodes of Lost: Season One on DVD. I only intended to watch one, but then I had to see the next and the next, then the last one was two hours. Ended up going to bed at 12:30. Had a headache most of the day and didn't feel like eating. I ended up watching the Harvard-Yale game on TV, which Harvard won in three overtimes. Everyone has their story of their life if they ever end up destitue and down and out sitting on a bar stool. Sometimes I think mine is I didn't get into Harvard. It actually probably was the best thing for me. I still root for them, even though they rejected me. Twice. Bastards.

**

Get called for an 86 year old lady difficulty breathing. We pull up and I say to my partner. "I'm not getting out out." He looks at me. "I'm not getting out," I say again. He keeps looking at me. "All right maybe this time, but one of these times, I'm not going to get out. One of these times, it'll be one too many."

"Yeah, right," he says, "Com'on."

Lady has a fever, feels weak. Went to the hospital two weeks ago for same symptoms. Etc. etc. IV, 02, monitor, a little hand holding thrown in.

***

While at the hospital I see the doctor from this morning. I ask him about the seizure/stroke patient. He says they treated her like it was a stroke, but ewhen they went back through the records, they discovered she is a complete psych. She's been in before for the same thing and there is never anything wrong after they do their battery of tests.

Later I tell my evening shift partner about the call, he recognizes the address and tells me how he went there once and his partner got completely faked out by her too.

***

As we get back to town, we get called to a nursing home where the commercial ambulance has gone for a patient who is too big for their stretcher. The nursing home says she is 420 pounds. Their stretcher is rated for 350. The woman is protesting that she is not 400 pounds, she is 399. "I think she's right," I say, and wink at the commercial EMT who I work with on Mondays in the city now. "She's just less than 400." She has fallen and has back pain. We roll her on to a board, then deadlift her up onto our lowered stretcher which is rated for 600 pounds. We transport.

**

I bought some salad at the hospital. Although I deadlifted her awesomely, I want to
get back to the gym on a regular basis as well as eating right. I'm also thinking about shaving my head. I got it cut real close when I went to Mississippi and I am unhappy with the way it is growning back. I'm feeling sort of bare in front on top. I'm starting to look balding. I think a shaved head will help me in the gym. make me feel like a strength-training animal. Plus if I eat sleep and train better I won't be so tired and the day when I decide I don't want to get out of the ambulance will be a little farther off.

John Henry Versus the Steamdrill

Only two BLS calls so far. A motor vehicle and a woman with a cough.

**

I wrote a letter to the head of the service commending the student who rode with me yesterday. I would really like to see him get through the EMT class and enter the field. I think he's got the bug already. Nothing like doing well on a good trauma to get a young person excited about the potential job. Action. Adreneline. Saving lives.

**

Read a news story about how the Autopulse -- the CPR machine did not fare well in clinical trials against human CPR and was quite shocked because I feel CPR in often performed quite poorly. In the story they speculate why the machine did so badly. One reason they didn't give which I think might be valid is the humans probably felt challenged and worked extra hard at it, sort of like John Henry versus the steamdrill.

Autopulse

Medics Do Better Than Machines at CPR

**

Ended the day with an old woman feeling light-headed.

Ma

Ma is back on the Thursday crew. I don't normally write too much about my partners because of confidentiality and the newsness of the internet, but I will write a little about her today.

She is seventy-eight years old and is back after her second hip replacement. She has been working with me on Thursdays for probably five years or so. She has been with the volunteer service maybe twenty-five. At one point my Thursday crew was a quarter of a milleneum in age. We had Ma, a new male EMT who was a spry 76, a 50 year old woman and me. Total age 250 years.

Ma can't do everything she used to do, but she does a fine job of handling the clipboard, getting the information such as patient demographics and medications, then while I treat the patient in the back of the ambulance, she holds their hand and talks to them. She grew up in the city on what now is one of the biggest drug streets. One afternoon we had a patient, a young man who lived on the same street that she grew up on. This young black kid and old Italian lady talked all the way to the hospital about their street. The kid was riveted by her stories of walking to school and playing in the nearbye park after dark. An interesting ride in the ambulance.

***

Do three calls. The morning is slow, then we do a two patient MVA. At about four we get sent to a car into a tree up in a wooded section of town. A seventy-four year old man hit a deer, then went off the road into a tree. Major impact. Fortunately he had an air bag. he was responsive to repeated shouting only, had a gaping wound in the back of his head, chest tenderness, and back pain as well as a deep lac on his leg. I had the young man, who fainted last week, with us and he did a great job of helping me get the guy out of the car, and then carry him along with police and fire up the hill back to the road. Our scene time was only 9 minutes, and while MA tried to talk to the patient and get any responses out of him she could, the kid did everything I asked on the way in. I gave him sissors and told him to cut off all the guys clothes. I had him do a blood pressure, and then hand me blood tubes and then tape to tape down my IVs. Then he was Mr. Clean with the gloves, cleaning solution and towels, giving the back of the rig which was quite bloodied from the guy's head wound a good scrub down.

