Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!

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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 · Overdoses · Protect and Serve

Commercial Quantities of Meds

Thanks to Aesop (https://raconteurreport.blogspot.com/) for the inspiration for this post. See his series of posts, July 10 2019 to July 12, 2019. I write this on 12 July 2019. He may have more: it appears that he is just warming up!

So, TINS©, TIWFDASL© as a midlevel in a county lock up. Our sheriff had a policy of no drugs (I.e, no euphoriants narcotics or sleepers) for inmates. I was told that the rationale was that he did not want inmates to “sleep their sentences away”. Cool story, there were very few occasions wherein I would consider prescribing scheduled meds (euphoriants, narcotics) anyhow.

I was working part time. One morning I came in, and an offecer invited me to step into his office. He showed me a dispenser pack of what looked to be 140 or more tablets, labeled “Methadone 10 mg”. The administration instructions read “take 9 tablets daily”. Holy cow! That’s 90 mg of methadone, equal in pain killing (or sedating) effect to around 1 000 mg of morphine every day. ONE THOUSAND MILLIGRAMS of morphine equivalent, every day! The medical history form related that this had been prescribed for debilitating arthritis.

The officer noted the department’s “No Narcotics” policy, and asked me, the medical authority (Hah!) present, for an opinion. I thought that placing this gentleman in the “detox”/observation cell, and obtaining and recording vitals every hour for the first 24 hours sounded prudent. I also provided a checklist of concerning symptoms to watch or. I provided my cell phone number, and directed that, if certain parameters of vitals or observation were exceeded, send him to ED by ambulance immediately. If any grey area, phone me at ny time of day or night.

So, the officers recorded vitals and made “nurse’s notes” on their guest. I came in early the next day, read the noted, and re assessed the gentleman myself. All nominal, no alarming findings. We repeated this process, now every 4 hours, and, again, the next day, I arrived early and re-re-assessed the inmate. Same nominal vitals, same unremarkable exam. This did not seem to all fit together as it had been presented.

Another day, another 24 hours of vitals and “nurse’s notes”, another benign exam.

After several days of this, the jail command suggested that , with nearly a week of normal vitals and normal exams, perhaps our guest could be moved into general population? It seemed alright to do do, and I seconded their initiative.

So, after nearly a week of no methadone, nearly a week of no abstinence symptoms, my attention wandered to other topics. One morning I arrived, and an officer beckoned me into his office. “Hey, I thought you’d want to see this!”, was his opening conversational gambit.

It turns out that there are surveillance camera throughout the jail. (Who knew?). One had captured the methadone-for-debilitating-arthritis fellow getting into an altercation with another inmate, and whupping same. That’s correct: the “debilitating arthritis” inmate, delivered a whupping onto the person of another inmate.

The officer turned to me, and observed, “I am beginning to think that that prescription is rather more of a commercial opportunity, instead of a medical intervention!”

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

“Just wait a while. He’ll stop doing that!”

So, TINS ©, while I was FDASL© as a medic for Da City, this one crew had gotten a run on a jackwagon who had engaged in a shoot out with the DCPD, and had lost. The story ran that he had shot at officers, secured cover behind a utility pole, and then had exited cover to fire, again, at the officers. It seemed one of the officers had, indeed, paid attention at firearms qualification, because Mr. Gonnashootacop received a bullet in his face, that exited the back of his head and took a substantial portion of his brain along with it. Not an outcome likely to promote his long term high level wellness, in my opinion.

It seemed to appear so as well, to the EMS crew that caught the run, as they determined that he was DRD (“Daid Raht Dere!”, as we say it in Da City), and they went in service and left the cadaver to the care of the investigating officers.

Unfortunately for that crew, Mr. Gonnashootacop had not attended to that memo, for it was told that after EMS had departed, he took another (final) (agonal) breath. The officers, unsurprisingly, freaked the phenomenon out, called for another ambulance, which crew read the writing on the wall (which explained, “This Way To Department Charges And Unemployment!”) and transported Mr. Gonnashootacop to the friendly local ED, where he was pronounced (again), this time by a physician. Finally.

The story continued relating that the first crew was granted 6 weeks of unpaid time off, in order to allow them to fully deliberate upon, and repent from, the error of their ways. The rest of us recalled the aphorism that “there is no teacher like experience, and a fool will learn no other way”, and figured that OTHER PEOPLES’ EXPERIENCE would work just fine for our own educations, thankyouverymuch!

