Night shift lost the medic bag, a fact we discovered *AFTER* we caught a run!

So, TINS©, TIW©, all psyched up to FDASL©, chatting with the off-going crew, with my partner Doug. I had just about completed dropping my bookbag full of nursing school homework on the desk, when the phone rang with a run. Unaccustomedly, we were on day-shift, this being summer and my class load being light.

Of course, our very first run of the morning was Not a “sick person”, was not a “stomach pain”, no, indeed, it was an arrest.

It was Doug’s day to drive, so I settled into the passenger seat, buckled up, and we were away.

It was the custom, in those dark days of antiquity, to gather our immediate aid materials in a “mussette bag”, generally mil surp, olive drab, canvas. With a capacity of around six liters, we could carry several roller gauze bandages, a dozen or more sterile 4 x 4 dressings, several 5 x 9 ABDs (variously translated out of acronym into English as Army Battle Dressings, or ABDominal Pads), tongue blades, plastic oral airways (NOT endotracheal tubes: in those days, we were running an entirely basic life support operation), and, most relevant to Today’s Lesson in Life In Da City, a bag-valve-mask resuscitator.

Mostly, Da City bought the Laerdal brand of bag-mask, branded as Ambu, Therefore, of course, we referred to these as “the ‘Bu”.

You may wonder why I am assaulting y’all with these details of my far gone workaday life, amirite? Well, ya see, on this particular day, on this particular “cardiac arrest” run, as I settled my bony ass into the passenger seat, I did NOT have to step around the green bag. This caused me to look around, as we sped to the run, and NOT find the bag. I twisted around, and gazed into the module from my seat, and, again, did NOT! See our bag.

This was not encouraging.

Shortly, we arrived on scene, and, fortunately (for certain narrowly defined values of “fortunately”), our named patient was not only arrested, but, also, in rigor mortis.

Please recall that “narrowly defined values of ‘fortunately’” thing, cited above.

This soul was not going to benefit in any manner from CPR, ventilation or any other intervention in our (missing) bag of tricks. Therefore, we pronounced him on the scene, called dispatch for a scout car to take report, and went in service.

Returning to the firehouse, we examined the log entries from night shift, listed several likely locations of our errant bag (and I retrieved my personal bag from my vehicle, so, in the interval, we would not face performing mouth-to-mouth on some unlucky stranger). Then, we went visiting.

On our second or third stop, a pleasant lady answered the door. “I was wondering when you fellas were going to come back. Them nice fellas last night were in such a hurry that they left this on our living room floor!” And she handed us our bag.

I asked how her husband was doing, he being the subject of night crew’s visit last night. “Oh, he’s staying in the hospital. The doctors said his belly pain was from his appendix, and he’s gonna have an operation today, but they say he’ll be fine!”

Doug and I applauded this news, thanked her for holding our equipment for us, and bade her farewell.

And, boys and girls, THAT is why I forever afterward placed my own green bag in the ambulance, for the duration of my days on EMS!

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“Fittin To Throw Down!”

When I worked the road for Da City’s EMS, several of my colleagues were simpatico with the majority of our service population. So, the habits and mores of the folks on the street were not much of a novelty for several of my colleagues.

Indeed, one gentleman who was my partner for a schedule or two told a tale of a cousin of his who, exchanging words with another soul, found their conversation adjourned outside the bar in which they had crossed paths. Words grew more and more heated, in my partner’s telling of the tale, and the party of the second part drew, displayed, and announced his intent to employ, a handgun.

My partner described subsequent events. “Well, my cuz stood up tall, and challenged the other guy, saying, ‘Well, hell! SHOOT me!’. Which he did. My cousin did not survive the exchange.”

Tough crowd.

So, TINS©, TIWFDASL© with my regular partner, Doug, and we (of course) had our squelch open so we could hear radio chatter from other medic units. If one of them got into trouble, well, THAT might be a handy thing to know, so we could begin to sidle our happy asses over closer to their scene, to lend a hand should medical hands be required.

Over the radio came the memorable tones of Abbie Smith. He was able to recreate the richly evocative tones, rhythm, and nuance of the patois of the street. Partly this was due to the fact that he was of the street, and partly because he was an old hand on the job, and therefore wise in the mannerisms of the citizenry from that perspective as well.

So, anyhow, he drawled out his greeting: “Dispatch, this is Medic Nine!”

