Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

Bradycardia and The Cough

TINS©, TIWFDASL©, nursing in the ED of this community hospital in Northern The Un-Named Flyover State. A gentleman arrived, somewhere in his forties, and he told his tale of chest pain. He shortly thereafter sported the latest fashions in IVs, EKG monitoring, oxygen, and much blood drawn and sent to lab for analysis.

Two things you should know about me. I am a bottomless well of generally useless trivia, for one. For example, the relevance of which will become apparent shortly, I read a bunch of stuff, including a report, years and years and years ago which asserted that individuals undergoing a cardiac catheterization would be instructed that, should they be commanded to do so, they should cough vigorously and repeatedly. This would, or so the article asserted, increase pressure inside the chest, compress the heart, and thereby expel blood from the heart. This was important because occasionally the catheter, introduced into the heart, could produce irritation sufficient to produce fibrillation. (an uncoordinated trembling of the heart, which produces no blood flow. A Bad Thing.)

Once they drew in another breath preparatory to coughing once again, the negative pressure inside their chest so produced would encourage their heart to again fill with blood, which would be expelled with the next cough. This could temporarily produce enough blood pressure to keep things idling along, until the cath lab staff could intervene and set things right.

The other thing about me, is that I am somewhat chatty. (“No! Say it isn’t so!”). Okay, very chatty. So, there I was, chatting with this gentleman, and noting his cardiac rhythm and heart rate as displayed upon his cardiac monitor.

I noticed that his heart rate, originally in the 90’s, was trending downward. (normal is around 60-80). Once it dropped below 55, I stopped congratulating myself on wonderful patient care, and began to worry.

He began to report feeling dizzy and weak. I directed him, “When I tell you to cough, do not ask any questions, simply do it!”

He, of course, asked me why, but at that point his heart rate had dropped below 30 (Very Not So Good!), and I was a bit terse. “Stop talking, and cough!…Cough!…..Cough!….”

I repeated myself at about one second intervals. Now, I am sure that the other nurses heard me, and wondered what variety of insanity had afflicted me. Once they came in to investigate, and I waved my hand at the monitor, continuing my coxswain like commands of “Cough!….Cough!….Cough!….”, they noted his very, very slow intrinsic heart rate. That, coupled with this guy, eyes fixed upon me, coughing every time I commanded him to do so, told them everything that they needed to know, and things got considerably more active in short order.

He soon received a temporary external pacemaker and and an ICU admit.

And we all lived happily ever after!

Fun With Suits! · Life in Da City! · Pains in my Fifth Point of Contact

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.

Sometimes You Get to Think That You Have Accomplished Something!

Crash of a Small Plane

So, TINS©, TIWFDASL©, working a mid city house, “Power Shift” (1400 to 0200) with Doug and Ed. It was one of those shifts wherein dispatch seemed to feel compelled to send us on a magical tour of Da City. We transported folks to hospitals that I had never expected to see in person. East side, west side, all around the town, as the song goes.

So, we were SNR’d on our latest run (SNR= Service Not Required. In this case, because the nominal sick person wanted no part of going to the hospital, and was only too happy to sign the waiver and bid us goodbye.) Since we had been out to the east side of nowhere that shift, well, I figured the Patron Saint(s) of EMS wanted us to head east.

There we were, motoring northwest along Alternate Main Drag Road, when Ed, looking out my window, saw a column of smoke. I wheeled north on Major Northbound Roadway, and, paralleling the airport, radioed in to dispatch, inquiring if there had been a report of a working fire in our vicinity.

Nope, they hadn’t heard a word.

Being inquisitive sorts, we continued northbound, until, coming to the roadway that formed the northern perimeter of the airport, we turned west, since the column of smoke was indeed to our west.

We found it, two blocks over, and turned onto the street in question. I pulled up in front of the house next door to the involved structure, thinking that our friends the firefighters might feel the need to place their engines adjacent to the burning structure. I noticed a light airplane sticking out of the roof of the burning structure, and supposed that the two were related.

I had no idea of what street we were on, so I called to the civilians milling about, asking for the name. They provided it to me. Then, I paused. I could see the house number of the house I had parked in front of, but had no idea of the house number of the involved structure.