That touching little parable, leads into a tale of (nearly) my own. I was, at the time of this tale, working a three medic house, with Marielle, and Tim. Tim was a new hire, and had come to the department as a transfer from being a bus driver for Da City. It came to pass that I had/took a day off, for one reason or another, and, when I returned, I entered the firehouse to find an very, very agitated Tim.

“You sunovabitch! Where the hell were you yesterday?”

“Uh, I had the day off?”

“Yeah! And you left me with Marielle! Did you know that she is crazy?”

“Uh, she hasn’t struck me as significantly more crazy than any of the rest of us.”

“Well, let me tell you what happened, yesterday! We caught a shooting, and once we were on the scene, found that this dude had been shot in the head. Pretty bad, most of his cranium had been emptied. It was my day to drive, and so she was on the bag (doing the patient care). So, she sauntered up to this dude, looked him over, and turned to go. I was a bit behind her, and so didn’t really contact the guy, myself, at all. I heard her say that he was dead, and so we wouldn’t be transporting him. While she was standing up to go, he took an agonal breath. Well, the cops freaked out, and started yelling, ‘He’s alive! He’s alive!'”

“She turned back to him, shined her light into the gaping hole in his noggin, showing that there was not hardly any brain left, and said, ‘Oh, just wait a while. He’ll stop that!'”

“Dude! I cannot afford to be suspended for a month and a half! You gotta talk some sense into her!”

Nice. Don’t give me a Herculean task, or something!

Life in Da City!

Medic Six: Medic in Trouble.

So, TINS©, TIWFDASL© in Da City. So, in the course of EMS in, really, any city, you occasionally encounter folks who fail to realize just how wonderful you and your partner truly are. Some of these folks, at a loss for words to articulate their world view, act out. Indeed, from time to time they seek to act out upon members of the uniformed city services, which is why cops have sidearms, firefighters travel in groups of 5 or more, and medics….well, we generally rely on good fortune. And the antipathy police officers most everywhere demonstrate, kinetically, upon those folks who lay hands on medics.

So, having taken note of the above cited occasional dilemma of the tactical variety, The Powers That Be in Da City administration, had established a radio code, to indicate that the crew employing it, was either in trouble, RIGHT NOW!, or anticipated things to get sporty, REALLY FREAKING SOON!. Since we were, by department rule, forbidden arms, we relied upon our friends at TBCPD to extract our bacon from the fire, when the occasion demanded it. In return, we paid very, very close attention to the calls of “officer (insert injury here)”. While nominally all our responses were “Code 1” (red lights and siren), there were varieties of “Code 1”. For instance, there was a “Code 1” response to the call, “man has cough, for two weeks”, and there was the “code 1” response to “Officer shot”. For only one of these, would the ambulance require brake replacement after the call, and other motorists wonder what was that orange streak that had passed them by at “Warp 8”.

Generally, EMS Dispatch was on the ball. They kept track of where you were, how long you had been there, and, if you had not cleared the scene after a suitable interval, they would radio you and check that you were alright. On (thankfully!) rare occasions, they were not. Whether this was to be laid at the feet of dispatch, or the elderly radio system we employed, is not clear.

So, this one time, several crews were hanging out at TBTCIDC, telling tall tales, conversing, and generally waiting for dispatch to decide that it was Our Time To Save Lives. Our handie talkies were on, because dispatch might NOT assume we were still hanging out at TBTCIDC. Our radios, at that time, were open, meaning that any traffic on the frequency was heard on our HT. Therefore, when Medic 6 called “Medic in Trouble”, well, the room went silent. We waited for Dispatch to respond, and heard nothing. One guy phoned dispatch, asking “Did you hear Medic Six call that they were in trouble?”

When answered negatively, he said, “Well, they just did so. What is the address of their scene?” Writing it down, he hung up. “Hey, partner! Wanna take a little drive?”

Sure. Where to?”

Medic Six’s scene.”

Abruptly, four ambulances called on the air from TBTCIDC. We sped over to Six’s scene, and (thankfully) beheld the crew strolling out of the house there. And, no police.

You guys alright?”, one of us asked. 

Yeah, but it go a little tense there, for a minute!”

Everybody drove away, and the rest of that shift passed, without making any more memories.

Thank Ghawd!

Life in Da City!

