clarity in policy...

some of the times i have directly affected policy in our system.
.....1)no fire personel, even the ones who work part-time for us, cannot drive an ambulance in when on the clock at the fire dept. this was 'cleared up' in the summer of '07 when DC and i were riding together. we had just came out of paramedic school in Dec. and they had faith in us to ride together (this was so awesome because we didn't have to be embarassed as we 'worked things out' with pt's and could correct each other). we got called to a respiratory distress, 6D, and arrived on scene without first responders, we later learned they were accidently not dispatched. the pt was sitting in a chair, outside in the dark. as we approached him his wife stated he has congestive heart failure and we could hear the fluid in his lungs as we walked up to him. we quickly got him to the ambulance and his SPO2 was above 90% with a NRB at 15 liters so we weren't sweating it and i placed him on the monitor while DC looked for IV access. but once on the monitor things got a bit different, V-tach with a pulse, confirmed with a 12-Lead. by this time first responders were re-dispatched and coming to us. i worked the v-tach/cardiac issue and DC started running down the pulmonary edema protocol, they actually start out very similar. the pt was not able to talk in complete sentences but he was very calm and was actualy joking with us and we all were smiling as the fire dept arrived. both DC and i were dealing with v-tach with a pulse for the first time and when one of the firemen opened the door and said 'what's up' i didn't hesitate when i saw who it was. i said 'drive' and he jumped up in the front and took us in emergency traffic. the fireman was DM and he works part-time for us so i just assumed it was no big deal to have him take us in. it was very helpful for DC and i and the pt got great care (just an aside, the amiodorone didn't convert him and since he had a semi-good b/p and was c/a/o x4 i called med control. they advised to cardiovert him and after some sedation and electrical therapy he, needless to say, did not want to joke around with us anymore). but within a couple days a new, clear, written policy arrived to let us know that firemen who are responding with the city or a county fire dept. cannot drive us in anymore, and if needed we could call a QRV to drive.
.....2)this year i was driving with JM and we got a call to a child, like a month or 2 old who was very feverish. we got there and the child had something like a 102 fever axillary so we took him and mom out to the truck and slowly started some passive cooling and i thought 'how about some motrin'. so i looked it up quickly because of his age and it said nothing in our little policy/protocol book. JM's wife is a pharamacist and they have some kids, i don't have any. he said they have given their kids motrin at this approximate age, so i thought, no problem. but when we got to the peds ed the PA there said 'don't give kids under 6 months motrin'. ok. as per the norm in our pediatric ed she was snotty towards me, but hey, nothing new. listen, they deal with babies ok? ok!?!? so within a couple days an IM appeared to not give kids under 6 months motrin and a new 'fever' protocol form took the place of the old one.
.....3)this is a bit different but one day i came in and was told to go out a take 103. this is a lead medics area and it is a QRV. working alone, jumping only the serious calls, getting there first on scene, intercepting intermediate crews when they need an ALS intercept, etc....it's all gravy on a QRV. so i go out and in the morning the other shift comes in and i get a sour look when they see me out at 103. by the next night crap is hitting the fan because (in a whining little voice) 'he's not QRV qualified' whatever the fuck that means. i guess back in the day, good medics were rewarded by getting to go out on QRVs sometimes but only after becoming 'QRV qualified'. my supervisor has complete trust in me and is laid back anyway, so i got to go. i even got to be 102 for a couple nights and that really had the other shifts heads spinning. the sad thing was a lot of my fellow FTOs on the other shifts were talking shit, but it was just jealousy. so now CH, DC, LC and i go out to the QRVs whenever there is an opening and other FTOs have come to our shift to work QRVs (if we are all blue-dotting new employees) and no one says anything anymore. the lead medics in our system are a strange lot and i don't have the next 10 hours free to write about all that bullshit.

got my hair did....