On the way back ten minutes before crew change, we were sent to a chest pain where fortunately my relief met me as we were about to transport to a distant hospital. I was glad to get home at a reasonable hour.

Priority One

We do a minor motor vehicle in a suburban town and transport a young housewife to the hospital with a shoulder strain. There are three stretchers ahead of us. While we are waiting we hear med patches for a man who had a car fall on his chest, and another man who fell twenty feet and hurt his ankle. Three other stretchers come in and bypass us -– a difficulty breathing, an abdominal pain and a stroke protocol. The fall arrives along with the man who had the car fall on his chest. The ambulance crew is breathing for him as they go past. We are in triage about an hour when they finally get to us. Then they tell us to put the patient in a wheel chair and wheel her out to the waiting room.

After we clear we are sent from the southern most hospital to a post in the northwestern part of the city. Rush hour is just starting. When we finally get close to our assigned post we are sent to another post on the central western border. Before we arrive there, we are sent to a post between two towns on the south western most section of our territory. Traffic is achingly slow. We have already been traveling for over an hour. Then we are finally given a call – but it is a transfer to a town beyond our southeastern border. It is now 5 and the highway we have to take is at a standstill. We have basically been driving a big long slow box around our territory, although now we are going so slow, you can hardly even call it driving. It takes us 45 minutes to get there going non-priority.

Since we came on this morning, we have hardly had a moment’s rest -- all either calls or driving from one post to the next. Started with a transfer from the wound care center to a suburban nursing home, then went from another suburban nursing home to the hospital for abd pain, then went to a nursing home in yet another suburban town to a hospital for insertion of a feeding tube. Then a bunch of posting driving around, then a half hour posting actually sitting in a suburban town, and then sent for a transfer at an eye surgery center for a person who turned out to still be in surgery, then the MVA, then this Charlie on the MTA run around.

Rainy day too.

**

After our long call, we actually get to sit awhile. The book I ordered arrived yesterday and I started reading it. It is a slender novel and it takes me no time to blast through 120 pages of the 210 page book. It is hard to call it a paramedic novel. The main character is a medic and there are some scene calls, but it is not really an EMS book. The basic story so far. The medic carries a camera around and takes pictures of sick people and dead bodies all the times. He starts dating a girl he met on a call who has HIV. They start to fall in love. He sleeps with her. He's got some kind of pain inside that we don't really know why yet. The guy does writes very well.

**

We’re listening to the fire radio. They come upon a motor vehicle and tell the dispatcher to send an ambulance and a cop. The dispatcher asks if there are any injuries. They say, the person isn’t sure if she is hurt and the ambulance can evaluate when they get there. A few minutes later our dispatcher gives us the call on a priority one. We ask if he certain it is on a one because the Fire said it was just an evalve. Our dispatcher tells us to check with the PD dispatcher. The PD dispatcher tells us it is on a one. She calls it a major incident. Enroute we heard the fire asking for our ETA. We get there and no one is directing us in. Two firefighters are standing in the road where we are trying to go. They don’t even see us. My partner has to drive by very slowly to keep from hitting them. They see us now and knock on the window. She’s in the back of the cruiser. It was cold and we wanted her out of the rain. I check her out. She has minor flank pain. My partner checks out the car. No damage. We take her to the hospital on a nonpriority and they put her in a wheelchair in the waiting room. Priority One.

I have been trying not to whine in my entries I think for the most part I have been avoiding it. But lately, particularly as we have been talking about lights and sirens use in the regional meetings, I have been upset at the gratuitous use of lights and sirens – sending on us priority ones in the rain for calls that are not priority ones or sending us priority one into other towns to nursing homes for calls that are not more than "emergifers" -- transfers going to the emergency department. The blame goes all around. Sometimes it is the PD, sometimes the company, sometimes the caller, sometimes us(when we inappropriately use lights and sirens to go to the hospital.) That’s why we need protocols to let people know where the boundaries are.

Everybody Better

Seven calls with lots of driving around in between. No time to rest. Two diaylsis transfers, a rectal bleed, an allergic reaction, a return home from the ER, a CHF/ pnemonia, and a chest pain/rapid afib. Made everybody better. One nitro and some 02 helped the CHF lady, some epi and benadryl stopped the reaction and cardizem did the trick for the chest pain/ rapid afib. Only got out eight minutes late.

An Hour Late

Driving slowly down Main Street with a patient in the back on a nonpriority, a car in the oncoming lane turns across traffic well in front of me, the car slows as it turns. The driver is wearing a gray uniform. He looks like a state trooper. He gives me the finger.

