Duty · Having A Good Partner Is Very Important! · Life in Da City!

Paying Attention Is Important

So, TINS (c), TIWFDASL (c), and working in Da Corridor. This was Da City’s, well, let us say, in paraphrase of the immortal words of Old Ben Kenobi, “Da Corridor: You will never find a more wretched hive of scum and villainy!” So, not the nice part of Da City.

I was working “The Corridor”, and an academy classmate, let us call him Gordon Lightfoot, was detailed in that day from another house. At this point of time, TBTCIDC was closed, as they were in the midst of moving kit and caboodle to the shiny, new, and in-the-medical-center hospital they had just opened. (Well, it had not been opened, just yet, and that little detail will figure prominently in this tale!) The hospital that was TBTCIDC’s “stand-in” was NOT generally the trauma center, but was in the medical center.

We caught call after call, transported sick (and a lot of not-so-sick) people, and generally saved lives. Our next run was on an asthma patient, and off we went. In fact, this particular address was only a block from the medical center.

We arrived, announced ourselves, and acquainted ourselves with this person’s malady. I brought the stair chair, and we wheeled this soul out to the ambulance, and settled them onto the cot. I had JUST entered the cab, preparatory to a leisurely trip to The Stand In Hospital, when Gordon stuck his head through the window connecting the cab with the patient compartment, and bellowed, “Reltney! He’s arrested!”

I hopped around to the back, and helped Gordon get set up for a spot of in transit CPR. Once he was set, I re entered the cab, and called dispatch: “Medic One, Code One, Stand In Hospital. Cardiac arrest, witnessed. Eta One Minute!”

Dispatch acknowledged. I tuned in the hospital alert frequency, and called: “Stand In Hospital, come in for Priority One traffic!”

They acknowledged, and I started my turn out into traffic, lights flashing, and siren wailing. “Witnessed cardiac arrest! CPR in progress! ETA one minute!”

The nurse on the radio was not clear on the message. “Say your ETA?”

“Open the doors! We’re here!”

Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Guardian Angel, Working Overtime

So, TINS©, TIWFDASL©, working a weekend gig in a very, very rural corner of The Un-Named Flyover State. I was a mid-level in, completely out of character for me, a very, very rural hospital’s (VVRH) walk in clinic. I was working with an LPN, a woman of sense, alertness, and industry. Sometimes, Blessings are not obvious.

So, mid morning, she gave me report on Our Next Contestant. Late 20’s fellow, had complained of back pain for a week or two, and he attributed this pain to “I pulled my back, working out doors”. So, this was long about February, and in VVRH’s catchment area, it was mighty freaking cold. Snow, long about hip deep, lined the roadways, and the roads, themselves, had been plowed, and, in keeping with Flyover State Rural Road Commission Operating Procedures, had *NOT* been salted. Since everybody got their water from wells, and most of us thought that salting our water was ill advised, the roads had some sand applied, “upstream” of intersections.

I listened to the vitals, and noted her assessment that “this guy doesn’t look right”. I entered the exam room, introducing myself. He told me that he had started to hurt a couple of weeks prior, the pain in his back, described as “Like something tearing”, had increased with time, despite his employing the ever popular intervention of “ignoring it, hoping it would go away”.

Having concluded on this beautiful sunny 8º F day, that is was *NOT* going to get better, he had WALKED three miles into town, by his estimate, seeking help.

He had muscle spasm in his back, true enough, but something about his story sounded several degrees out plumb. I palpated his belly, and felt something therein pulsing away. He also reported that my pushing on his belly, made his back pain worse. I was not certain what it was, but I was pretty sure that this was way, sway above my pay grade.

I phoned the ED physician, spun my tale of oddness, and he accepted my patient. My nurse wheeled him down the hall to Emergency, and we plodded through the rest of our day.

Nearing the end thereof, the ED physician walked in my door, and told me a story, featuring my long walking friend. He, the physician, had also thought that the examination, along with the back pain, was odd, and so he, the physician, had CT’d my patient. That study revealed a honking big, seriously dilated abdominal aortic aneurysm (a dilation of some part of the aorta, in this case in my patient’s abdomen).

For those in the studio audience who are not medically inclined, the aorta is the single largest, highest pressure, artery in your entire body, running about 2 cm in the area just below your diaphragm, about at the level of your renal (kidney) arteries. Those of us who have studied the US Military’s tactical trauma care course, or have had some sort of “care under fire” training”, will have learned that, should the aorta be penetrated, either by projectile or through a rending of it’s wall, the entire blood volume of an adult male (running around 5 quarts) can empty out in something approaching a minute, plus or minus. One thing that places you at risk of experiencing that, besides the projectile-through-your-aorta thing, is having a large aortic aneurysm abruptly rupture.

Of course, in VVRH, there was no abdomino-thoracic surgery service. My friend the ED doc attempted to arrange a transfer for this fellow, only to be SOL (Surenuff Outa Luck). The roads in our corner of the state were being snowed in, and therefore ground transport to pretty nearly anywhere was not going to happen.