Yeah, you’re right. After 2-3 seconds of reflection, it struck me that, if I could identify the burning house from my location, the highly trained, very experienced, thoroughly professional firefighters likely could replicate my feat of high level cerebral functioning.

I radioed in to dispatch, “Medic (number) on scene of a fully involved house, aircraft crash, casualties noted in the yard. Please send fire and additional ambulances.”

Then I unassed the rig. Ed had already pulled one fellow, laying in the driveway between the involved structure and the neighboring one, around the uninvolved structure and out of the radiant heat pouring from the fire. Doug was just getting to the other patient on the ground, and we pulled him, also, into the lee of the neighboring house and into their fenced in yard.

Once relatively safe, we conferred: Ed wanted a couple of backboards so we could rapidly splint these guys and get the hell out of dodge. I hopped the fence, grabbed the requisite materiel, and tossed it over the fence.

Doug and Ed rapidly backboarded the one guy, set the head of the board on the fence, and then one of them hopped the fence, he and I finished the lift, and trotted him to the rig.

We returned, helped Doug complete boarding the second guy, and back to the truck we went.

Once both were strapped into the ambulance, we were off. Coincidentally, the first engines were about set up and beginning to flow water as we departed.

I do not remember the run to TBTCIDC. I DO remembergiving report, and the smoke smell we tried to clean out of the ambulance.

Funny thing. A couple of months later, I was visiting my brother in Alexandria, VA. Since he was working, I played tourist during the day. Now, this was 1983, around a year after the plane crashed into the 14th street bridge. The very bridge I had to cross into DC. As The Fates would have it, an aircraft– a big passenger jet– was landing as I was crossing the bridge. I don’t want to say it was close, but….I could count the rivets on the bottom, as it passed over my head.

Yeah, I didn’t break out in a cold sweat, or anything. Except, I did.

Pre Planning Your Scene

mURPHY rULES! (and how to try to stymie him)

Among the blogs I visit more or less regularly, is “Notes From The Bunker”, featuring the adventures of the thoughtful and experienced Commander Zero. Today (As I write this it is 5 Sept 2019), The Commander reviews thoughts on idiot proofing your kit, particularly your first aid kit. (see for yourself: http://www.commanderzero.com/?p=6547#comments , “Mylar After Two Years Of Exposure”) He makes a mighty compelling case for, in effect, double bagging your first aid supplies, and he has, indeed, harshly tested his packaging. He has not found it wanting.

Aesop of Raconteur Report (ANOTHER regular read! Find him here: https://raconteurreport.blogspot.com/ ) commented on the original post, (found here, from March 15 2015: http://www.commanderzero.com/?p=2511), and, as usual, his comments are insightful, practical, and reflect studies in Advanced Placement courses at The College of Hard Knocks. I reprint them here, because I don’t want you all to miss them.

“1) Any FA kit that isn’t waterproof is worthless. If not now, then when you need it, which is worse. As you’ve discovered, and as I did the first time I was working on a movie set on a rainy day. It’s a mistake you only make once.
2. Mylar is nice, but you can’t see what’s inside. Consider heavy-duty Saran wrap or equiv. as something still see-through, but easier to tear open than mylar or two-hand zip-loks.
3. If you’re any kind of handy with a sewing machine, turning mil-spec poncho materials into pack and bag condoms is a quick and elegant way to make your favorite bag far more water resistant. It also gives you options as far as external appearance, whether more camo’ed, or more non-descript than Tactical Timmy camo patterns in urban use around the unprepared muggles. YMMV.
4. Given your penchants anyways, you can get single-use heat seal clear plastic bagging material too, and simply resolve that if you tear something open for use, you’ll re-stock and re-seal it at the first opportunity.
5. As far as opening, putting a guard-protected single-edge razor or retractable box cutter in the top of the kit is never a bad idea. For some of the sterile wrap crap used in the ED, I need bandage scissors, trauma shears, and/or a hemostat (think ER pliers) just to open the goddam packaging, and that’s indoors in air-conditioned comfort, with two hands.


(THIS PART THAT FOLLOWS IS GOLD, RIGHT HERE!)