looking back at '09 and found this: on April 21st was sent to a severe allergic rxn, 2D. walked into the house to find a black girl, a little plump, early 20's sitting on the floor up against the couch with major swelling to her face and neck and hives all over her arms and legs. the firefighter/first responder alerted me to the fact that he just hit her with an epi pen (one of the only 'drugs' a fireman carries so he was amped up that he got to give it). we quickly loaded her on the stretcher and bolted to the ambulance, the pt did not eat anything new today and did not have any new meds. the only thing she did differently was go to a different hair stylist and got a weave about an hour ago. i looked at her head and saw her scalp was bright red, bam...there's the culprit. got her on the monitor and she was the first person i have ever been able to go down the entire length of the anaphylaxis protocol. gave her 50 mg benadryl, solu-medrol, albuterol neb and she was still swelling and her airway was getting restricted. called med control and gave her epi IV...that was the trick, damn did that not work fast. had never given a person with a pulse epi IV before. the entire time i had a fireman with me and all he did was use shears to cut out chunks of her weave. we walked in to the recess room and the staff felt so sorry for her they made us stop and one of the nurses got very tiny scissors and cut the rest out. lets just say up until we got into the ED we weren't too worried if it was half her hair and half weave.

capitalism and the police state

I am a medic on both the city SWAT/ERT and the county SWAT/SRT. Went on a raid late one night with the city to a ‘gambling establishment’. the guys on the team said that they normally would never raid a place like this, but certain situations were forcing them to act. The main one was that some of the local soldiers, that have returned from Iraq and Afghanistan, have been losing big money at this place and some of their wives had followed them to the establishment. Now the wives are demanding the city to stop the gambling. I may not be the biggest supporter of capitalism, some have jokingly called my a ‘commie’, but when you are making a choice to gamble it should be on that person not the person who is providing the service. And let me tell you, this guy had a beautiful ‘service’. I am so glad I did not know about this place because I would have loved to play cards there. We rolled up and after the 2-3 minutes of action I walked into paradise. The dude who was running it was in his late 20’s, tall, skinny white dude and his mother was running the door. The ‘owner’ had his brand new 250Z parked right up next to the door. Of, course the old lady was having an anxiety attack and after checking her I went inside. The location was half of an auto body shop with a garage door and a large main shop/room with an office area in the rear with a storage closet and bathroom. The owner had the place straight decked out. There were 6 professional card tables with a dealer for each, a pool table in the middle for guys who bust out or were waiting to get on a table, 8 flat screens on the walls, a convenience store cooler with beer and soda in it and a place in the back to buy chips and snacks. It was wonderful, a man’s playground. There were about 40 guys and gals in there playing cards at the time of the raid, a lot of them soldiers (I could tell by all the military ids turned in). The cops zip tied them and searched them and they were all given tickets and sent on their way. If they had a small amount of drugs that was taken and they were given another ticket. Now, this took awhile to go through each person and while it was going on this big thick white dude was sweating at one of the tables and told me he was having chest pain. He was a good guy, he wasn’t giving me any crap, he just was refusing all treatment and stated that he was going to be fine, so I just stayed by him. Eventually he let me check his b/p, he had a hx HTN, and as he began to calm down a little his b/p dropped and he stated his chest pain went away. Now, when the cops gave you your ticket and you were going to leave they walked out with you and checked your car before letting you go. It turned out that the big man had coke, weed and pills (a lot of all) in his truck and that was the reason for his worries. Poor dude. This is a service economy and he was just providing a service to the community. Like I said, if your husband is out gambling all the money he got fighting in Iraq (yes, yes, yes…I know, the wife is at home worried and watching the kids, blah, blah, blah) then as a wife you need to stomp them balls. My fiancé would NEVER let me get away with that shit, she would stab me in my sleep. So, to the wives of those soldiers who stopped a wonderful illegal card game…..shame on you (I know, harsh words, but hey medicine tastes bad sometimes).

pooped....

poor Medic 9 got sent on a 26A, sick person, today to the rest area on I-95. the pt info was as follows "6 year old male, constipated, sitting on the toilet inside". how sad a story to tell of your family xmas vacation. billy couldn't poop. :(

GSW

2009 recap: on Feb. 5th RVC and i got sent to a 27D, GSW. the guy was in a very poor part of town that is also crime ridden and violent with a lot of prostitution. he was shot in a drive-by on his porch, but he didn't have a phone so he crawled across the street, maybe taking 10 minutes, to his neighbor who called the police. we arrived on scene and the pt was standing on his good leg on a porch, it was very dark but i could see he was very ashen and moaning. the police and fire dept. were just standing in the dark, below him on the ground, just looking up at him. i yanked the stretcher to the steps and walked up and grabbed the guy, we need to be off this scene in 10 minutes or less, he was a definite 'load and go'. as i grabbed him all the fire fighters groaned and yelled he was bloody, too late, i pulled him down to the stretcher and he covered my shirt in blood. we checked him quickly and noted that he was not shot above the waist but the pt's femur was crunchy and obviously destroyed and a large compartment injury was happening. the thigh can hold a fatal amount of blood in it and he was walking that line. we loaded him in the ambulance and his b/p was crap over crap and he was very cold and ashen. he was ALSed and rushed to the hospital. one of the worst femur injuries i've ever seen. i remember he told me who shot him, i seriously don't remember the nickname he gave me, but i told him you can tell that to the cops at the hospital. i don't need some thug life fag comin' after me for snitchin'. word life.