Dead man on the roof

We typically ran a three medic house, at Medic Seven, just so one of us could take a road trip in the event that somebody or other called in sick, was injured, or other wise was absent for one reason or another. I got the detail, and wound up working Medic One with (let’s call him) Roger Whitaker.

It was his house, and I therefore was the medic that day. It was mid summer in Da City, one of those days with blue skies, sunshine, and temps running high 70’s to low 80’s. Simply a great day to be alive, in your twenties, and working outdoors. We cruised along, between runs, windows open, talking about inconsequential things, and listening for our next run. And, it happened.

We were sent out on a “unconscious man”, at an address down the street from the engine company where we commonly gassed up. At one point, like 30 or more years ago, this had been a prosperous, upper middle class neighborhood. Just off Main Street, the buses (I suppose, at that time, it was trolleys, but the same effect obtains) ran to downtown and back, and north to, let us call it, Middleville, where another of the industrial empires had several of their factories. The managers and suchlike, living in this neighborhood at that time, could take public transport to and from their jobs, and the families, with domestic help, could keep the home fires burning.

Once Da City changed, and the prosperous moved to Da Burbs, well, all those 4, 5 and 6 bedroom homes became multiple apartment buildings. One of them was our destination.

We pulled up in front, called on the scene, and walked to the door. One of the residents met us there, and led us up the staircase, into one of the apartments, around a corner into the kitchen, out of the kitchen window, and onto the tarred roof of the grand porch the building boasted.

This had evolved into some sort of patio for the residents, and there were three men there, two of whom were drinking something from a brown paper bag in the sunny July afternoon, and the other lay, as if asleep, semi prone. Alumni of the old-school Red cross Advanced First Aid And Emergency Care course (yes, I AM THAT old!) might recognize this posture as “the coma position”, as it facilitated drainage of oral secretions from someone who could not manage them on their own. Like, someone in a coma, fer instance.

Roger approached the upright, actively drinking folks, in order to elicit some information regarding our presumably somnolent subject. I approached him, and, kneeling, channeled my inner “CPR Manikin”. I did not quite bellow, “Annie! Annie! Are you all right?”, but I did attempt to shake our friend, to rouse him for conversation.

It quickly became evident that no amount of shaking, nor shouting, nor any other sort of human intervention would cause this gentleman to join in our conversation, without a Ouija board. When I lifted his off arm, as a lever to roll him preparatory to sitting him up, well, he rolled as a unit, as if he was a man shaped board. Students of emergency care might recognize this as “rigor mortis”, and it occurs variably, on the order of 6-14 hours after death.

Our patient had been laying on that hot roof for a long time.

Roger asked one of the bystanders, “When was the last time any of you all talked to him?”

One looked at the other, squinted up into the sky, and answered, “I guess it was before noon when he sort of moaned, laid down, and sort of rolled over. He hasn’t moved since.” Since this was late afternoon, well, this was not going to be a successful resuscitation.

I looked at Roger, he looked at me, and we shook our heads. He retrieved the handie talkie, and called dispatch for TBCPD, and a medical examiner’s crew, and holstered the radio. The second fellow, agitated now, asked, “Is he….? Is he….? Is he….?”

Roger interrupted, “Man, he daid!”

This gentleman walked to the parapet of the porch, threw one leg over same, and made as if to leap. Roger peered over said parapet, admiring all the broken concrete piled against the foundation, and said, “Friend, if you don’t mind, kinda jump a ways out there, into the yard, why doncha? My knees are aching, and I just know I’ll wrench something if I have to pull your broken body off all those rocks!”

The guy stopped, frozen, and stared at Roger for a moment. He lifted his leg back over the parapet, re entered the building through the kitchen window, and was last seen walking down the middle of the street, gesticulating and cursing, heading westbound.

Life in Da City! · Pre Planning Your Scene

Stairway To The Bathroom

 

So, once upon an EMS, I was working a medic unit in the center of the city. We caught a run to the near west side, and so, off we went. It was late on a lovely July afternoon. I remember the leaves shading the yard of the house we were called to. We walked up the steps, up the porch that ran along the side of the house, and knocked upon the door.

An excited gentleman answered our knock, and directed us into the home. There, a turn into the bathroom revealed our patient. He had, or so we were told, stumbled while descending the stairs, had fallen down those selfsame stairs, and, since the stairs terminated in the bathroom in which we were standing, when he came to a stop, he did so abruptly, having struck his head upon the bathtub. He seized, and our correspondents thought that this was a bad thing. Their opinions were not changed by the fact that our new friend had not awakened at all since the fall and seizure.