The dispatcher on duty that night was another old hand, who had been dispatching since Marconi had first dispatched “S” from Cornwall, England. He, in contrast to Abbie, was an old white boy, who was renowned for knowing off the top of his head where every ambulance was, and what they were doing, at any given time. When you are in a tense, hostile scene, is is reassuring to have a sort of radio bodyguard looking over you!

So, he acknowledged Medic Nine’s call: “Medic Nine, go!”

“Dispatch, could we get the po-leece out here?”

“Very good, Medic Nine. Why do you need them?”

“Dispatch, these folks are all hot and bothered, and they fittin to throw down!”

Remember, our dispatcher was a white boy. He had not immersed himself in the vibrant, and ebonics speaking, culture of the street. In contrast, our friend Abbie, had. Dispatch sought some clarification.

“Medic Nine, what are they going to throw down? And, from where?”

We could hear the sigh from Abbie, before he even keyed up the microphone. “Dispatch, this is Medic Nine! They fittin to throw down! You know, get it on! Fight!”

That cleared things up for our friend the dispatcher. “Are you involved in this fight, Medic Nine?”

“Naw, we down the street. But, they gonna get to fighting pretty soon!”

Dispatch got it. “Medic Nine, clear that scene! Clear that scene! Police are on the way, repeat, police are on the way!”

“Dispatch, this is Medic Nine! We clearin the scene!”

Again proving the importance of speaking, so that they can understand you!

Sleeping With a Chainsaw

A long, long time, in a galaxy not so very far away, I was working for Da City’s EMS. Since I was in school during the daytime, I worked nights.

So, TINS©, TIWFDASL©, and it was my turn to take the detail. In those days, several of the medic houses on each shift had three medics assigned. In the event that another unit had a sick call, or somebody off injured, well, “Tag! You’re IT!”, and somebody got to pack their crap up, drive across town, and work an unfamiliar house with a (occasionally) unfamiliar partner. The night of this tale, it was my turn.

EMS, in those days, was sort of a small town. There were around 160-170 personnel on the rolls, and what with shift rotations, details, and commonly running into a couple of the dozen or so hospitals in Da City, well, nobody was an unknown quantity. For example, during several of the years I was on the road, I was dating one of my nursing school classmates. She was, let us say, “of the African persuasion”, whereas I am purely white bread. One fellow, who I was acquainted with only in passing, had occasion to work with one of my former partners, and was quoted, by that partner, as inquiring as to the status of my relationship with my classmate. The exact quote was relayed to me as “Is McFee still seeing that (‘N-word’) bitch?”

(clears throat) Uh, well, ya see, (a) the pejorative referenced nowadays by the circumlocution “The N-Word”, was not acceptable among persons of education or pretense of good upbringing, even in those benighted times. (b) My girlfriend was in no way, shape, manner or form “a bitch”. Indeed, the time we shared lifted my own life in ways that, now, nearly 40 years later, I am still discovering. And, of course, (c) My partner stood up for me, inquiring of Mr. “More Mouth Than Sense”, if his mother was still employing her skills as a practitioner of The Oldest Profession. For some reason, in my partner’s report, further conversation ended right about that point.

So, nearly everybody on the job in those days either knew everybody else, or knew of everybody else. So, it came to pass that I was detailed out to work with Lonnie Evans, let us call him. He was renowned as working two, perhaps three, full time jobs. This led to his reputation as the soundest sleeper in the department. In addition, since it seemed that he was acutely-on-chronically something like 2500 hours in arrears on his sleep allotment, well, when you add obstructive sleep apnea to that recipe, stir lightly, and allow to rise overnight, you get to observe what 40-60 seconds between breaths sounds like. And, due to the fact that he snored with a sound like a tractor trailer starting up on a very, very cold morning, well, if your 8^th cranial nerve was functioning, you were not going to miss it.

I had a sleepless night, with only a few runs. (talk about mixed blessings!). The next night I reported to Medic Four, and regaled my partners, Doug and Andy, with a review of my night across town. Andy had had a similar experience, a few weeks previously.

He reported, “Yeah, Lonnie snored like a chainsaw starting up, alright. That wasn’t the bad part! Every time he stopped breathing, I snapped awake, wondering if I would have to start coding him! After considering this possibility for several minutes, I decided that I was NOT going to do mouth-to-mouth on him, so I got the bag-valve-mask, an oral airway, some tongue blades, and positioned the handie talkie where I could reach it in a hurry. While I did not sleep any better, at least I knew I wouldn’t have to wind up kissing his wrinkly ass!”