6. As a general rule, whether for first aid or any other kind of kit, anything that couldn’t be reliably used during a year’s service in the WWI trenches of the Somme probably isn’t proper kit to rely on, and you’ll find that out at the worst possible moment. Field-test your gear and eliminate the flaws now, when mistakes are free.


7. Just random curiosity, but for a bike kit, why not something along the lines of a screw-top or screw-twist together PVC pipe or somesuch thing, clamped/strapped/zip-tied/etc. to the frame? Bombproof, compact, and totally watertight, and you could size the tube diameter to the largest items, and adjust the length so everything fits. Just thinking out loud there.”

With that preamble, may I direct your attention to my own humble work, from mid June of this year? (https://musingsofastretcherape.wordpress.com/2019/06/14/do-it-yourself-emergency-care/ )

With Commander Zero’s (herinafter referred to as “CZ”) insights, and Aesop’s commentary, I have been stimulated to consider shortcomings in my own arrangements.

I have never had my own kit(s) fail as in Czs experience. Mine are presently indoors or in my vehicle trunk. Previously, for years, my kit rode in the back seat of my dual cab pickup truck. When we loaded up, kids, luggage and all, it went into a tote in the back of the truck, inside a camper shell. That has/had worked out alright for me. On the other hand, I have never done a rainy weekend FTX, either. THAT sort of adventure might have elicited Aesop’s perspective.

Since one of the objectives of much of my hobbies/avocations/off duty activities is preparing for unwanted possibilities, the next generation of my deliberations will be considering how I can benefit from the above insights, and integrate them into my own preps.

For example, if I am compelled to hike my happy ass home from work, due to EMP/Carrington Event/One Minute After/civil disorder/Zombie Apocalypse, what is the likelihood that it will be sunny and seventy outside, versus raining cats and dogs at night in a gale? (Select option “B”, if you please!) Or perhaps mid January, with ass deep snow and wind, at a daytime high temp of 1 degree (for our European readers, that approximates minus 17 degrees C)?

The “I don’t want to freeze my butt solid, to the ground” aspects are likely intuitive, to anybody who has lived in The Midwest for any length of time, but protecting your equipment from those conditions may not be so obvious. (To be honest, this particular aspect had not made it’s way to the front of my own consciousness, until today!)

Broadening this thinking to other aspects of, say, a “Get Me Home” bag, suggests that packing said bag in sub-modules might be clever, if said sub modules are water proof (or, at least, repellent). Again, as of present experience, I’ve had no issues with water etcetera damaging my medic bag, or anything in my “possibles trunk”. That’s fine, until my 13 year old vehicle develops a hole allowing water or whatnot into my trunk.

Or, until I have to hop home in the Oobleck Storm. (or whatever). In those settings, I will regret not acting on CZ’s or Aesop’s insights.

Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

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.

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve

The Leviathian Comes Alive!

So, one time we got dispatched to an unconscious person run on the east side. We arrived to see a number of police officers from DBCPD standing around. One of them pointed out a large slumped soul, leaning up on the steps on a rear stairway of some house.

He was not entirely flaccid, and he WAS breathing on his own, both desirable attributes from my point of view. Even so, leaving him to metabolize towards mobility appeared to be a bad plan, so Porthos and I attempted a hold-him-under-his-arms walking assist. It worked, sort of. Well, it appeared to be working well enough that we could maneuver him to the truck, and thence to TBTCIDC, where he could indeed metabolize to freedom, under the loving and watchful eyes of the TBTCIDC Emergency Department nursing staff. For bonus points, he would then not be our problem.

Porthos and I were making progress, of a sort, toward the ambulance, and the police were doing their police type stuff, when I got the bright idea that perhaps a whiff of an ammonia capsule might energize our guest.

Now, with the wisdom that comes with hindsight, THAT might have a good idea to, ya know, DISCUSS with my partner. That discussion might have elicited several beneficial outcomes, like problem solving IN ADVANCE, and anticipation of ways in which this brainstorm of mine might have turned horribly wrong, for example.

As might have become evident, I did NOT discuss this little plan of mine with my partner, and simply retrieved an ammonia cap from my pocket, snapped it, and allowed Mr. Leviathan to breathe deeply of the healing aroma.