My partner at this point, who we can think of as Heinrich Hobson, was a veteran of the streets, and schooled in the ways of Da City. So, of course, once he left for the ambulance to retrieve the cot, backboard, and suchlike so we could transport our patient, well, THAT is when the excitement began.

So there were two ambulatory men, and one huge woman, on our scene, in addition to our unconscious patient. This woman was carrying an enormous purse, and began to exchange (heated) words with one of the gentlemen. The shouting escalated, and Mrs Large Purse decided that it was time for Show and Tell, and therefore Showed us all her nickel plated semi automatic pistol, all while Telling us how, in her words, “Alright, m0th3rf4ck3r, now you gonna DIE!”

It was not immediately clear which “m0th3rf4ck3r” was “gonna die”, or whether this was a particular prediction, or applied to all of us in the room. Since I kinda stood out, being (a) in uniform, and (b) the only paleface present, I felt as if I were a lightning rod awaiting that thunderstorm, and wondered, to myself, if there was not someplace I ought to be. Like, anyplace but that house.

I began to sidle my happy little way out of the room, and onto the porch. Once on the porch, the voices in my head held a debate regarding the proper way to unass the fatal funnel that the porch presented. One chorus encouraged, nay, DEMANDED, that I “RUN!”. The other viewpoint was that, in running, I would both attract (more) attention, and likely would elicit the predator-prey response in the nice lady with the pistol. I was not altogether certain that I really would enjoy the starring role of “Prey” in this production, and so, while the voices in my head held their debate, and then broke out for focus group discussions, I longstepped my way down the porch, and into the street.

Heinrich was collecting the straps, board, sheets, blanket and whatnot useful in comfortably transporting our patient, and I walked right up to him, and in the scholarly, educated, calm, thoughtful manner of speech for which I have become justly famous, brought him up to date on events within the domicile. What I said was, and I quote directly, “G! G! Guh! Guh! Biigggg! Biggg, guh!” Several choruses of that gibberish followed, until The Nice Lady With The Gun appeared on the porch, and I finally orchestrated a semi coherent thought. “We go now!?”

Of course, calm as could be, Heinrich grasped the handie-talkie, and began to bring Dispatch up to speed.

Dispatch, Medic 8. We need police here, my partner reports that there is a woman with a gun inside on our scene.”

Dispatch did not require a lot of time to process this. “Medic 8, have you cleared the scene?”

Negative, our patient is still inside.”

Dispatch’s opinion of that plan? “Medic 8, clear the scene! Immediately!  Police are on the way!  Repeat, CLEAR THE SCENE!” 

At this point I was in the passenger seat, listening to all the wisdom Our Friends At Dispatch were sharing with Heinrich, and wordlessly testifying to their TRUTH! Heinrich debated the ethics of unassing the scene wherein our patient lay, vs returning to save lives another day (the latter course of action I enthusiastically supported), with dispatch, articulating the position that we could not leave our patient.

I had my own thoughts on that matter, mostly along the lines of WHY THE F4CK WERE WE NOT IN THE NEXT PRECINCT BY NOW?! While this conversation continued, and I slunk down in my seat, thinking invisible thoughts, one of the gentlemen from the scene, he of the “Alright, m0th3rf4ck3r, now you gonna DIE!” insight, came to MY side of the truck, grasped the sill of the door, and asked, “You all ain’t gonna leave me here, are you?”

I started to roll up the window as fast as I could (no, I do not know why), and told him, “Mister, if you do not pull your fingers back right quick, I ain’t gonna leave ALL of you here!”

So, as it happens, if you really feel a burning need to know just how many officers DBCPD has on duty, and with access to a car, at any given time, I recommend that you find a seat across the street from a scene wherein an EMS crew has just called “Medic in Trouble!” Let me tell you, it made me feel all warm and fuzzy inside, as car after car squealed to a stop, and officer after officer piled out ready to kick ass and take names. Fortunately, by this time, Ms. Gottagun had strolled down the street and into another house altogether, and the officers declared the scene secure. Our friend of the tub-strike (remember him?) got bundled onto a spine board, and trucked off the TLHTTIC.

No medics were harmed in the telling of this tale. For some of them, however, their foundation garments will never be quite the same shade of not-brown.