**

I’m wheeling a patient down the hall in nursing home, looking at the paintings on the wall. A lot of nursing homes have some really crappy art work, the kind of big prints of rich people having picnics in top hats or girls in nightgowns playing with kittens that are sold in crappy five and dime stores for $15 each. That would be my idea of hell, ending up having to spend my last years looking at those prints. This nursing home has a Van Gogh – blue irises. I could handle a nursing home with a good collection of impressionist prints. I think if I could have any painting I would want a Renoir – the one of the guy and the girl dancing. I could stare at that painting and remember what it was like to hold a woman in my arms. Though I suppose when I am in a nursing home I may be a little demented. I could ask for prints of Munch’s The Scream, and some Goya. Some twisted visions of hell. I guess those would scare the visitors and families looking to place their loved ones.

**

Did a dialysis transfer, a woman with Alzheimer’s acting more confused than normal according to the nurse’s aide, a woman with bloody stools, a homeless man with hip and back pain from sleeping in his wheelchair, a girl who gashed her forearm when her hand went through glass when she was trying to open a door, and a transfer back to a nursing home following a stay for a PE.

**

Staring at myself in the ambulance window, my reflection illuminated by the light of the laptop screen, I am starting to look like a younger version of my grandfather when I first knew him.

***

Last call of the day -- just when we are ready to get called in -- is for a woman with abd pain and high blood sugar, vomiting all day. She is an IV drug abuser. I go for the IV. She says she has no veins. I find a little tiny one. She says its scar tissue. No, it isn't. She is angry at me for trying, but I know this is a good vein, although a tiny one. I put in a 24 and run 150 cc in before we get to the hospital. Not a lot of fluid, but better than nothing. Just before we wheel her into the room, she pukes all over our stretcher and the floor.

We get out an hour late.

Pakistan Earthquake

Had the day off.

On Sixty Minutes tonight there was an interesting segment about NYC paramedics who traveled to Pakistan to help survivors of the earthquake.

Sixty Minutes

The group included Joe Connelly, author of Bringing Out the Dead.

A great story for paramedics.

A Flute

Did a code at a nursing home this morning. Patient, last seen allegedly an hour earlier, found apneic and pulseless in bed. She was asystole with cool, cyanotic skin. No shock advised on the first responders' defibrillator. I intubated her, did a round of epi down the tube, then got an IV and did 25 minutes of ACLS, including 25 grams of Dextrose because her sugar was less than 20, but got nothing back, and so I presumed her. It wasn't until I came back to the base and was writing up the presumption that I recognized the medical history as someone who I had transported on Wednesday for a broken knee. Dead people really have nothing in their faces because I had not a clue that I had actually been talking to this person a few days ago.

When I did the tube, I didn't initially see the chords, but with my right hand, I applied crick pressure for myself, using my fingers like the fingers on a flute to find the right spot -- a modification of a technique I learned in a half-day airway class at the JEMS conference in Phillidelphia three years ago. When I pressed down with my middle finger tip the chords dropped right down into view. I said to my partner. "See where I am pressing with my finger. Put your fingertip right there." She put it right in the right spot, and I easily slipped the tube in. I have had a number of tubes in recent weeks, and am feeling much more comfortable again.

The code was the third in three weeks for our service's newest EMT -- a young high school junior, who has made great strides over the last year. He has gone from someone who shyly stood back and watched to an active participate in care. We are kidding him, however, that he is becoming a black cloud.

***

Also did calls for a seizure, a dehydration, and a medical alarm.

***

Last call was for hypertension at a nursing home. One of our EMT students took a blood pressure -- for the first time -- and said she was sure her reading couldn't be right. She said she got 80/60. The nursing home had said the patient, who had a fever had a BP of 176/120. I took the BP then myself and sure enough it was 80/60. A good lesson for her -- don't trust the nursing home. A lesson for me -- another student with real potential.

Bacteria

The old woman wearing a long winter coat meets us at the backdoor. She mutters as she locks the door. She is a tiny bony, wrinkled woman wearing an obvious brunette wig. I ask her how she is and she mutters, “terrible, terrible.” I try to ask her some questions, but she is so busy fussing with her keys and her pocketbook that I just give up, and decide I’ll start again in the ambulance.

“What’s wrong?” I ask once we have her all secured on the stretcher and I apply the BP cuff.

“I’ve been vomiting.”

“What does it look like?”

She looks at me like I am crazy. “There’s bacteria in my urine. The medicine they gave me is making me sick.”

I try asking her other questions, but she is too busy rooting around in her pocketbook to pay attention to me. “What did I do with my teeth?” she asks. “Where are my teeth?”

“I don’t know,” I say, but she isn’t talking to me.

She finally finds them in a plastic bag, then slurps them into her mouth.

“What kind of medical problems do you have?” I ask again.

“Why there’s bacteria in my urine,” she says.

Our conversation doesn’t get much better. She is stable so we just take her in.