He abruptly, and I mean RIGHT FUCKING NOW! Became considerably less stumbling, and way, way more energetic, shaking loose of my grasp on his arm, and turning on my partner.

This might be a good point in my tale to note that our guest was tall, and big, and outweighed me, as well as Porthos, by a considerable margin. If he should commence to some wrasslin’, well, whichever one of us was the object of his affections, would not enjoy being so objectified.

Porthos had noticed our guest’s reanimation, although he was a fraction of a second slower than I in so noticing, and so King King, our newly energized patient, was advancing upon my partner, hands outstretched, and backing Porthos rapidly into a corner.

I realize that things happen quickly, and it appears that time stands still, nevertheless those officers sure appeared to be statues, while this shambling wreck of a man-mountain was advancing, cornering my partner, presenting a clear and present danger of laying hands on him.

I found my Mag Light in my hand, and advanced, on my toes, behind him. My flash plan was, once he had indeed grabbed Porthos, well, I was going to go for that line drive, featuring his head as the baseball.

So, Ninja like, I was advancing upon Leviathan, Leviathan was advancing on Porthos, the cops were unmoving, and I, catlike, managed to step on his foot.

Good news: he forgot about Porthos.

Bad news: he figured that I was oh, so very much more deserving of his attention than my partner. He began to turn on me, so as to show me some love. Of some sort.

Good news: whatever was the source of his previous lethargy, it slowed his synapses, and so the insight that he would rather be thumping on me, rather than Porthos, took him a not inconsequential amount of time to process, and then to act upon.

Good news: Porthos took that opportunity to zig to Mr. Leviathan’s zag, and begin to beat feet to the truck.

Good news: I accelerated to warp speed promptly, and so managed to arrive at the ambulance about the same time as Porthos.

Good news: our officer friends were, themselves, in motion, and they converged on Mr Leviathan, and dissuaded him from pursuing any further laying-on-of-hands ceremonies.

Indeed, they were so persuasive, that they elected to transport our new friend to TBTCIDC, themselves.

Porthos and I had, well, I suppose you might consider it “a teaching moment” once we were back in service. My ears stopped burning after a couple of hours.

Fun And Games · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

“Speck’ ah got it figgerred out!”

So, TINS©, TIWFDASL© at Rural Community Hospital ED one fine summer afternoon, nothing exciting (for me, at least: the folks who were here for sutures, or chest pain, likely thought that their dilemmas were entirely more exciting than they would otherwise desire!).

So, this fellow trotted in, carrying a crying child. He announced that the child had cut his head. Our nurse aid escorted the gentleman to one of the carts, and started to look into the problem. I tagged along.

Quick witted, she promptly determined that stapling this child’s head would likely result in a net minima of drama and caterwauling, so she plucked up a surgical stapler, and some betadine, and began to clean up the lac.

The physician arrived, and she briefed him on her findings. Me? I occupied myself trying to get vitals, allergies/meds/medical history on the child from the (clueless) dad. Doc began to perform his own assessment, as the mother arrived.

This elicited another chorus of wailing, tears, and general drama. Predominantly from the child, although the mother contributed her own share. The physician informed the parents that he was planning to staple the wound, once my friend the nurse aid had completed her task of cleaning things up.

“Is that going to hurt him?” was the mother’s question.

My bad, I answered her truthfully. “Yeah, but it will only be 4 pokes. If we stitch it, there will be 8 or more pokes to numb it, and then another 8 or so pokes to sew it up.”

Likely, it was lost when I used the word “numb”. I suspect that she stopped listening at the word “numb”, and failed to do the math. “Oh, I don’t want him to hurt! Can’t you numb him?”

The aid tried her hand. “Well, yeah, but that will require 8 needle sticks, whereas if the doctor simply staples it, there will only be 4 pokes”.

Mom had One Thing on her mind. “I don’t want him to hurt!”

The physician tried. “Ma’am, nobody wants him to hurt. In fact, if I simply staple the cut closed, he will avoid something like 12 additional punctures, and the discomfort associated with those 12 punctures.”

“Please, numb him up! I don’;t want him to hurt!”

