Hard time of year.

I hope this post finds all of you happy, healthy, and excited about the new year having had a wonderful Christmas! I know I certainly did! :) I'm not going to write about one specific call this time because to be honest I don't know which one I would choose. The holiday season can be a very hard time in EMS. It is, believe it or not, the time when we have more deaths/suicides than any other time of the year. That rule has certainly held true this year as I have run more codes this month than I have all year. It is really sad and I'm not sure exactly why this happens. Some ideas that float around are that it is a high stress time of the year, people are sad or depressed that they don't have family around, or even that the diet of the average American is fattening to say the least during the time period of Thanksgiving to New Years. Whatever the case may be it is very sad to see so many people lose their lives in what could be the most happy and exciting time of year as we celebrate the birth of out Savior. 

What a night!

Squad 6 respond for a 78 year old male chief complaint difficulty breathing. My crew and I marked en route and were on our way. We knew this would be a very long call because our patient lived in our 4th due response area. We arrived on scene 40 some minutes later. The patients driveway was so steep that we had to put the ambulance into four wheel drive just to make it to his house. Finally at the top of the driveway we realized that there was no place that we could turn around at, but figured we would go inside and get our patient then figure out how to handle that problem later. After we got our patient loaded and out to the ambulance we marked en route to the hospital with dispatch and our driver began to try to turn around. After a good ten minutes of maneuvering the unit every way possible we finally figured that we would have to back down. It was so scary! The entire time I felt like we were falling off the edge of a cliff. We were running over things and clanging and screeching all the way down. When we finally got down to the bottom we realized that something was very wrong with the medic unit. We could not get out of four wheel drive no matter how hard we tried! Our patient was having a harder time breathing as every minute passed. Finally on our way the truck made a loud clunking noise and stopped in the middle of the road. After some checking the guys figured that the only way to continue on was to keep in in four wheel drive making it difficult to go more than ten miles an hour. We decided to call for another crew to come pick up our patient and we would call a tow truck. We didn't want to have to drive the medic unit any further for fear of severely damaging it. A few short minutes later the other ambulance pulls up. I started getting ready to transfer our patient and asked the driver of the ambulance that had just arrived what level they were to make sure I wasn't downgrading care by handing over my patient to a crew that was not Advanced Life Support (ALS). He proceeded to say, "Oh no it's just me. I will drive and your crew can ride with me." Oh wow could this night get any worse? So we did what we had to do. Eric and I climbed into the back of the other medic unit and began patient care out of a completely different truck. Once at the hospital (after an hour and a half ordeal) we wrote our report then sat there and waited on our driver to get the ambulance taken care of then drive to the hospital to pick us up. It was quite an evening! We were extremely tired after it all, but in the end the outcome was the same as any other call...you do what you have to for your patient. 

Miracles still happen!

It was the day after Thanksgiving and Eric and I and another crew member were on call 6pm-midnight. Nothing had gotten toned out all day and we were beginning to think we were not going to get a call that shift. We had just sat down to eat when we heard the tones drop for a 61 year old male that was unconscious and not breathing and that CPR instructions were being given to the family members on scene. The residence was right down the road so we jumped in the medic unit and headed down the road lights flashing and sirens screaming. When we got there we already had another member on scene that had taken over CPR for the family. We got a quick report of what was going on then set to work alternating CPR rotations, inserting a breathing tube, getting an IO established, placing the patient on a cardiac monitor, and starting the rounds of drugs that we would give. In no time at all we had 10 people on scene working tirelessly to bring this man back. After 25 minutes of working on him the Paramedic got up to talk to the family and tell this man's wife that we were going to have to call his death because there was nothing else that could be done. I was so disappointed! We had so many people on scene and circumstances could not have gotten any better. I started praying for this man and his family; pleading with God to give us a pulse back. Just as the Paramedic came back into the room to tell us that we could discontinue treatment I heard Eric say, "We got a pulse!" Praise God! We all knew that the likelihood of us getting this man back after 25 minutes was very small, but I also knew that God still works miracles and am so thankful that he chose to bless us with one that day! As of today this man is doing fine!

It could have been so much worse!