***

Next we do a nursing home psych I have taken in before and a motor vehicle with a pregnant female. I BLS the psych and at the last minute just before we get to the hospital I toss an IV into the pregnant woman who is due in a couple weeks. I have her c-spined with the right side of the board elevated. She says her abdomen hurts and her head is spinning. She was in the backseat and didn’t have a set belt when the car was t-boned at a low speed. I give her a little 02 just to be cautious.

QA/ A Hit

Interesting online article at Slate.com about ambulance errors.

Ambulances Can Be Dangerous Places

Here's two excerpts:

In 1999, the Institute of Medicine published its report To Err Is Human, which estimated that up to 98,000 patients may die each year because of the mistakes of doctors, nurses, and other hospital workers. But few published studies have tried to quantify or even characterize the injuries to patients that take place before they reach the hospital. How frequent and how serious are the mistakes that take place in ambulances—and are there simple changes that could help prevent them?

Based on what we know about hospital-based medical error, ambulances may be one of the more dangerous places to be a patient. Studies have shown that medical error is more common when conditions are variable, like in the emergency room, than it is in other parts of the hospital. The problem likely has little to do with experience or skill. Instead it's about the lack of predictability: Doctors and nurses make more mistakes when they work under changing conditions. Think about that and compare the working conditions of paramedics and EMTs with an operating room. Before surgery, an entire staff is prepped with information about a patient's condition, medical history, and the anticipated plan of action. On an ambulance run, there is no plan. Paramedics and EMTs have to improvise as they encounter the obese, frail, terrified, combative, near-dead, stoned, violent, and newly born. And they have to deliver care in a cramped space with relatively few resources.

***

Thought-provoking article. At my monthly EMS meetings we often talk about the problems of quality assurance. As the number of patient runs increases, and as people charged with QA, whether ambulance service employees or hospital clinical care coordinators have increasing demands on their time, QA is suffering. I recently heard the laments of a fellow paramedic who works for another service complain that his service posted spread sheets detailing employee compliance with filling out billing information -- everything from getting the patient's signature to their next of kin's name, but nothing has been done to QA the front of the form or compliance with vital signs, ASA for chest pain. etc.

***

Only one call so far today. A 90-year-old man who woke up this morning and was unable to pee. "Don't get old," he said.

***

Get called for a back pain. Woman is in so much paid she is crying. Has a history of disc problems. Bent down and that was it. She can't get on the stretcher the pain is so great.

I get orders for morphine and give her a little at first. She does not like the flushing feeling at all. On the other hand, she still can't get on the stretcher. We are on scene for over an hour. Eventually she gets 10 milligrams of morphine. She weighs 260. I have to give her the morphine very very slowly and in very small increments. While I am giving her the drug, one of our EMT students, who I have great hopes for -- a tall young man and former star high school football player, has been holding the woman's hand as she squeezed his. He is watching me inject the IV lock, then all of a sudden like a big tree, he starts to lean, and he slowly, slowly falls over to the ground. "He'll be fine. He just fainted," I say to the onlookers. My partner attends to him, and in five minutes, after stripping off his jacket and outer shirt, he is back holding the woman's hand. Keep me in, coach, I'm ready to play. We are able to finally transport the woman now pain-free, although not quite singing The Farmer in the Dell. As for the fallen football hero, when we get back from the call, he signs up for a shift the next week. The kid can take a hit.

***

We do a chest pain.

***

A Bigger Ambulance

"You're going to need a bigger ambulance," the police officer says when we pull up in our van.

"I don't like the sound of that," my partner says.

Niether do I. Already I can feel my back tightening up.

Inside the small dirty apartment we find a tiny older woman, who points us down a hallway. At the end of the hallway in the bedroom, our patient sits on the edge of his large bed, leaning against a cane. I'm guessing he is 600 pounds -- a wide 600 pounds. The man, in his late thirties, says this is the heaviest he has felt, and his heaviest recorded weight is 619. He says he has been retaining water and feels bloated. "I can't even get up to go to the bathroom anymore," he says. "I had to pee into a water pitcher just now," he says. "Basically I'm drowning in my own fat."

I pride myself on my ability to figure out situations, but when we find out that our bariatric ambulance, which is capable of transporting people up to 1000 pounds is out on a distant call, I am at a loss. Our dispatcher tells us to unscrew our stretcher mount and use a fire department stokes basket. The problem is the local department's basket is only rated for 350 pounds, plus the man cannot lay flat. He is too heavy and too wide to even consider our stretcher. And there is no way he could walk out to the ambulance and try to step in and sit.

While we are trying to figure out what to do, the tiny woman, who by now we know is the patient's mother, asks her son if it is okay if she has a can on his minestone soup. He thinks about it, then says, "okay, I guess, go ahead, you eat it."

Strange.