13 in 12...

looking back at the year (in my day-at-a-glance) i see that DB and i worked on July 19th and had 13 calls in 12 hours with 11 transports to the hospital. the 13th call was a 9E, cardiac arrest, that we worked to the hospital but she did not make it. i remember her family telling us she was a diabetic and that recently she had not been taking her insulin and had stopped eating.

chewing on fentanyl patches....

looking back at this year in my day-at-a-glance. on Jan. 6th i was working some overtime on Medic 12 with JM. called to an overdose, 23D. arrived on scene to a beat up trailer in a crappy trailer park that butts up against a major roadway, this was the trailer right up against the road. as with most trailers there was no way to get the stretcher up in there without some major shucking so we grabbed the bag, suction and monitor and entered the mad house. there was a dude and a chick, both obvious young meth heads. the guy walked us into the bathroom and laying on the floor, soaking wet, fully clothed, pale, cyanotic, and breathing about 4 times a minute was a skinny white chick. her boyfriend stated, after hemming and hawing until we said "we are not police, we don't give a shit just tell us what she took", he finally stated she was "chewing on morphine patches" and he was trying to wake her by soaking her in the bathtub with cold water. we pulled her freezing cold body straight out onto the living room floor, i cut her shirt off and placed the pads on her chest, she still had a pulse but was bradycardic, and JM began to bag her with a BVM. it was my call, we are both paramedics so we switch each call, and i started an IV and got the narcan out. JM checked her mouth for patches but they were not there anymore, pupils pinpoint and sluggish. while i was getting the narcan ready her dumb friend was on the couch behind me and was crying and asked me "should we have called?". since they are all youngsters i was able to swear at her and fully let her know how stupid she was for 1) asking that question and 2) not calling sooner. bam! 2 mg narcan and she opened her eyes and gasped for air. within 30 seconds she was crying and talking to us. she was about 5 minutes away from death and then the narcan snatched her back to the toilet bowl that is her drug addicted life. narcan is such a cool drug. one ED MD asked out loud once why they can't make a "narcan for alcohol". if you can develop one you could make millions.

Cadillac and crab legs

(straight away...i had a fever and was delirious when i went on this call and my BS guard was down) went to some guy in his late 20's, call came out as a sick person (26A), pt has a hx of HIV. this call was in a trailer park, not one of the bad ones, but still a trailer park (this damn one has like 200 speed bumps and takes almost 12 minutes to get about 4-5 blocks). the dude is sitting on the couch when we walk in the house. his mother is very upset and begging him to go to the hospital with us, she is the one who called 911. the pt obviously has a fever and a bad cough but since he can answer all our questions we can't kidnap him. plus, he's a real asshole and very stubborn, but since he has HIV/AIDS an infection, like this, is not good. after numerous times asking him to come with us i turn to the mother and tell her that he needs some ibuprofen to break that fever and maybe later she will be able to talk him into going with her, or us, to the hospital. she starts to cry and beg him to go and says that she doesn't have any money to get him any Motrin. so i go out to the truck and get some children's Motrin that we carry and i give it to her. now while i'm out getting the stuff my partner is outside of the house talking with the mother. so i give her the medication and as we are leaving i finally notice that in the only parking spot for this trailer is a Cadillac STS, brand new, backed into the space. and then my partner tells me that when he asked the mother if the pt was eating well recently she said that he didn't have any of the crab legs she made tonight. she has a Cadillac in the driveway and crab legs for dinner BUT can't afford Motrin!?!?