A rush of adrenaline...this doesn't sound good! I listen intently as the tones drop for our neighboring rescue squad. "Aplha Response! Respond for nursing home on fire, approximately 50 residents to be evacuated." Normally when the tones drop for another squad you wait until your squad gets toned out before responding because it is not technically your call. When I heard this dispatch I didn't hesitate in marking our Advanced Life Support crew en route to the scene to help out. I asked for more information from dispatch while I was on the way and was told that there was indeed already smoke in the residence halls and the staff was getting all the people out into the parking lot as quickly as possible. "Great! If the smoke doesn't get them they will freeze to death outside!" I was glad that we had gotten en route so quickly because half way there I heard dispatch begin to tone out for multiple squads all across the county to come out and help. This was a nursing home. It wasn't like we could announce to the residents to please exit the building and wait outside. Most of these people were in wheel chairs and could not be left alone anyway. We arrived on scene to find the small amount of staff that was working at 10:00 at night trying to take care of almost 50 residents that were cold and scarred out in the parking lot. Fire alarms were sounding and people were running everywhere.With the help of multiple different rescue squads we were able to get the people over to another building with minimal problems. Thankfully after the whole escapade we only ended up having three patients one suffering from smoke inhalation, one that had injuries from a fall, and one that was unresponsive from a condition that had nothing to do with the fire. All in all everything turned out very good considering what could have happened and it was great to see the community coming together to help us in our efforts. Some of the neighbors even came out and helped us calm the residents down and help in any ways that they could. After only about an hour and a half we cleared from the scene and were back in service with the residents back in their beds and all the rescue personnel very thankful that everything had turned out so well. It could have been so much worse!

The Small Details Count

My crew and I recently responded to a call for an allergic reaction. We had a small crew that night with only Eric, a student, and me. Eric was driving so it was just me and the student in the back. We arrived on scene to find a female that was basically "out of it". I asked her daughter what had happened and she said that she had taken an antibiotic that had been prescribed to her and she thought that she was having a reaction to it. In the case of an allergic reaction time is very important and getting medication into your patient to combat the reaction as soon as possible is very important because often times the airway is the first thing to be affected. We quickly brought in our equipment and loaded her onto the stretcher. Before leaving I asked the lady's daughter what all of her known allergies were. She replied and I repeated them back to her so as to make certain I had heard right. Asking a patient or close family member about allergies is a very important thing that is done with each and every patient encounter. We loaded our patient into the back of the medic unit and marked en route to the hospital. Once en route I started an IV and administered a medication to combat the allergic reaction. She seemed to be somewhat better by the time we got to the hospital so I was very much relieved. As we were unloading our patient and getting ready to take her inside the hospital her daughter came up to me and asked how she was doing? I told her what I had done and that she was doing a little better. The look of shock on this woman's face told me something was very wrong. She stated that she was very sorry, but she had forgotten to tell me that her mother was severely allergic to the medication that I had given her.I couldn't believe it! Wow how could you forget something like that! Praise God that nothing had happened and the medication had actually helped her like it was supposed to. There was no way I could have known that the lady was allergic to the medication, but I sure was happy that God had been with me in the back of that ambulance and that everything went ok!

Don't cry wolf!

There is a lady in our 1st due response territory that continues to call 911 for help over and over for reasons that do not warrant EMS response. Now, I will say that we get calls from people most everyday that they should have not called 911 for, but this woman gives a new meaning to "crying wolf". We have gotten called to help her down the steps, to help her to the dinner table, to help her to the car, and to help her into bed. One of the last times I actually called dispatch and reported her for abuse of the 911 emergency system. When a person gets reported for abuse of the system the next time a call goes out for that residence instead of dispatching us (rescue) they dispatch the head county Paramedic and he responds. This happened and she was informed that if she continued to call she would not get a response that it was very dangerous to do this because if something was ever really wrong no one would come to her aid. Well last week when my crew and I were on call at the station we heard our tones drop for that residence. Naturally we were not happy about it and some of the crew did not even want to respond because we knew it would just be another wasted trip. We marked en route anyway because even though we are not obligated to respond we knew if something actually was wrong we would feel bad for not going. On our way we asked for patient information and dispatch told us that she had said she was bleeding uncontrollably. Right! She'd tried that one before too! We got on scene and and I walked into the house in no big hurry whatsoever. When I got inside I heard the lady's husband yelling from the back bathroom, "Get in here!" Again, no big deal because they were always demanding and rude so I was used to the urgency in his voice. When I got to the bathroom the lady was sitting in a chair by the sink. The counter was covered in blood! The clamp on her dialysis port had come off and she was bleeding heavily. Both her and her husband were panicking! I was even caught off guard...this was an emergency! We finally got the bleeding controlled and got her to the hospital. Finally, this woman got the point! Real emergencies happen and if you abuse the system and call for help when you really don't need it you can get yourself in real trouble. In other words, "Don't cry wolf!"