Back to what to do with him. The only option I see is to get a flatbed truck, but it is pouring rain out. The cop finally comes up with the solution. He looks stable, why don't you just wait for the big ambulance. They tell us it will be an hour and a half at least. But the man's problem is not acute. The bottom line is he's 600 plus pounds and feels crappy because of it. He agrees to wait for the big ambulance, signs a refusal, and says he will call us back if he experiences any problems while waiting.

We go back out to the ambulance and clear. Our dispatcher won't let us leave the scene. He sends a supervisor on a priority to see what is going on. They had sent us on a priority one for difficulty breathing, we have mentioned the patient is large, and now we are clearing refusal. Sounds suspicious, even though we have thoroughly assessed the patient and found him stable and we did set it up with one of the dispatchers to have the big ambulance sent to the address as soon as it is available. We meet the supervisor outside, and explain the situation. This is a chronic problem, not an acute problem. Since we have a bariatric ambulance, and there is no rush, it makes the most sense to wait till it is available, as opposed to taking him in through the rain on the back of a flatbed. He won't fit in one of our van ambulances. The patient prefers to wait for the big ambulance. We go back in to talk to the patient. We find him happily eating cherry popsicles.

***

They station us near the scene. We are certain that when the big ambulance becomes available, we will be sent to do the call. Then we get called for another emergency in the town. While we are on scene, we hear a crew being dispatched for the 600 plus pound man. We hear later that when the crew of the bariatric ambulance takes him in, the hospital staff says, don't leave, he'll be going home as soon as the doctor sees him. Evidently, he is a frequent flyer, although an increasingly larger frequent flyer.

The call we are at is for a man with COPD and a probable respiratory infection. I have taken him in before. He is the man who called the ambulance a few moments before the child was run over by his mother in the same town. If he hadn't called 911 when he did, my partner and I would have been the crew dispatched to that horrific scene. He spared us from that call, and now he has spared us from the 600 pound transport. I shake his hand when I say good bye to him at the hospital.

***

Eight calls total. The above two and a nursing home transfer to the wound care center, a broken knee in a nursing home(gave her morphine), a female heroin addict with HIV with pnemonia which weakened her to the point she couldn't get out and get her fix so now she was in withdrawl, a 60 year old man in heroin withdrawl, a motor vehicle with no injuries, and a mentally retarded kid who lay down and said he felt sick and wouldn't get up.

Let's of driving, lots of rain, lots of traffic, the days are getting darker. My back hurts just from looking at the 600 pound guy.

Committees

Went to my regional ems meetings today. What did we talk about?

Educational Standards: new paramedic protocol exam, whether annual skill sessions should be a validation of skills or simply an educational sessions, should basics be allowed to use the selective spinal immobilization protocol, use of the autopulse CPR machine.

Medical Advisory: Protocol revisions, intubation data collection form, use of lights and sirens, putting paramedic discipline under the auspices of the State Medical Board.

Interesting issues, lively discussions.

I like being on these committees.

We actually get work done. It takes awhile sometimes, but it is interesting work and I feel that people listen to a paramedic there.

I resigned today as the paramedic committee representative because the paramedic committee hasn't met for quite some time. I will continue to go to the meetings as a member of the public, and will continue to be on the many subcommittees I am. I just won't have a vote, but we do everything by consensus anyway.

***

Back to work tomorrow.

Lights and Sirens to the Rescue

I wrote the other day about cluster days. Today was child psych cluster day. Our first four calls were for child EDPs(emotionally disturbed persons). The first call they sent us lights and sirens for the 12 year old violent psych, police on scene. The next was also lights and sirens for the 9 year old misbehaving on one of the floors at a pyschiatric hospital. What is wrong with these pictures? Cops on scene and a patient in a psychiatric hospital and they need an ambulance lights and sirens to save the day? In both cases as expected the scenes were well under control before we arrived. Why were were sent lights and sirens has more to do with how the EMS system is set up then with common sense. I intend to use these cases as an illustration tomorrow in the medical advisory committee meeting when we talk about developing a region wide policy for lights and sirens use.

Other calls: nursing home altered mental status, chest pain, dialysis transfer and a cheerleader who threw a cheerleader up in the air but had trouble catching her when she came down.

Safelight

Slept late -- till 8:00. Went to the gymn and did a light full body workout. Went to a new health foods store called Trader Joes, which was awesome because it was healthy and it was cheap. I really need to get back on a healthy program. The job has been mashing me down and I need more resilience to combat it. I worked some on my blogs, some on my EMS projects, went to the movies, played some poker, cleaned up some around the house. Ordered a book from Amazon -- a novel about EMS that came out last year, but I had never heard of --
Safelight by Shannon Burke.

I try to keep up with most of the EMS books that come out -- at least those from major publishers. I am a little discouraged that a novel could have come out from Random House over a year ago and me or most paramedics not have heard of it. I'll post a review after I've recieved and read the book.

Prostrate/Statistically?