Caught in a Snowbank with Marielle.

One schedule Doug rotated onto days, and I found myself working with Marielle. In keeping with usual practice, we rotated driver vs medic duties. One snowy night found us en route to a “heart attack” in the East Side projects. We arrived on the scene, so advised dispatch, and trudged to the indicated door. Things progressed as per usual, and our patient and Marielle seated themselves in the module.

While we were taking care of business inside, the snow had continued to fall. In addition, I had elected to park the ambulance in a snowdrift. Generally, no big thing, either drive our happy ass out of the snow, or rock things a few times, and off we go. As it happened, our truck had settled, snow had fallen in job lots, and, well, rocking that big ass truck was not about to extract us from that snowbank, at least, not tonight. I radioed dispatch to share this fact with them, requesting apparatus meet us with a wrecker. No go, they were at the scene of a multiple alarm fire across town.

Marielle and I discussed this revelation, and tried to brainstorm an escape from our snowy parking spot. I tried to rock us out, several times, and accomplished just about nothing. While I was allowing the tires to cool down, and contemplating my next move, I was startled by a knock on the driver’s window.

The gentleman who had knocked, evidently a resident of the projects, once I rolled the window down, asked me if I was stuck.

I admitted that, indeed, we were stuck. He noted that this might interfere with our transporting this patient to the hospital. (remember her? She was kind of the reason (a) we had jobs, and (b) we had come to find ourselves stuck here.) My new friend admonished me, “Don’t go anywhere!”, and I thought that I had that pretty much covered.

Minutes later I realized why he had so admonished me. This gentleman, and around a half dozen other residents gathered around our ambulance, and everybody picked their own piece of bumper, and commenced to heaving. We moved, briefly, until everything settled again, refusing to move any more.

I tasked Marielle to maneuver the vehicle, and I joined our block club meeting at the rear of the ambulance. Another maybe six or seven souls had exited their nice, warm homes, and joined us in the knee deep snow. At night. And cold as a politician’s heart (should such an organ actually exist!)

As it developed, the bumper was taken, so extra folks tugged on door handles, pushed on their fellows’ backs, and so added perhaps 12 “citizen power” to our efforts at movement.

Slowly, jerkily, gradually, the truck moved closer to the roadway, and eased out of the parking lot. Soon, we were in the middle of the street, and able to move under (the manufacturer supplied) our own power. I effusively thanked the gathering of neighbors, recognizing their irreplaceable efforts, and we set off to the hospital.

Nearly 40 years later, I remember those folks. When I hear smack talk about inner city residents, or residents of public housing, or people-who-don’t-look-like-us, I realize that, perhaps there is less sunscreen sold in those precincts, but Children of God are Children of God. Some are vermin, some are saints, and most simply want to pay their bills, raise their children and love their families, and make it from one day to the next.

Not altogether different from me.

In Review….

I’m an old stretcher ape. Started in EMS a long, long time ago, working in, and for Da Big City. Worked my way through nursing school, and eventually went to grad school, in my capacity of Official Old Fart. I’m chock full of stories, all of which begin with the obligatory disclaimer, followed by the Mark One, Mod Ø preamble: “This is no shit! There I was, fighting disease and saving lives….”

Abbreviations, Acronyms, and Terms Of Art: I tried to assemble all the esoterica in one place, for ready reference/translation to the non-medical readers. Somebody suggested that the link/page of this stuff was inaccessible for one reason or another. Here’s another go at it!

I’ll try to collect all the unusual, non-standard-English phrases and suchlike here, for easy translation.