Diagnosis: Inexperience

Anytime a crew gets dispatched for a call involving a Pediatric patient I think there is always an element of apprehension. One of the things that you are taught in emergency medicine is that kids are not "little adults". They can not be treated the same way because their body systems are so much different than that of an adult. Children are very resilient, which is a good thing, but they also have a tendency to compensate for a very long time and then crash all at once when you are least expecting it. My crew and I responded to a call for a three month old male that was having a seizure. We arrived to find a young mother standing outside of her residence holding her little baby. Naturally, we were all a bit nervous because we just don't see as many children in the back of the medic unit as we do adults. After we had checked the baby and were on the way to the hospital we came to the assumption that the baby had a seizure only because the fever had gotten so high. An experienced mother would have probably recognized this, but this young mother had no idea. We took the baby to the hospital and on the way I got the opportunity to "educate" this young mother on some things involving medical emergencies in children. Being able to teach and be able to prevent future emergencies is one of my favorite things to do!

Thoughts...

I have been looking into becoming a CPR/First Responder/EMT instructor. Being able to teach others to do what I am so passionate about doing would be amazing! I have helped with multiple classes, but would love to be able to implicate my thoughts and beliefs into the medical teachings. When people start out in emergency medicine they think they are invincible and that they can handle anything. Few instructors will tell you that you are helpless with out God. This fact has become so real to me in my experience in EMS and is a great comfort when despite your best efforts with perfect circumstances your patient dies. Likewise, I have cleared from calls and thought, "How on Earth did that person live?" I try to always remember when I mark en route to a call to pray for my patient and for God to allow me to use my medical skills to help the person I will soon come into contact with. I have personally seen miracles happen in the back of an ambulance! It is such an amazing place to work because truly every second counts!

What were they thinking?

So every once in a while you run one of those calls that just makes you stop and say, "What on earth were they thinking?" The next few calls I depict are true and are not exaggerated.

The latest one was this past week when we got tones out for a 59 year old man that was vomiting and having difficulty breathing. Once on scene we found out that his problems were caused when he went outside in his front yard, saw a mushroom, took it inside, cut it up, and ate it! He had poisoned himself!

A man wanted to cut a large branch off of a tree out in his field. He had to use a long ladder to reach it so he propped the ladder up against the branch that he was cutting off. I won't even go into the details.

A woman needed to reach something on the top shelf and thought that it was a good idea to put a small step stool on top of a rolling office chair. I think everyone gets the picture.

And then there is the people who I say, "What were you thinking?" when they call us. Like the woman who called us when she dropped a can of Lysol on her toe or the lady that called us at 6 in the morning to take her to the hospital because she had an appointment that day and she didn't want to be late!

All this for nothing!

Last night my crew and I got dispatched to a 22 year old female that was having severe abdominal pain. This woman lived in our fourth due response area which means we had an extremely long response time. When we marked en-route we had no idea how far out this call really was. We drove for over 30 minutes on gravel roads, and wound around hairpin curves that were most often times single lane roads. When you are driving around in your personal vehicle on roads like these it is bad enough, but doing so in the back of a bouncy ambulance and not being able to see in front of you is ten times worse!The entire crew (even the ones not normally affected by motion sickness) began getting really sick. By the time we got to the woman's house all of us were sick! It was a terrible feeling knowing that you had to suck it up and go out there and take care of your patient when you felt sick yourself. So after getting her inside we began the horrible ride back out of the "woods" and to the hospital. I almost passed out on the way there and both of the guys in the back with me were sick as well. It was a miserable ride. Finally, we got to the hospital and got the patient transferred to the nurse. I was feeling terrible, but knew the woman was in a lot of pain so I was glad we took the call and was able to help her. As I was walking back to the EMS room to begin the paperwork the nurse asked me for the woman's last name. When I told her she just looked at me, smiled, and said..."Oh, her again. Yeah she was in here two days ago for the same thing. Frequent flyer." With disgust I walked back to the EMS room to inform the rest of my crew that we were missing sleep and were all feeling sick for someone who was just faking it!

Wow, now that's gratitude for you!