I am so glad I am off tomorrow because I am wiped out. Had a runny nose this morning, but that seems to have gone away thankfully, but I still feel tired.

Only two calls so far today with lots of napping before and after.

An old woman with epigastric discomfort and an acidy feeling in her throat and a nursing home patient who had a burgandy colored stool.

I managed to write the respiratory section of our draft new regional protocol exam.

Other than that I have been prostrate on the bed in the back bedroom.

***

9:30 P.M. A half an hour to go and the damn tones go off. The one problem with my suburban post is that they can't pull you in early like they do in the city as crew change approaches. You have no protection. A call comes in at 9:59 and your relief doesn't come in until ten, well, sucks to be you. Maybe I need to just view my Saturday night as getting off at 11 or 12, instead of 10, but when I have worked 80 hours in six days, I want to have a couple hours to raise a beer, play some music, and unwind from the week, instead of coming home to find my girlfriend asleep on the couch with the TV still on.

Tonight it's a girl with asthma, who is hyperventilating. She is drenched with sweat and can barely sit up she is so tired from breathing so fast. She has an expiratory wheeze, but seems more panicky, than truly suffering from constricted airway passages. Since she is sitting in a parking lot, we get her on the stretcher quickly and into the back. I tell my partner to go on a priority. I don't like to waste time on respiratory calls(But maybe also in the back of my mind is my crew change and the late hour?). En route I give her a treatment and encourage her to breath deeper and more slowly. Her SAT goes from 94% to 99%. Her lungs are clear by the time we hit the hospital. She is no danger.

But I have to ask myself would I have gone on a priority if it was two in the afternoon? Maybe. I didn't have a handle on what was going on with her right away. But maybe not. I don't know. Maybe I would have taken the extra minute to try to calm her down more before we left. But then maybe, I might have upgraded us. I don't want to risk a patient's life by not acting quickly in a potentially life-threatening moment, but at the same time I don't want to put a patient at risk by going lights and sirens when it is not indicated. It was a coin flip. I guess I'd be curious to see the results of a research study on my calls. Statistically, do I go to the hospital more on a priority the closer it comes to my crew change?

"I don't think so."

I hate difficulty breathing calls. I particuarly hate calls in the nebulous CHF/COPD/Pnemonia area. You get an old person in severe distress, and they are anxious and struggling for breath. They keep gasping that they can't breath. They are big and sweaty and live in old houses with narrow halls and you can't get the stretcher in to them and you are worried they are going to arrest. And its just you and your partner and the patient has poor IV access and all their meds are in pill cases, and you are trying to figure out how to do everything you need to do and in which order, all the while getting them out of the house and on to the hospital while they are fighting you and trying to pull the mask off because despite the 02 they can't breath and they are afraid.

"Just drive," I tell my partner.

Sometimes they arrest on you, sometimes they make it to the hospital where they get tubed, sometimes they get better.

This morning the lady was gray and clammy and had rales and expiratory wheezes. No fever, positive JVD, positive pedal edema, hypertensive, tachycardic, big cardiac history along with CHF and asthma.

I caught a break on the IV, where I got a flash, lost it, but then was able to reposition and advance the IV. I gave her nitro, lasix, and a breathing treatment. I've written before about how sometimes the treatment seems to cause them to flash, and I was worried this time, but she had the asthma history and was wheezing, so I went ahead with it. I didn't see much improvement on the way in, which took us just nine minutes after a 16 minute scene time with a difficult extrication. I did the IV and gave all the meds enroute. They gave her more of everything at the hospital, and when I brought my paperwork back to the room, she looked a whole lot better.

The nurse was telling me how she loves these calls where they look so bad, but get fixed. I tell her I will never get used to them. I just fine it so hard to manage anxious patients who need so much attention, particuarly when some of the meds you give can cause more harm than good. If they have pnemonia, the lasix is bad for them. Sometimes the treatments make them flash, and the nitro can bottom their pressures. It's hard to hear a BP on many of them when they are thrashing about, and you are going lights and sirens, and if they need to be bagged, well, its hard to do when you are by yourself, as is trying to do a nasal tube. You just have to hope the meds you give work or that at least you will get to the hospital before they go out. Don't care for these calls at all.

***

Nursing home for the unresponsive, find a man cool and clammy but alert. Nurse says he arrived last night to rehab from an aortic bypass. They got a pressure of 79/53 when he was out. We lay him down -- they had him sitting in a chair -- and get a pressure of 108/70, which rises to 130/80. His heart rate is steady at 72. he has no pain. Soon, he is warm and dry, good cap refill, steady pulse, mentating well. At the hospital, we use their BP machine to take pressure and heart rate for the triage nurse. The reading is 150/90. We are sent back to one of the room, where I give my report to the nurse as she puts the patient on the monitor and hooks up the machine BP. Then suddenly she leaves the room, and returns with three other staff, all I believe doctors. She asks me to give my report to them. I say, once we got him on our stretcher, we got a good pressure. "And just what is a good pressure to you?" the doctor demands.