• BVM: bag-valve-mask. A device for introducing room air into the lungs of a     nonbreathing person, by compressing a bag, pushing the air from that bag through a one way valve into the mouth (and therefore airway) of said person via a mask. Releasing the bag allows it to self inflate, and the patient to exhale, so you can repeat the whole process again. And again. And again…
• Carotid pulse/Artery. Large bore neck artery, main pathway for blood to travel to the brain from the heart. One on each side of the (kinda) front of the neck. High pressure. Lotsa blood flow.
• CLOVER: (from The Urban Dictionary): Clovers believe that they are always doing the right thing, and therefore everyone should wait on them, or are basically oblivious to others’ needs.  Clovers generally believe that if someone does something that irritates them in some way that a law should be made to correct the problem – “There ought to be a law”. A Clover will always side with the police or the government no matter what egregious evil they have committed.
• “da corridor”: the district immediately south of Da University, a sort of wrong-side-of-the-tracks “entertainment” district. An environment rich in overdoses,alcoholism, prostitution and assorted pathology. Commonly, in the spring you would notice new, young, generally female faces among the inhabitants. Towards autumn, most of those faces were absent (Ghawd, I hope that they went home!), and the ones remaining were in no way as fresh, bright eyed, or as healthy looking as they had been around 5 months previously.
• DBCPD (Da Big City police Department)
• HEARN: Hospital Emergency Alert Radio Network, a  VHF. radio channel employed for (surprisingly enough) alerting the hospital of pending arrival, particularly of a priority patient. 
• Kel-Lite: heavy duty, police-style flashlights, useful for illumination, or as a bludgeon
• RFN: Right Fucking Now
• SBTHIDC/SBTCIDC: Second Best Trauma Hospital/Center In Da City.
• “Stat”, “Stat-like”, or “right Stat like”, all equate to “IMMEDIATELY!”
• TBTCIDC: The Best Trauma Center In Da City
• TINS: This is no Shit
• TIWFDASL: There I was, fighting disease and saving lives….
• TLHTTIC: The Little Hospital That Thought It Could
• “To”: (pronounced “toe”, like the digit) short for “ghetto”, as in “Life is tough in the ‘to”
• “Wheedle-Deedle”. The sounds made by an electronic siren. See Also, “Most weird Noises From An Electronic Siren

Accident Letter

So, TINS, TIWFDASL, and responding to some sort of emergency or other. It was my day to drive, and I was merrily coding along. Approaching The Major North Bound Thoroughfare as I headed west bound, light and siren flashing and a-wailing, I slowed and observed cross traffic (who had the green light), stop on the rain slicked street.

That appeared encouraging. I began to accelerate through the intersection, when, lo and behold!, I beheld a driver swing into the center lane, pass all the stopped traffic, and proceed to strike the ambulance aft of the driver side dual rear wheels.

He had built up to fair clip, because he rocked the modular ambulance pretty good. Indeed, given my own momentum, the aft of the rig slewed to the right, and we entered a skid.

I corrected, steering into the skid, and noted in passing a pedestrian on the northwest corner determine that he did NOT want to remain standing where it appeared I was going to roll over, and so he started stepping lively toward the south.

Remember that “I corrected my skid” thing? Yeah, about that. It turns out that correcting a skid, in a, oh, let’s guess 5 ton truck, is not a fact, it is a process. So, when I had corrected our slewing-sideways-towards-the-northeast skid, we NOW had a slewing-sideways-towards-the-west-southwest skid. Less off axis, so there was that as an improvement, but our friend the pedestrian (remember him?), last seen high stepping to the south, did not think much of this as it portended his own immediate future. He demonstrated this understanding, as well as outstanding situational awareness, as he skidded to his own stop, about faced, and accelerated north.

I had noticed that we were skidding kinda sideways, in a west-southwesterly direction, and so, once again, I corrected, steering into the skid. Once that had been accomplished, we were merely proceeding catty-wampus, in a more or less northwesterly direction, and, it appeared, tracking our poor increasingly frazzled pedestrian friend as if we were a pedestrian seeking missile. With target lock.

Fortunately on several levels, all these gyrations had bled off considerable speed, and I was able to come to a complete, and rather abrupt, stop, short of squashing the pedestrian.

My partners were uninjured, as we had vicariously experienced many, many motor vehicle collisions, and had scant desire to recreate the experimental results we had witnessed. We were all buckled up.

While I was attempting to determine if my SVT (supraventricular tachycardia: an accelerated heart rate running around 150-200 beats per minute) was self limiting, or my new normal, Doug figured that (a) we were not completing this run, and (b) this might be a nice thing to share with dispatch. He did so.

We checked the other driver (who was fine), and awaited the police, city wrecker, and the inevitable chat with The Lieutenant. Fun times ahead, indeed.

