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.

guns · Life in Da City!

Still MORE Gun Fun in the ER!

 

So, after everybody heard of my rollicking good times with Mr. GottaGo and his knife, well, they were SOOO jealous. Or, not so much. In any event, subsequently, restrained folks had their clothing removed and placed in a bag, “for safekeeping”, and property inventoried so as to ensure that everything brought in, went home with them.

Soon thereafter, I was working, and our local fire department brought in this soul, who got restrained (for seemingly good reasons, although, at this distance, I could not tell you what that was). The other nurses appeared to have things under control, and so I was busy doing something else. Knowing that I am a “gun guy”, one nurse came to me, TINS©, with a revolver in one hand, and a magazine in the other.

Look what we found in Mr. Man’s pants! Sure glad we got everything!”

I took the revolver from her, and dumped the cylinder into a specimen cup. I checked it again, and again, and, once almost convinced it was unloaded, I asked her, “It that everything you found?”

Yep! We got it all!”

Uh, no you didn’t. That (indicated magazine) does not go with this (indicated revolver).”

What do you mean? Isn’t that how he reloads it?”

Nope. Just for an experiment, why don’t you try to reload this with that?”

She took a couple of minutes poking, turning, and re arranging, but could not get the magazine to mate with the revolver. I retrieved both from her, and placed them into a property envelope, locking both in the narcotics drawer. “Let’s frisk our friend, one more time, just to be certain”.

We found nothing, but when security arrived to secure the firearm, they, too, frisked our guest again, wondering what he had done with the semi-auto the magazine went to.

Knives · Pre Planning Your Scene

Why do ER staff frisk patients? This is why!

TINS©. Once I had left Da City’s EMS, I was an Emergency Department nurse in , surprisingly, Da City. Now, this was in the depths of the then current round of the nursing shortage, and so (a) they put me in charge (BIG mistake!), and (b) we had rent a nurses working with us. You might imagine, folks who have spent their careers working in the hospital may not be entirely as cynical as I am, and so might have a different level of urgency regarding, say, frisking a patient, than I do. Remember that thought.

So, one soul, a frequent flyer at our department, was brought in by the local fire department. This municipality was entirely within the border of Da City, but had stand alone police and fire services. These firefighters also provided EMS for the community. This particular wintry evening, they brought us an intoxicated fellow, who wanted to misbehave. Prior to my arrival, the evening staff had placed this gentleman in a vest type restraint, and settled him into a corner with a couple of blankets, and an admonition to take a nap.

So, once things had pretty much cleared out, I figured that a walk through, and placing eyes on my charges might be useful, and so I set out.

As I cleared the curtains surrounding our friend (mistake number one), I noted that he was fiddling with his vest. Closer inspection revealed that he had secured a knife (frisk fail, mistake number two!), and appeared to be attempting to cut his way free, presumably thereafter to make his escape. Acting prior to thinking this all the way thorough (mistake number three!), I grasped the hand with the knife, and extended his arm over the top of the bed, bending it, and securing it, and the knife within, with both hands.

That gave him the opportunity to consider the advantages he might enjoy, by popping me in my face with his off hand. Having considered, he tried to act, and so there we were, me holding onto the knife hand with both of mine, bobbing and weaving to avoid punches directed, drunkenly, my way by our guest, and calling for assistance.

One of the agency nurses walked over to see what the fuss was about. She stood there, motionless, for a long moment, until I suggested, “Ya know, if you could get some security in here, right stat like, that would be wonderful!”

I shit you not: she pivoted in place, and bellowed, “Security Stat To The ER!”

Sheesh! I amended my suggestion. “That was very nice. Now, if you were to open that door over there, and go out in the hallway, where our friends from security actually are, and tried it all over again, it might be just a little more helpful!”

She did earn bonus points for “Listening to and following directions”. Shortly, our friends from security piled into the room, relieved Mr. GottaGo of his knife, replaced his restraint, and frisked him, thoroughly this time. I frisked him, myself, because, well, reasons. I found no surprises. This time.