In our system, like many, the private ambulance companies in the area handle most transfers, but when they are out of rigs, they can reclassify a dialysis patient as a critical care cardiac patient to get out of their contractual requirement. Or there could be an actual legitimate medical emer…Oh who am I fooling.

THE EMERGENCY
A local private ambulance company (I’ll call them F&B) has called in a request for a transfer, stating the patient meets code 3 priority status, which requires 911 activation.

THE ACTION
I can get you to the ER. I can get you to Pediatrics. I can get you to L&D in a hurry using the big elevator, should you need the extra room. I know where that hidden door button is to get into the cath lab. I can find most places in most hospitals, but when our instructions were to the Critical Care unit, I got curious.

We made our way up to the unit and got the usual hospital staff response. We were ignored. Often when ignored in the ER, we park the gurney so nurses have to find a new way out of the nurses station. So far no one has jumped the counter, but I’ve seen a few consider it.

Ignored and feeling lonely, I ask if anyone called for an ambulance. Nothing.

A physician approaches us doing a strange walk looking from us, then back over her shoulder down the hall, then back to us.
“Are you here for Mr Johnson?”
“We’re here for a medical emergency. Did anyone request a private ambulance recently?” I offer to the entire room.
“I called for a transport for Mr Jones, but he just left for CT. He won’t be back for 30 minutes.” says a Doc barely looking up from a computer monitor.
“Did you request the ambulance code 3, lights and sirens?” Asking as I approach him.
“Yes, critical abdominal injury, we’re going to operate tomorrow morning at Saint Farthest.” Checks his watch, “I need to get a move on. The nurses can fill you in when he gets back, thanks.”
And away he went. Not believing we had the correct patient I called the ambulance company mentioned on our data screen and, sure enough, the guy we were sent lights and sirens for is in the CT scanner.
Not to waste time, we notified dispatch of our situation, then filled out all the paperwork we could from the gentleman’s face sheet.
35 minutes later, and ambulance still parked blocking the main entrance to the hospital, the nurse returned with Mr Jones who looked at us and frowned.
“You guys aren’t from F&B, where’s my crew from F&B?” he asks.
“They’re a bit busy today, decided to upgrade you to 911 status.”
“You aren’t scheduled to pick him up for another hour, he still has to give labs,” the nurse tells us.
“Maybe someone missed something here. We’re here to get him right now, we’ve already waited too long. If he’s not urgent or even ready to go, I’m going to have to leave and put him back in line.”
“Fine, sorry to bother you.” She snipped from behind the hastily drawn curtain.
I wish I had my own to slam shut as we push the gurney back out.
We left and never had to come back. Found out later an MVA happened near our station and a unit had to come from across town.

I was back in a house I haven’t worked in for a while and saw a memento from the old days and wanted to share.

Imagine you’re on vacation, sound asleep in your crisp white sheeted bed in a luxury hotel. Then, while you’re dreaming of never going back to work, you are awakened by a revving chainsaw at 3 AM. Then you hear the blades ripping through a door and a woman screaming. Scary? No, all in a days work.

THE EMERGENCY
A local hotel reports a woman has fallen in her room.

THE ACTION
Escorted up and into the quiet hallways we’re met at the door by a clearly tired middle aged man and his teenage children. They explain that their mother has not been feeling well and has possibly fallen in the bathroom.
We make verbal contact and she is alert and uninjured as far as we can understand, but she tells us her back is in so much pain she can not move. As we begin to open the bathroom door she screams in pain and begs us to stop moving the door.
We take a step back and rethink the situation. The door opens inward and we have no access to the pins and there is no other access to the room.
Then one of the firefighters gets a smile on his face. Not a word passes between us as I smile back. The boss asks what we have in mind and I tell him.

“We’re going to chainsaw the top half of the door and climb in to extricate.”
The hotel manager turned the same color white as the walls.
“You can’t damage our property like that.” he whispers, confused.
“You called us, my guys will do whatever they need to do.” the boss shoots back.

The saw is upstairs after a few minutes and we tell the patient what she is going to hear and feel. We’re cutting the door just above the middle hinge so we can open the top without anything falling on her.
“NOOOO!” she is screaming, “Just let me lay here!”
We tell her if she can simply move a bit we could figure out how to get in, otherwise our solution.
The boss made the decision for her. “We’re coming in!”

The look on the manager’s face will never leave my mind. His jaw slacked as the firefighter began to throttle up and make the cut. It was a hollow core door, but made a big mess. Less than 30 seconds of cutting yielded a space just big enough for me to climb in and into the bathroom.

Our patient was screaming that she’ll move now and we smiled. Now she can move. We got her out and off to a physician for a checkup. No drama there and no injuries, just an old back injury kicking in while she was resting in the john.

After we got off shift I decided to return to the scene of the crime and see if we could get the door. It now hangs in the firehouse with our autographs on it and a brief description of the incident.

Somewhere along the line “drunk” became an emergency. I guess someone let someone else sleep it off and they sued. Can’t think of any other reason. Fortunately it gave me the opportunity to gauge when you’ve had too many.

THE EMERGENCY
The PD are on the scene of a woman who is screaming at the top of her lungs, “It’s going to kill me! Get it off! Get it off!”