The officer taking the report only had about 7,000 questions, and, once he was done, dropped us off at apparatus. There, we got to switch from our rig, into a back up rig. Back up rigs were too rickety to be in front line service, but not so obviously rattletraps that they could not serve as interim ambulances until our rig was repaired. Which in our case was likely to be sometime around the heat death of the universe.

We returned to quarters (with Doug driving!), where we awaited Lt. Evans. Once he had arrived, he directed me to write a letter (standard practice) detailing the events that had led up to our nice new truck getting bent up.

At this point I was the union’s chief steward, and was familiar with the contract. One of the provisions thereof was that any member, facing potential discipline, had the right to consult with a steward prior to making any official statement. I figured that, hashing this out with another steward might allow me to avoid talking myself into (harsher) charges (than I already faced for the collision).

Another peculiarity of Da City’s system, was that it appeared that the algorithm for assessing fault ran as follows. (each yes answer advanced you one more round) “Were you driving?” (Y/N) “Were you driving a city vehicle?” (Y/N) “Was that vehicle involved in a collision of any sort?” (Y/N)

“GUILTY! GUILTY! GUILTY!”

No shit: on one call, I had parked the ambulance in the street, four way flashers flashing, beacons in operation, I and my partner were IN THE REAR OF THE AMBULANCE, when some jackhole decided that, as IMPORTANT as he obviously was, he could not wait for us to roll off, and had to depart NOW! In the course of snaking his way out of the parking spot right next to us, he nudged the ambulance bumper, causing the vehicle to rock on it’s springs.

Like a dummy, I reported it. To my astonishment, it took the Accident Review Board SIX FREAKING WEEKS to ascertain that I was NOT at fault.

So, with these lessons in mind, I was reluctant to make any sort of official statement without at least having another steward tell me I was doing it wrong. I said so the Lt. Evans, and said, “So, sir, I officially request that I be allowed to speak with a steward prior to making an official statement, as guaranteed in our contract.”

He gave me the stink eye. “You’re the chief steward, right?”

“Yes, sir.”

“So, go chat with yourself , and write my damned letter. Now would be good.”

“Uh, sir…?” I began.

“Mr. McFee, I am making that an order. Do so, at once!”

“Yes, sir!”

I therefore drew up a piece of Fire Department letterhead, and composed the following letter:

“TO: Superintendent of EMS

From: Reltney McFee, EMT

Subject: Collision involving Medic 23 this date

Date (date)

Sir: Lt. Evans ordered me to write a letter regarding Medic 23’s collision this date. I requested the opportunity to speak with a union steward prior to making any official statement, and Lt. Evans ordered me to write you a letter at once.

This is that letter.

Respectfully, Reltney McFee EMT, Medic 23”

I pulled it out of the typewriter, placed my carbon copy in the desk, and handed it to Lt. Evans. “Here’s your letter, Lieutenant!”

He looked at it for a minute, and glared at me. “McFee, this is unsatisfactory. Write this letter, all over again, and this time do it right!”

“Yes, sir!”

I assembled another set of letterhead and carbon paper, and captioned the next letter as before.

My opening line was as above. I asked the Lieutenant, “Sir? What do you want me to write now?”

He said, “McFee, I’m not going to tell you what to write!”

I typed in, “Lt Evans told me to write, “ ‘McFee, I’m not going to tell you what to write!’ “

“What’s next, sir?”

“Goddammit! Stop that! Just write what happened in your accident!”

My next line of text was, “ ‘Goddammit! Stop that! Just write what happened in your accident!’ “

“Yes, sir? What is next?”

He glared at me. Again. “McFee, get up from that chair. Do not type another word!”

I stood. He asked me, “McFee, what do you think you are doing.”

“Well, sir, you ordered me to write a letter about an accident prior to my having the opportunity to speak to a steward about a matter that might result in my being disciplined. I complied with that order, and wrote a letter citing everything that I was willing to say at this moment. You did not find that satisfactory, and ordered me to re do it. I was rewriting it to your specification, when you abruptly stopped providing me directions. Sir.”

Again, with the glare. “It is now 1300 hours. You will have that letter, and I mean the letter that you KNOW you have to write, in my hands no later than 1700 hours today, without fail! Am I making my self clear?”

“Perfectly, sir!”

He stormed out.

I got his letter to him, after a phone consult with another steward.

Oh, yes, And I got a written reprimand for my role in the collision.

Suburban Community Hospital (or) Be Careful What You Ask For!