So many times before I started this blog I had stories in my mind that I wanted to put down on paper or just find someone to tell about them because they were just so wild! Once in a while you will run a call that just sticks out in your head and you can't forget it...this was one of those calls! It was December of 2009 and we had just had one of the biggest snow storms that Virginia had had in many years. We had almost a foot of snow on the ground and it was bitterly cold outside. It was almost 11:00 at night when we got toned out for a 76 year old male patient that had fallen and was bleeding uncontrollably. My crew and I marked en route to the call which was just minutes from our station. The man's house was on a back road with a lot of hills and we knew that we would have to be careful as our ambulances were not usually driven in this much snow. Thankfully we had the most experienced driver on our crew so I wasn't worried. We got about a mile from the man's house when, despite our driver's best efforts, we slipped off the road and into a snow bank. We tried over and over to drive the unit out, but with no success. Finally, we decided we were going to have to call a tow truck. Even though we were over a mile away from this elderly man's house, it was in the middle of the night, there was a foot of snow on the ground, and it was freezing I wasn't about to just sit and wait for the tow truck with this man bleeding uncontrollably. I grabbed my bag and informed the guys I was with that I felt we needed to walk the remaining distance to this man's house. Our driver decided to wait on the tow truck while me and my partner started up the hill to the man's house. I had not however planned on being out in the snow for more than a few minutes and I was wearing cowboy boots that were soaking up the wet snow more and more with every step that I took. When we finally got there my boots, socks, and feet were soaked and my toes had started turning blue. I ended up having to take my socks and shoes off to get the circulation going again and borrow a pair of socks from this man's wife! That was a new one! We got to the patient who was lying on his back on the floor with a moderate amount of injuries.We knew we were going to have to take him to the hospital and we also knew that we had to have a backboard and more supplies to do so. My partner decided that he would walk back to the ambulance and I would stay there to take care of the patient. When he got back with all the equipment he informed me that the ambulance was now out on the road, but could not come all the way to the house because it had slipped off the road two more times. We finally figured that the only way to get this man to the hospital was to load him into his own pick up truck and drive him down to where the ambulance was sitting. This was not an easy task however. It was now about 1:00 in the morning and it had started to snow again. Our driver walked up the hill to the house and drove the man's truck to the back door. We then carried him out on the snow to the truck. Then came our next string of problems; this man could not walk, he was very big, it was extremely slick, and his truck was high and hard to climb into. I had to get in the truck and wrap my arms under his arms and pull as the two men I was with pushed. The man ended up laying on top of me for the ride down the hill...very uncomfortable, but you do what you have to do. When we got to the unit they opened the door behind me and reached under our patient and pulled me out. We then slid a board under his body so we could lift him out and load him into the back of the ambulance. We were finally on our way...so we thought! Almost to the main road the chains broke on our tires and we had to stop at our station to switch out units. It was now after 2:00 in the morning! When we finally got to the hospital it was almost 3:00 and we were all beyond exhausted! We got the man to the room in the ER told the ER doc what had happened and told the man that we hoped he felt better. As we were about to leave to go start all the paperwork that we had to do before leaving the hospital the doctor turned to the man and said, "Wow I bet you sure are grateful! These people really went above and beyond the call of duty to help you!" His response still blows my mind to this day even though were hear things like this all the time. He said as he laid in his warm bed that we had safely gotten him to,"Why should I be thankful? They had to use my truck to get me out!"

All worth it!

Often times when running EMS in a small town you run into people that you know, and while this can be great because you already know your patient it can also create many other emotions as well. It is always hard to come across a situation where despite your best efforts you are not able to save the person, but when it is a friend or neighbor it can make things extremely difficult. Also, believe it or not it can also be quite awkward in some situations to arrive on scene and find that the person in distress is someone that you are acquainted with. However, one the most rewarding things in running EMS in a small town is when you walk into a person's home and have them look up at you and say, "Oh I am so happy to see you!" In my career as an Emergency Medical Technician this has happened to me many times. The time that sticks out in my mind the most was a call that Eric and I ran last year. We responded to a call and it turned out to be a woman that I had met before, but that her children were personal friends of ours. When I walked in the house I picked up the sense that everyone was really scarred. I talked to them and tried to comfort them as best I could while still providing the medical care to my patient. As we prepared to leave I turned to the family and even though it did not look good assured them that I would do my best to take care of there mother/grandmother. Despite all Eric's and my efforts the lady passed away soon after we got to the hospital. I stuck around the hospital long enough to explain to the family what had happened and to try to provide some support. Later in the week  Eric and I went to the funeral where I was hugged by the family and told how very much they appreciated what we had done for there mother that night and how it had put them at ease knowing she was with someone that they already knew that they trusted. The next week I even got a hand written letter which expressed how much everyone in the family appreciated the fact that I was willing to give my time to help their family when they needed it most. This kind of thing is what makes all the getting up in the middle of the night, the skipping meals, and the mental and physical exhaustion all worth it!

Why EMS?

So one of the reasons I love EMS so much, other than the obvious being able to help people, is because it is a job that is never the same. When marking the medic unit en-route you never know what to expect because half the time the dispatch is not even right. I can not even count the times that I thought I was going for something simple and it turned out to be a major medical emergency or it was supposed to be very serious and it turned out to be nothing. Also, things can change in a second. One minute things can be fine and your patient can be up and talking to you and the next they have crashed! You have to be on your toes! EMS in the country is totally different that that of in the city. In the city you are close to a hospital and often have plenty of help at your fingertips, whereas in the country you may be 45 minutes from the nearest hospital and not be able to find anyone to help you. Every call is an adventure where you get to have the rewarding experience of helping people, (and run at high speeds with lights and sirens in the process).