Doc cast his net more widely, and more widely. Adjacent State Big Time Medical Center would accept him, but, alas, we would have to figure out how to beam him up transport him there. Middling Outstate Medical Center could not accept him, since they had no vacant ICU beds, which our new friend would certainly require, assuming he survived (a) the trip, (b) the surgery, and (c) the post op period. Any one of which could end him.

Next Up Upstate Medical Center, alas, similarly had no ICU vacancies, and so, finally the physician negotiated a transfer to Downstate Academic Medical Center, who, miraculously, sent a fixed wing aircraft and critical care transport team to our little single runway county airstrip.

A couple of weeks later, I was working a weekend as was the physician in question. He made a point of strolling over , and relating the above to me, both because it was remarkable that the patient had not only survived the trip, as well as the surgery, and the recovery, into the bargain, but was home, and evidently neurologically intact. The doc knew this, because this fellow had come into ED seeking care for a sprain or some such thing, that he had newly acquired, working outdoors!

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

Retail Pharmacy, So To Speak

A long, long time ago, in an ER very far away, I was a night shift ER nurse.

Surprise!

So, TINS, TIWFDASL, well, uh, not so much. I and the other nurses were capitalizing upon a slow moment and gabbing away at the nursing station, when one of our security officers ran in (literally!) and announced that “We got a shooting in the driveway!”

Having heard no loud noises, I was puzzled, but, these officers were not prone to overstatement, so I asked a couple of the other nurses to grab a cart, I grabbed some gloves, and off we went to the ambulance entrance.

Now, by way of background, this was in the early days of the crack cocaine epidemic (although, how one contracted “crack cocaine” from another person without active, willful action on one’s own part is unclear to me). A couple of blocks away was what might be considered to be an open air drug market. Folks (commonly suburbanites) would drive up, engage a soul in conversation and arrange a transaction, another confederate would be summoned and the exchange would take place, money from the buyer, drugs from the vendor.

We were told that in this particular transaction, the named patient, seated in the back seat of this two door vehicle, appeared to believe that he was the designated quality control inspector. Indeed, the tale appeared to paint this fellow as believing that he ought to remonstrate with the vendor regarding the unsatisfactory nature of the product that had been delivered.

As the History Of Present Illness unraveled, the vendor did not seem to have fully committed to a “Zero Product Defect”, nor a “Every Customer Fully Satisfied, Every-time” merchandising philosophy, as, when the shootee indicated that he, the shootee, intended to enforce his product quality complaint by with holding payment, he, the vendor, is reported to have produced a handgun, and shot the shootee.

Bad times ensued. The driver, unsurprisingly, panicked, and sped away. A few blocks later, he, the driver, noticed our bright “Emergency” sign, and pulled in, bellowing an incomprehensible narrative.

So, security cleared the car of the terrorized goslings, and I (and security, and my nursing partners) tried to extricate Mr. Beenshot’s inert form out of the rear seat of a coupe, indeed, a compact coupe.

It only closely resembled a cluster fuck. For a while.

We maneuvered Mr. Beenshot into our code room, and commenced to resuscitating. Before things had progressed very far, our doc had determined that this guy had a “STAT!” transfer in his very near future, and so the nursing supervisor, who had come at a run upon our paging a Code Blue overhead, peeled off to arrange with our transfer ambulance service that they produce a crew and truck RFQ (Right F*%king Quick), and then phoned TBTCIDC to provide them a heads up.

We eventually got him stabilized (kind of, sort of), and the physician had a detailed chat with TBTCIDC senior physician. Off Mr. Beenshot went, and we sought out the entourage, intending to elicit more history, more circumstances leading up to the shooting, more pretty nearly anything, so we could provide that information to TBTCIDC, as well as, well, notify next of kin.

Alas, the posse had unassed our waiting room sometime while we were distracted, trying to save the life of their friend, I mean, co conspirator.

Duty · Fun With Suits! · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Improvise, Adapt, and Overcome!

TINS, TIWFDASL at Medic 13, and we caught a run. Initial dispatch information suggested that this was a heart attack.

We arrived on the East Side of Da City, at the stated address, and discovered out patient was awaiting us, upstairs. The folks who were encouraging us to step right up and set to business, were pretty excited. As we arrived and entered the bedroom wherein our patient awaited us, well, we could see why.

Our initial patient survey was, to be charitable, not encouraging. The bedroom was nearly entirely filled by a double bed, and that bed was nearly entirely filled by an unbreathing human being. Unable to detect a carotid (big ass neck artery) pulse, we concluded that this soul was in cardiac arrest. Doug and I knew that there was NO WAY we were going to move this person, let alone move them down the stairs, into our ambulance, continue a resuscitation en route, and offload same at DBTCIDC.

While I started CPR, as best as I could on the bed, Doug called dispatch on the handi talkie, and brought them up to speed. “Dispatch, we need an engine company, or two, for manpower. We have a active cardiac arrest, on a patient estimated weight of 800-1000 pounds. That is a stat call.”

Dispatch acknowledged our call, and responded, “We will send you help”.