Resigning ourselves to our fate, I collected the lidocaine, syringe and needle, and my friend the aid swaddled the child in a blanket.

The kid promptly figured out where this was going, and he wanted NO PART of this ride. So, I set up the doctor’s suture set and lido, and joined the rodeo.

The kid screamed, and he flipped, and he flopped, and he writhed, and he twisted, and he turned. He shook his head, so I was detailed to seize his head, and immobilize it. Mom, to her credit, laid across her child’s legs, and dad laid across his torso, so the doctor only had to zig and zag over roughly 30 degrees of motion as he was injecting the local anesthetic into the margins of the wound.

Did you know that lidocaine, injected into your skin, burns? Yep, burns like a sonuvabitch, for a minute or two. Now, may I watch YOU explain to an 8 year old, that the burning will go away soon, and then things will be numb? Because, he was not listening to me at all, which, of course, assumes that any earthly creature could distinguish my speech over his screams, and cries, and shrieks, and general high volume protestations. Because, I could not.

So, once the doctor had established that the process was going to be pain free (because, of course, the anesthesia had been SO! MUCH! FUN!), the child was going to lay very still for the suturing?

Totally! And, the Democrat candidates for President are not vying to convince the electorate that they, only they, will be the BEST! At providing free stuff to non citizens, as well as college graduates who find themselves in the food industry.

Of course, no. Just, NO! More rodeo nursing, more Brahma Bull On the Suture Table.

Finally, at long last, we were done. The aid unwrapped the (limp)(sweaty)(hoarse voiced) child from the blanket, and we all stepped away, so Mom could hug the child.

She looked at us all, and said, “That was awful! Ohmigawd! I should have listened to you guys!”

I bit my tongue, and shuffled off to the nursing station, to complete my charting. The aid sat down next to me, and said, “Hey! I did my best!”

“That you did.” I replied. Then, taking on a stereotypical hillbilly voice, I continued. “Hyuck, hyuck! Ah’ve bin doin’ this here ‘mergency nursin’ thang for might’ near six, mebe seven weeks now! Speck’ ah got all figgerred out!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

Car Fire

So, before Mallory and I had begun to live together, I had one of my ex partners, let’s call him Adam, as my room mate. Mallory would come over from time to time, and the three of us would chat, or share dinner, or simply hangout.

One day, she came into the house, and asked us to hurry out and see what was wrong with her car. Now, this was her baby, one she had purchased because, as she termed it, “I look so good driving that car!” It had been her very first new vehicle, ever.

So, Adam and I threw on some shoes, and trotted out to see what was the matter. She had told us that it was smoking, and once we got outside, it became clear why. The smell of burning plastic emanating from beneath the hood told the tale.

Mallory was starting to get excited, hopping around and beseeching us, “Can’t you guys do something?”

Adam looked the vehicle over, and asked her, “Do you REALLY want us to do something? If we let it burn, or call the fire department, then it will be totaled, and you can get a brand new one. If we extinguish the fire, you are gonna have to get all that burned shit replaced, and it may never be altogether right, again.”

Mallory was nigh unto break dancing by now, and simply couldn’t bear to see “her baby” burn up. Adam asked her again, simply to be certain, “Are you REALLY REALLY sure you want us to do something?Again, she pleaded with us to act. Adam looked at me, I looked at him, and we charged the garden hose, donned work gloves, and sprayed it down through the grill as well as we could. Once it had dampened down, I opened the hood, and stood aside, while he blasted it (or, at least, “blasted it” as much as one is likely to be able to, with a garden hose!). It was evidently sufficient to the task, for soon the smoke stopped, the smell abated, and we were unable to identify any further burning stuff after diligent search.

Mallory called her insurance company, they sent a wrecker, and she got a loaner.

Several weeks later, her car was returned to her. She subsequently had repeated complaints about this, that, or the other thing not performing properly. Soon, she turned to Adam, and admitted, “If I had listened to you, and let it burn, I’d be driving a new car by now!”

Fun And Games Off Duty · Protect and Serve

Christmas Eve MVA

Christmas Eve MVA

This one time, at Band camp….no, wait: that doesn’t seem quite right….