Another time, with dispatch whimsically sending us on a scavenger hunt all over Da East Side of Da City, we had occasion to transport sumdood to Suburban Community Hospital. This was a fairly sizable establishment, even by the standards of the day, and the ED was pretty busy upon our arrival.

We handed Mr. Dood over to the nurses, gave report, and began to prep the cot for the next lucky contestant. One of the nurses ambled over, and engaged us in conversation.

“How come you guys only bring us drunks? We can handle anything TBTCIDC can handle!”

Doug spoke up. “Uh, Ma’am? That’s kind of the majority of what we bring to TBTCIDC, ya know? Most of our runs are sick folks and drunk folks.”

She wasn’t gonna let this go. “Aw, c’mon! How come we never get any good trauma! I know you guys take all the trauma to TBTCIDC! Howzabout occasionally bringing us some of the stuff you always are taking to TBTCIDC?”

We mumbled something that maybe could have been taken as assent, and she meandered off to fight disease and save lives, or something.

As Kharma sometimes deigns, our next run was not too far from Suburban Community Hospital. Indeed, the Grin of Kharma must have been epically large, as the next call was for a very drunk, very loud, very combative inebriate.

Once we had him restrained and in the truck, we conferred. Consensus was, we were about to return to Suburban Community Hospital. After all, they had ASSURED us that they could handle ANYTHING that TBTCIDC could handle.

Well, to paraphrase Bill Engvall, “Heeerrreee’s yer patient!”

When the nurses began to chastise us about our patient selection, as well as our destination selection, our refrain was, “Well, you told us that you were perfectly capable of handling anything TBTCIDC could handle! This fine young man, right here, is completely typical of their patient population!”

And, then we scurried away……

HIV Transfer

So,TINS©, TIWFDASL©….well, OK. I was a nursing supervisor, and therefore, in the view of my peeps, I was, at best, not an impediment to their doing their jobs.

So, in any event, this was way, way back in The Dark Ages, Before Cell Phones (Gasp! No! There were PEOPLE, way back then?!?). This was around the time that some bright clinician noticed that there was a peculiar form of impairment of the immune system, that seemed particularly prevalent among homosexuals (currently described as MSM, for “men who have sex with men” in the clinical literature), and IVDAs (“Intra Venous Drug Abusers”). Nobody was really clear on how this was transmitted, although some sort of exposure to bodily fluids originating in one of the sufferers of this malady seemed a common feature of acquiring it.

My little hospital had a drug rehab unit, the purpose of which was to smooth the discomfort of discontinuing narcotics use, so as to help the recovering addict start to re arrange the other pieces of his/her life, into a non drug dependent direction.

So, it developed that our medical director of this unit had determined that one of his patients on the rehab unit did, indeed, have this acquired immune deficiency syndrome. (You may have already recognized the acronym “AIDS”). In these dark days, the capability of treating this disease was limited to specialty units in tertiary referral centers, and therefore we made arrangements to transfer our patient to The House of God, Local Edition.

I called the contract transfer ambulance service, and provided the needful information. All was set, I turned to my next problem. Or so I thought.

On the order of an hour later, I received a page from the drug unit. They desired my presence, pronto. I trotted on up.

Once buzzed into the unit, I beheld a pair of basic EMTs, one irritated patient, and one pissed off charge nurse. I drew the charge nurse aside, and asked WTF was happening.

“These idiots are acting like extras from “The Andromeda Strain”, and refusing to take our patient unless they and he are in full isolation garb, and they didn’t bring anything. They are insisting that we outfit them with masks, gowns, gloves, masks, and surgical hats. You’ve been to the same in-services as I have. That’s bullshit. Unless they are going to share needles in the back of the ambulance, there is nearly no risk whatsoever. Could you please talk some sense into these guys?”

I invited the ambulance crew to join me in the nurse’s lounge, and asked them what the issue was. One spoke up. “That guy has AIDS. I don’t wanna catch no AIDS. That’s why we need all that protection!”

Now, remember. This was a BASIC transfer. This guy was alert, lucid, cooperative, not bleeding not coughing up amphibious life forms, continent. All in all, not spreading any bodily fluids anywhere at all. It had, I’ll admit, been several years since I had been on the road, but my paramedic license was still current, and I was unaware of any evolutions in pre hospital care on a basic inter hospital transfer that might place these guys at any measurable risk. I told them as much.

