Fun And Games · Life in Da City!

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

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

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

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

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

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

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

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

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

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

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

And, then we scurried away……

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.

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! · 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!

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!