Oh, yeah: TINS©, TIWFDASL©…(no, not altogether correct, either…). Well, I was NOT FDASL, rather I was visiting The Momette, in The Un-Named Maternal State, and, it being Christmas Season, I was shopping for Christmas presents for the family. Indeed, it was Christmas Eve (for am I not well prepared, and forward thinking? Well, no, not so much) when my brother, The Attorney, and I were attempting to find an open store for the Christmas Shopping, that I had not yet accomplished.

So, there I was, motoring down the highway, and my brother, a veritable fountain of trivia (as is his brother, come to think of it), observed, “They call this stretch of highway the Death Mile, because it narrows from 4 lanes to two, just ahead here, and there are a bunch of collisions right along here.”

How interesting. Just about that moment, I noted beacons in my rear view mirror, and moved to the right to allow a Maternal State Police Trooper to zoom past us at flank speed, siren wailing and beacons flashing. The Attorney commented, “He sure seems like he is in a hurry! Wonder why?”

A few seconds later, ANOTHER Maternal State Police Trooper zipped past us, at about Warp 8, similarly beaconing and sirening, and sped around the upcoming corner and off into the distance.

As we, ourselves, rounded the curve, I noted chaos, as one would normally find at the scene of a high speed collision. Indeed, it certainly appeared that there had been such a collision, with three cars scattered across several lanes, and the shoulders, of the roadway. I parked on the shoulder, clear of the debris, and alighted. Approaching one of the troopers, I introduced myself. “I’m an off duty medic from Da City, Can I help?”

The trooper looked over my shoulder, and pointed. “Yep. Talk to those guys, right there.”

I turned to see an ambulance stopping. I approached one of the medics, and repeated my spiel. He nodded toward one of the vehicles. “You take that car, my partner and I will take the other two.”

I whistled to get my brother’s attention, and directed him, “Get the medic bag in the back of my truck. It’s got that Medical Star on it. I’ll be over here.”

I approached the car, my brother running over and handing me my jump bag. I noted an adult male seated in the passenger seat, another adult male laid over, sideways from the driver’s seat, his head in the passenger seat occupant’s lap. He, the laid out guy, was not speaking. I saw the head sized divot in the windshield over the steering wheel, and supposed that might have something to do with that.

The guy seated in the passenger seat stated, “I don’t think he’s breathing!” I invited the passenger seat guy to move out of the vehicle, and assessed things myself. Yep, he was not breathing. Didn’t have a carotid pulse, either. I asked the recently moved passenger seat guy, “Do you know CPR?”

Yep”

Good. Get on his chest, I’ll ventilate him.”

My new friend set to chest compressing, and I dug my BVM (manual resuscitator) out of my bag, and began to ventilate our patient.

We resuscitated along for a good little while, until the arrival of a second ambulance heralded our relief. We continued CPR until the medics had cut off our patient’s coat (feathers everywhere!), initiated an IV, and began cardiac monitoring (VF, about as I had expected). Once all the technology was in place, we all four of us moved the patient onto their cot, and they took over from there.

I walked back to the truck, set my medic bag in the back, and approached one of the officers.

Officer, do you need my contact information?”

He squinted at me. “Who are you?”

I’m the medic from Da City, who worked that guy over there.”

He turned fully to me, and shook my hand. “Mister, gotta tell you, I’m really sorry I couldn’t talk to you before you left, because I really, really, want to tell you thank you for getting involved here, several states away from your home. Drive carefully, try to have a Merry Christmas!”

I was surprised, but said, “You’re welcome!”, and returned to my truck. I told my brother about my surprising conversation with the trooper. He looked at me, and finally asked, “You just don’t get it, do you?”

I had to admit that I didn’t.

He just did you a tremendous favor. You just gotta know that, with a likely dead person in this collision, there is gonna be a huge trial, right?”

Uh-huh.

And, you are a witness, right?”

Again, I “uh-huh’d” him.

So, being a witness, you would be subpoenaed to testify, and would be required to comply with such an order of the court. Which means you would have to travel your happy ass across the country, and find accommodations, and then miss work while you were here, to testify. At no small expense, both directly as well as in lost income. Said subpoena cannot be served on ‘Sumdood, Da City, usedtabeamedic’, right?”