“Yeah, well, I dunno how it was way back in your day, but nowadays, well, we gotta protect ourselves!”

Uh, yeah. “Back in my day”. So, my response was measured, and professional. “Gentlemen, please get comfortable. I’m going to chat with your supervisor, and we’ll get this all squared away, pronto!”

I lied. I talked to MY supervisor, the director of nursing, and told her my little tale. She was, to be charitable, irritated, and mused aloud about her to-do list for the morrow. Prominently featuring contracting with the Non Imbecile Ambulance Service, which, so it appeared, would NOT be the employer of the happy go lucky souls with whom I had shared our nice little chat. She suggested that I share that project with the on duty supervisor of the Incumbent Ambulance Service, with the suggestion that they may want to reflect upon how far into this project they really wanted her to get. “Yes, Ma’am!”

I called their dispatch, invited them to have their on duty supervisor call me, right stat like, and awaited the return call.

This worthy was not any sort of improvement over the dolts that he had caused to be sent to us. I smiled, reminded him that we’d be in touch, and went back to the unit.

By this time, both EMTs were garbed as if for joint replacement surgery, absent only the PAPR respirators. They had wrapped the cot with plastic, and then, standing several feet from the cot, invited my patient to “Sit!”.

Nice.

I apologized to the patient, and wished him the best of luck at the House of God, Local Edition. He shrugged, thanked me for my efforts, and gracefully in demeanor, settled in for his ride.

A couple of days later, one of the medics from A Competing Service stopped me in the hallway. “I heard you put a good word in for us, and we now have your transfer contract. Thanks!”

I corrected him. “I didn’t say one thing about you guys. Likely, my boss remembered your stellar performance with our out-of-state transfer a couple of months ago, and when the need for a new contract came up, remembered you and how smoothly you guys ran that.”

I didn’t tell him to thank The Incumbent Ambulance Service, and their crew of Laurel and Hardy.

If You Are Taking Medical Advice From The Voices In Your Head, You Are Doing It Wrong!

So, TINS©, TIWFDASL©, when we caught a run for a “sick person”. My tales of adventure notwithstanding, the overwhelming majority of EMS runs in Da City were what the personnel called “sickies”. This tale is about one such soul.

We arrived, and things progressed in the usual fashion. Six questions, one command.

1. “Who’s sick?” (show of hands).
2. “What kind of sick are you?” (the response generally ran along the lines of “I’m really sick”, or “I’m just sick, that’s all!”) (so much for “History of Present Illness”)
3. “How long have you been sick, Sir/Madam?” (typical response was some variation of “A good little while.”)
4. “Do you want to go to the hospital?” (A surprising number of people did NOT want to go to the hospital. Some wanted to be told that they were alright, others wanted to go to some place in West Bumfuck, way, way, way outside of Da City’s service area, or wanted a ride to the doctor’s appointment that they, surprisingly, had made. We did not take folks to their doctor appointments or to BFE Community Hospital. Fire department rules.)
5. “Can you walk?” (the correct answer is always, “YES!”. Occasionally “No”, but the number of trivially ill/injured folks traveling to ER via EMS was both surprising and disappointing.)
6. “Where are your shoes?” (Again, a surprising number of folks who presumably had lived in Da City all their lives, and had noted snowfall and freezing ass temperatures arrive each and every winter, did not think to have their shoes staged, oh, I don’t know, NEAR THE DAMNED DOOR, once they had determined that they required ambulance transport to the hospital emergency department for their sniffles or whatnot.)
7. (Command) Follow Me!”

So, one such soul, seated in the back of the ambulance with me late one night/early one morning, was being interviewed by me. I asked him his allergies. “No, none, not really.”

I asked him his medications. “Well, no, none, I guess.”

That did not sound right. I asked, again, differently. “Does you doctor think that you are taking any medication regularly?”

“I suppose so.”

“What might that medication be, that you suppose that your doctor thinks you ought to be taking?”

“Oh, some nerve pill.”

“Oh? ‘Some nerve pill?’ Why aren’t you taking your nerve pill?”

“Well, the voices in my head told me I didn’t need them any longer!”

“The voices told you that, did they?”

“Oh, yes! They were very clear about that!”

“I bet that they were!”

MAST Trousers

A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.

So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.

In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).

We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.

So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.

We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.

I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.

I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.

To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.

We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”

I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.

Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.

Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.