Doug and I both set to resuscitating this soul, until our help, a second MEDIC UNIT, arrived. This crew, Mariel and Don, while welcome, came nowhere near the lifting power we anticipated in ten firefighters. Doug relieved me, and I shared this insight with dispatch. “Dispatch, we need at least one full engine company, perhaps two, and we need them several minutes ago! This is a working cardiac arrest, and there is no way we can move, let alone lift, this 800-1000 pound patient!”

Dispatch informed us that that would be a chief level decision, and I was happy to buy into their decision making process. “Very good dispatch. We need our superintendent on this scene, stat. This is a patient safety issue, and our patient is in full cardiac arrest.”

The field supervisor, a captain in our division, jumped in. “Dispatch, this is shift captain (insert name here). I am on the way to Medic 13’s scene code one. They need an engine company. Please dispatch one immediately.”

Soon, a DCPD scout car arrived, disgorging two of the single tiniest female officers I had ever seen.

Right behind them came our captain. He (the captain) edged his way through the crowd of civilians (who were, helpfully enough, insisting that we simply “snatch him on up, and carry him on down to the hospital!” (while NOT climbing the stairs to lend a hand!)

Our captain surveyed the four rescuer CPR taking place, and retired to his vehicle to have a chat with dispatch.

Mariel had removed our cot from our ambulance, securing it in their rig, wisely determining that our patient, upon the floor, would fill the entire module. As she returned up the stairs, bringing every backboard strap that she could find, the first engine company arrived.

The officer of that company trotted up the stairs, took one look, and about-faced, running down the stairs. Shortly, he returned with 5 firefighters, and a salvage cover. Everybody heaved, and the cover was stuffed ½ way beneath our patient. Everybody “Ho!’-d, and it was pulled out from beneath him. Now we had a carrying apparatus, and the firefighters set themselves at each corner, Doug in one middle, me in another, Don at the head, and Mariel at the feet, and we slowly maneuvered our patient down the stairs, and into our ambulance. Mariel and I climbed in the back, Don took off to meet us at the ER, and Doug set out.

I had the walkie talkie in my pocket, and I could hear his conversation with dispatch while Mariel and I CPR’d our little hearts out. Doug suggested that another engine company ought to meet us there, and that the ER ought to be notified of our patient’s girth. Initially, they seemed unenthusiastic, until our captain suggested that either they dispatch an engine company to the ER, or the Chief of the Firefighting Division, since he, the fire chief, would be the one explaining everything to the news media.

Engine 5 met us at the ER. TBTCIDC had lashed two cots together outrigger style, and everybody moved our patient onto the cot. Once he was in the ER, our part of the show was over.

We effusively thanked our captain, as well as the fire crew.

Fun And Games · guns · Life in Da City!

“Doc, am I gonna die?”

 

So, TINS©, TIWFDASL©, and we caught a run for a shooting. Being full of excitement, because, gosh, THIS was an opportunity to, ya know, SAVE A LIFE!, we coded our happy way to the scene, there to meet the police. They pointed out the named patient, who, to our surprise, was NOT hovering at death’s door. Rather, he had sustained a small caliber gsw to his lower leg, had intact pulses downstream of his injury, and no evident bony injury. We walked him to the rig, buckled everybody in, and set out for TSBTCIDC.

We had dressed and bandaged his wound, and I was busily documenting same, along with the vitals we had obtained, when he asked me a question.

“Doc, am I gonna die?”

I looked at him, and shook my head no.

“Doc, really, am I gonna die?”

Sighing, I tucked my pen away, and addressed him. “No, you are not gonna die from this wound. You may not even be admitted to the hospital overnight.”

Hearing no further inquiry, I turned, again, to my charting. But, it was not to be.

“Doc, really, I can handle it. Am I gonna die?”

Some people, and one track minds. “Sir, you are not gonna die today, and not from that wound. Really, I’ve seen hundreds of shootings, and your injury is in no way life threatening. Okay?”

He nodded, as if in understanding. I (attempted to) return to my charting.

Shortly, he spake again. “Doc, really, I can handle it. Tell it to me straight, Doc. Am I gonna die?”

I was about over the “Doc” idiocy. “Sir, I’m not a physician, I’m a medic. And, do you really think you can handle the truth?”

“Yeah, I can handle it! Give it to me straight?”

“You sure you can handle the hard, icy, no bullshit truth? Because, if you are really, really sure, I’ll tell it to you straight! No punches pulled, no bullshit, no evasions. Is that really what you are looking for?”

“Yeah, Doc! Tell me the real deal!”

(Ah, well, it appeared that ‘listening to and following directions” was not at the very forefront of my friend’s skill set.) I rubbed my forehead, as if confronting some weighty ethical dilemma. I looked skyward, as if seeking Divine Guidance. I gazed at him, and delivered my response.

“Ok, if you’re sure you can handle it, here’s the real deal! You are not going to die! Do you know why, you are not going to die?”

“No, Doc, why?”

“Because you are not going to live that long!”

The rest of the trip was in blessed silence, as he endeavored to make sense of my revelation.

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 remember giving 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.