Might be tough to serve.”

Yep. That cop just thanked you, in certain and unmistakable terms, for your service to his community.”

He paused, and then looked at me as if he had never seen me before. “I watched you out there. You really, really looked like you knew what you were doing. I would have been totally lost, but you just stepped right up, and started working away. Pretty impressive!”

I shrugged, just a little embarrassed. “Not like I haven’t done the same thing like, I dunno, a couple of thousand times before, right?”

Pre Planning Your Scene

Small Town Hospital Fun And Games

 

TINS. TIWFDASL in a small rural ER somewhere, and the local EMS had brought in Sumdood who had sustained some sort of injury, that necessitated placing him on a long backboard, and cutting off his clothing. Said Dood subsequently, and contrary to my exhortations, removed his backboard straps, ripped out his IV, exited the cot, and started trying to assault another patient. I overhead paged “security stat to ER” (try not to hurt yourselves laughing), and the reporting officer ran back in, and took down my crazy, naked, lunatic wannabe fellow patient assailant.

Mr Naked was trying to cold cock the cop, the cop was trying to cuff Mr. Naked, and it looked to me as if more hands were needed, on The Good Guy’s side. I grabbed Mr. Naked’s off hand, and it was on.

So, the three of us were rolling around on the floor. Neither the officer nor I was making much progress, because Mr. Naked was sweaty and (shockingly enough) uncooperative. In addition, and simply making my day so very much better, he was bleeding enthusiastically from the site from which he had ripped his IV. Nice.

One of the nurse aides came over, and asked, “Is there something I can do to help?”

I replied: “Go over to the phone, dial 9 to get an outside line, dial 911, and tell the nice dispatcher that you are at Rural Community Hospital ED, and you have an officer in trouble. Repeat that, over and over, without stopping, until you hear the sirens. Now. Now would be very, very good!”

Long about this time, one of the (male) floor nurses, having determined from the overhead page that This Was Likely To Be Bad, had gotten another floor nurse to watch his patients, and trotted into the fun and games. So, by the time that the first backup officer had arrived, there were FOUR of us rolling around on the floor. In the blood. And sweat. And, every bit as much fun as it sounds to those of us who really, really do not like to exchange bodily fluids in the middle of the ER. On the floor.

Well, it soon developed into a Public Safety Roll Call. Every officer in our rural county screeched to a stop in our parking lot. There were city cops, there were county deputies, State Police officers rolled in. I even think that the county’s Department Of Natural Resources officer joined in the festivities. EMS showed up, firefighters clumped in.

Mr Naked was subdued, and cuffed. The offices went to pick him up by his cuffs and feet, and I suggested that they were much less likely to hurt their backs, should our friends from EMS place him on a backboard, and transport him to the pokey in their truck.

On the way out of the door, the ER physician asked the medics to pause a moment, and the doc asked the patient if he, the patient, desired to be evaluated for any injury or illness. Mr. Naked responded with an oration on the peculiar mating habits of the physician’s mother. We took that to mean, “Why, Doctor, how thoughtful! No, thank you very much, but these nice officers and I have made other arrangements! Y’all have a nice evening!” (or, something like that)

I retired to the nursing station, to write a nursing note that looked like a Take Home Essay Final on “Emergency Nursing in The 20th Century: Issues and Answers”. It ran on the order of 2500 words, and I made certain that this narrative was filed where I could find it should the need arise.

So, out of the blue, maybe 5 years later, I received a phone call from the Prosecutor’s Office for Rural County. I was asked if I remembered Mr. Naked Guy. I replied that I did, indeed, remember Mr. Naked Guy. I was asked if I could recall the events that I just finished recounting, in slightly altered fashion, above. Why, yes, I replied, I certainly could.

She continued. It seemed that Mr. Naked Guy was now out of jail, and was alleging that the responding officers had employed excessive force in subduing him. Did I recall anything that might relate to Mr. Naked Guy’s allegations?

I asked her if she had read my nursing notes? She had not.

“Ma’am, why don’t you read my nurse’s notes, and, if you have any more questions after that, call me back.”

She told me that she would do so.

I never heard another word.