V-tach with a pulse...upstairs, of course.

this call happened in the early morning hours of 8/17/09. i was working that night on medic 14 stationed out of city #7 with another paramedic RVC. call came out and it was just around the corner from the station and we beat the first responders there. the call came out a 10C (chest pains, hot call), we arrived and the wife escorted us to the second floor of a very nice, well kept home. the pt was a 54 y/o male who was laying supine in bed and c/o chest discomfort, pt had a strong radial pulse that was irregular with gaps noted by me upon palpation, i just assumed we would see some PVCs on the monitor and the pt's b/p was good and he was talking to us fine and not in distress. the fire fighters arrived and slogged up the stairs rubbing the sleep from their eyes and i turned and told them we were good and that we would just use the stairchair to get the pt down to the stretcher (we recently got new stairchairs that work wonderfully). they left as my RVC was placing the electrodes on the pt. i was kneeling next to the bed writing down the pt's hx, we were going to do a 12-lead in the house and give some ASA and then move the pt, when i heard my partner ask the pt "do you have a pacemaker" and it immediately said "oh, shit". and there it was, v-tach with a pulse on the monitor. my partner placed the 12-lead cables on the pt while i ran down and stopped the FD from leaving and asked them to grab our stairchair. i came back up as the ECG was printing and it was upright in V6 to confirm, without a doubt, v-tach. again the pt was c/a/o x4 and was hemodynamically stable, if had not been it would have been some cardioversion. an IV was established and amiodorone was mixed in D5W with a 60 gtt. set and administered. we kept the pt and his wife fully aware of what was going on. after the 10 minutes the pt converted into a NSR with occasional runs of PVCs/V-tach but the pt stated he was feeling much better and stated something like he wanted to run down the stairs, but of course he was helped to the stairchair and brought down the stairs still attached to the monitor. the compartment the stairchair is in is very cluttered and i just had the FD place it in the passengers seat. so our new stairchair rode shotgun as my partner ran us emergency traffic to the hosptial. below is our activity log and after is the narrative found on our run chart.

08/17/09 02:30

226

140 / 90

107

97

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

4

Manual Cuff

Normal

08/17/09 02:34

Cardiac

v-tach with pulse12-Lead EKG performed by RVC. was successful.

08/17/09 02:35

159

132 / 90

104

99

16

Wide Complex Tachycardia (REG)

4/5/6

WCT - S

4

Auto. Cuff

Normal

Initiate IV

Peripheral IV initiated by RVC with 18 ga. at Left Antecubital. Attempts: 1 successful

08/17/09 02:37

Medication

Amiodarone,150 MG via IV - PUSH given by ParamedicX mixed in 100 cc D5W flow with 60 gtt set ran over 10 minutes

08/17/09 02:42

122

126 / 84

98

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Cardiac

runs of v-tach, irregular, perfusing on normal beats with strong radial pulse, non-perfusing during v-tach runs12-Lead EKG performed by PX. was successful.

08/17/09 02:50

118

130 / 84

99

100

16

Wide Complex Tachycardia (IRR)

4/5/6

0

Auto. Cuff

Normal

pt moved by stairchair and stretcher to ambulance, pt on monitor at all times, paddles attached to pt since before medication admin

08/17/09 02:55

100

110 / 70

83

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Medication

Normal Saline,150 MG via IV - PUSH given by PX fluids given enroute

08/17/09 03:00

106

136 / 68

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

117

0

Auto. Cuff

Normal

bsl checked at this time

08/17/09 03:05

98

140 / 66

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

54 y/o male woke from sleeping with heart palpitations and slight chest discomfort and called 911. pt laying in bed at first EMS contact, FD arrived at same time as EMS, pt c/a/o x4 and talking well without resp distress, pt radial pulse irregular but strong with gaps of non-perfusion, pt placed on monitor showing v-tach with a pulse, pt hemodynamically stable and on second floor of home and decided by EMS on scene to treat on scene. pt given 12-Lead, confirming, and IV est. pt given 150 mg amiodarone via 100 cc D5W over 10 minutes with 60 gtt set. pt converted out of constant v-tach on the monitor to runs of v-tach and pt stated he was feeling much better and that the discomfort in his chest was gone and when pt was moved to stairchair pt stated he would be able to "run down the stairs" if we wanted him to. pt moved by stairchair and stretcher to ambulance with constant monitoring. pt with rare skin disease and prolonged admin of prednisone and lasix with constant fluid retention in lower legs and periodically into abd. pt legs wrapped in bandages due to pressure ulcers in lower legs. pt in good spirits during entire EMS contact and pt transported emergency traffic to CFV and taken to the recess room upon arrival where ED staff and ED MD were waiting.