"120 130, very stable."

She points, almost accusingly at the BP machine, which reads 60/40.

"I don't think so," I say.

As I leave the room, I hear the doctor order the nurse to take a manual blood pressure. My partner says their next machine reading is 140.

***

A lady turns her ankle running and we take her in. On the way back, I stop at the garage and pick up my car. Good news is it was just the battery. Bad news, I will soon need rear brakes.

***

Lady twists her ankle. Broken or sprained, I don't know. We take her in.

***

Nursing home call for dsypnea. Patient just returned from the hospital has rapid shallow breathing according to the nurse who wants her out of the home and back at the hospital. The patient (with dementia) appears to have "tachysniffles." She is breathing rapidly through her nose, rubbing her nose and poking at the cannula. She doesn't appear to be in any distress. We take her in.

***

Get a call at 5:30, but then are cancelled en route. Thankfully.

I am beat and ready to go home and sleep.

Don't Tell My Sister

Slow day, which is just what I needed. After three twelves in the city, a slow start to Thursday is always appreciated. I slept, got caught up with my blogs, checked on the status of medic supplies, and generally took it easy.

Only call so far has been a man with a syncopal episode after taking a nitro.

I'm hoping for another slow day tomorrow so I can get caught up with my regional EMS work in preparatation for the meeting next Tuesday.

Tonight I am hoping for a quiet night at home. I may stop at the new supermarket and get a steak to grille. The last couple nights I have had one cold beer before bed with my late meal, and in addition to it tasting good, I have slept well. That could be because the meal was cold turkey and lime nacho chips. I think another cold beer tonight would be nice. Maybe even a hot tub. I like the weather this time of year the best -- cool and crisp.

45 minutes to go.

***

Oops. Cursed myself. With 44 minutes to go, the tones go off. Diabetic. We find the patient -- a man in his late fifties -- in his driveway. He's fallen off his tractor, his feet still in the air, lying on his back with his head against a stone wall. I c-spine him, then move him into the garage, where I check his sugar. Its low(less than 20). I give him an amp of D50 and he comes around. He is a regular for me. I have been treating him for over ten years. His sister is there as she often is. She is the one who found him. I saw him in fact yesterday at the hospital. Another crew had brought him in, which was unusual because he is normally a refusal. They found him in a car in another town -- in a bad part of town -- unresponsive. As the man beomes alert today, I ask him what he was doing today. "Don't tell my sister," he says.

"He won't tell her," his sister says.

The man swears.

We take him in to the hospital because he says he hurts all over and because he is somewhat hypothermic from being outside -- probably for at least six hours. I have to give him another amp on the way in.

***

On my way home I stop at the supermarket to get a steak. Because of the call, it is much later than I wanted, but I still have the taste for steak. I come out of the store and my car is dead. I walk across the street to a gas station and they let me borrow a portable jumper. I get the car going, drive home, and when I check my car again, it is dead. I think the problem is corrosion on the battery so I take the cables off and scrape them, but that doesn't work. I try to jump the car, but it won't work this time. After an hour of trying to fix it, I end up calling Triple A to tow it to a gas station near where I work. I figure I can get a ride in the morning with a friend, then pick the car up in the afternoon. Triple A comes, takes the car. I go back inside, but ten minutes later I see they are still there. Their flatbed has broken down. They are out there for two hours until another flatbed comes. They end up leaving the broken one in the street.

I hate it when my car breaks down. I guess at least I wasn't stranded. That's good. But no steak for me tonight. I settle for leftovers. Maybe tomorrow night I'll get to eat it.

"For the Unconscious"

Crazy day. It seems like every call we were dispatched to was an “unconscious” or “cardiac arrest” and the location was on the other side of the city from where we were.

Signed on in the morning and was sent for a sick person in the north end. While enroute, we were switched to "the unconscious" at the train station. Got there and could find no one so we cleared no patient. Later we were sent "for the unconscious" also in the north end, possible drug overdose and no one was there. In the afternoon, we were sent "for the the unconscious" in the height of rush hour. Arrived to find a man slumped over at a bus stop. He was just drunk.

Earlier we were sent for fall at a chicken restaurant in another town. We found a man lying on the ground writing in pain. He said his knee hurt. He had fallen earlier in the day at a senior center – that man was 90 – felt okay, then went about his way. While eating chicken, the pain became so unbearable he thought he was going to pass out. His knee did look a little deformed, but then so did his other knee. Only a little pain on palpation. His pressure was 93/60 – he said he usually had low pressure. He said he felt dizzy like he was going to pass out. We took him to the hospital – it was very odd – he looked terrible, but said the pain in his knee wasn’t as bad. The one problem with the call for me was he was hard of hearing and he had the most foul breath – it was so foul – it made me think there was something wrong with his insides. I had to lean forward to shout at him, and then he would answer before I could pull my head away and I’d get hit with a toxic plume of breath. Very unpleasant. We finally get him in the room at the hospital, and then he starts to puke. He fills up three emesis basins with thick food like emesis.

I was writing up my run form, when I heard on the radio of one of our fly car medics in a suburban town that there was a cardiac arrest there. Both fly medics were at the hospital writing there run forms up. I got a page then asking any available car to clear, so my partner and I cleared and we sent to the cardiac arrest.

It turns out it wasn’t a cardiac arrest, but was very interesting. A forty year old woman, who had had a cardiac arrest a couple months ago and had an implanted defibrillator was mowing the lawn when the thing went off, knocking her on her back. It went off three more times. She was extremely anxious when we got there and worried she was about to die. It was the first time it had ever gone off. I did what I could to reassure her, as well as giving her some Versed to ease her anxiety and take away some of the pain should the defib go off again. Her kids who were with her when it went off were all bawling and we had to try to calm them down as well.

Toward the end of the day we were sent "for the unconscious" man in a car. Enroute we get an update from one of the fly car medics that the man is in his car in the garage with the engine running. Then before we can get there we get cancelled. I am guessing the fire department got him out and the medic called him dead.

Not two minutes go by before we are sent "for the unconscious" – a woman in a car outside a medical building. We arrive first and a woman directs us to a car where I can see someone sitting in the front seat. I knocked on the glass she says, but she wouldn’t move. The door is open. The woman is elderly, head slumped forward. She is cool and not breathing, but still limber. I shout to my partner that it is a code, and then I pull her out onto the board and do CPR as we wheel her to the stretcher. One of our supervisors has arrived and then the fly car medic.. She was asystole. It was nice having two medics with me. All I had to do was hold out my hand and they would hand me the ET tube or drawn up drugs. She had the tiniest chords. I was just barely able to get a 7.0 through them. We transported her to a local hospital, but we didn’t get anything back. If she had died at home I would have worked her twenty minutes, then called her, but here the twenty minutes wasn’t up until we were reaching the hospital.

***

Also did a couple transfers and a refusal for a baby who choked on his mother’s milk.

***

One funny or not so funny from the day was when we arrived at the scene of the drunk at the bus stop. We pulled in to the bus stop opposite traffic so only my partner could see the patient. I got out the passenger door, grabbed the blue bag from the side of the ambulance, then went around the back, thinking my partner had gone directly to the patient. As I’m walking around the rear, the back door catches me face on, as my partner is pulling out the stretcher. I gave him a hard time about it. I was lucky I had my arm in front of me holding the strap of the blue bag slung over my shoulder. Otherwise my partner would have had to have requested another ambulance "for the unconcious."

***

Food highlight of the day was chicken empanadas at a Spanish restaurant. We went there late and the empanadas they had in the window were a little dried out so they offered to cook us some fresh ones. Delicious – right out of the oven – light, crispy, juicy. Only $1.25 each.

Cigarettes and Tasers; One of the First EMTs

We get sent to a nursing home for a “violent” patient. Cops have been notified. We find a man with no legs in a motorized wheelchair waving his fist at a nurse. Here’s the deal. He goes outside to smoke. Sometimes he ventures too far in his chair they are worried he is going to get hit by a car in the parking lot. Plus, his guardian doesn’t want him smoking so for his health they have put an electronic guard on his chair so when he approaches the front door it locks so he can’t get out. For him at least it’s about freedom and his cigarettes. Don’t mess with a man with no legs’s cigarettes.

The cops tell him since he threatened the nurse and threatened himself, or at least said his life wasn’t worth living, he has to go to the hospital for evaluation.

“Take me to jail,” he says.

The cops don’t want to take him to jail. They want him to go with us. He has called their bluff.

“I ain’t going,” he says.

“You’re not to win this argument,” one of the cops says. “There are five of us and one of you.”

“I ain’t going.”

“I’ve got a taser,” the cop says.

I’m about to suggest that I have Ativan and Haldol and maybe the chemical restraint will be a better idea if he is going to try to resist, but I can see the man is staring at the cop’s holster that holds the taser. He is probably picturing the same scene that I am. The cop tasering the guy. His body becoming rigid as the electricity shoots through him, his hair turning into an instant Afro. Peeing his pants. Biting his tongue.

“All right,” he says. “You going to see my chair gets put in my room?”

“We’ll take care of it,” the cop says.

“They’re a bunch of thieves here,” he says.

“We’ll keep it safe.”

“Fucking assholes won’t let me smoke,” he says as we head out to the ambulance.

**

We do a lift assist, a wait and return transfer from a nursing home to radiology, a diabetic with a sugar of 27, a police standby, a woman with a GI bleed.

***

Last call is a dialysis transfer. Guy has one leg and sores all over his body. He says he is a former EMT in the city – one of the first.