THE ACTION
I have to hand it to the boys in blue. Either they can keep a straight face better than I can, or they stopped laughing before we arrived.
Our “patient” is indeed well under the influence of the fire water, lying supine on the floor of her little apartment. We down shift seeing there is no immediate life threat.

When I ask what the trouble is, the officers tell me, “Just wait until her arm starts moving.”

So we waited nearly 2 minutes when her arm began to slowly rotate, her nervous system clearly experimenting with proprioception. As it began to noticeably move along her chest, where it had rested until only recently, she began to take note.
The look on her face was similar to those movies you see from the 40s where they tell the actress, “look horrified.” Her eyes grew so large and she tried to wiggle away on her back, but ended up simply making her own arm move more. As she writhed in horror to escape this threat she began to scream what made her neighbors call the police in the first place.

“Help! It’s going to kill me! Get it off! Get it off of me!”
I reached down and gently moved her hand away from her chest and smiled.
“Thank you,” I remember her saying. I wanted to say something about the fact that if this was the hand that poured all that liquor down your throat, it is killing you, but I didn’t.

I did, however, learn the cut off between drunk and DRUNK. When you think your own body is trying to kill you, you are DRUNK.

The ever exciting Unknown Medical Aid. We just cleared a very unhappy bicyclist and were on our way to an “unknown bleed, getting interpreter.” Great.

THE EMERGENCY
There may be blood.

THE ACTION
Not getting any information about people shouting or blood from, say, a bullet passing through living tissue, we proceed into the basement unit in an older part of town. As we enter we see the religious artifacts that tell us our patients are from south east asia and looking at my partner, who is whiter than white bread, I know we’ll have trouble communicating.

The little old woman meets us first, pushing past without so much as a glance, simply shouting something about “tongs” and “has.” We continue back through the hallways of the unit to find a computer room inhabited by 12 year olds playing games.
“Who wants to be a hero today?”
Not even a glance. They’re not even playing a game I recognize. No Halo, no Super Mario Brothers, not even a Circus Atari.
“Who’s the oldest here?” Hoping I can get someone to rat out someone else.
A hand rises and we grab him as an interpreter.
Turns out grandpa has had a nose bleed for a few days and grandma wants him to go to the hospital to get checked out.

Thing about nose bleeds is, they tend to bleed either from trauma or hypertension and keep bleeding as a result of…trauma or hypertension. Blood thinners aside, and since he gets all his medications at the local pharmacy, labeled in Chinese, I’ll assume both to be true as we enter the bedroom and find him.

And no blood.

No bloody towels or tissues, even his nostrils are clean. His shirt is clean, his pillowcase is clean. I ask the kid to tell me when it stopped bleeding and he relays the patient’s answer.

“Yesterday.”

“Why am I here today?” I’m interrogating a 12 year old about a 70 year old. Only in EMS, right?
“He needs to get it checked and no one here can drive him to hospital.”
It dawns on me then that we’ve been activated for a ride. Taxi 99 responding…
Not in the mood to argue the merits of the situation through a 12 year old, we grab grandpa and get moving. I was staring at the strange shapes on his medication bottles and wondered what they were, homeopathic or engineered.

Didn’t lose a drop on the way in.

Usually its my patients that bring me the greatest thrills, but so far today (I’m again here at Medic 99) our best chuckle was from a pedestrian.

While returning from an actual legitimate run (I know, Oh my god!) we went through a trendy part of town to girl watch, um, check for road closures, when we noticed a car in the middle of an intersection. In this area there is a large above ground trnsit system and the car is almost blocking the tracks, but the train operators seem to get by just fine.

As we approach, curious, we see the man standing in the crosswalk, facing the car, mere inches from the bumper, jaw clinched and shaking, just slightly, holding a grocery bag.

We are able to see the car is occupied and appears to be in the park gear since it is stopped and the brake lights are out.

We light up ol’ 99 and block the fellow in the crosswalk so folks turning don’t make him into a customer. The following is too crazy not to be true.

HM – “Hi there? Are you OK here in the street?”
Baldy – “I want this woman detained, I want the police, she almost hit me. She’s not from around here and she refuses to back up and go the other way.”
HM – “Do me a favor and just step over to the sidewalk before you get hurt.”
Baldy – “I’m tired of this!” the shaking gets more noticable. Not a seizure, but years of frustration coming to a head. In anticipation my driver undoes his seatbelt and cracks the driver’s door. If this guy charges us he can kick the door at him, buying me time to run like a coward.
“This is a NICE NEIGHBORHOOD!” and there goes the top. He screams into the sky. In a movie, birds would have flown away and the shot would have widened out.
HM Driver – “Why not just bang on the hood of the car, take down her license number and go about your day?”
Baldy – “You’re not from here either. I’m not moving.”
HM – “What do you want to do? You can’t stay in the street all night.”
Baldy – “I’m not moving until the police make me move.”
Looking around, a crowd is beginningto gather. A woman offers her cell phone to the man, “Here call 911 from my phone” she tells him.
HM – “HELLO? We’re already here.” I grab the mic knowing this will get them giggling at the dispatch center. “Fire control this is Medic 99. I need PD at [our location] for a man standing in the street, causing a hazard.”
“99 can we get a description?”
I couldn’t resist replying: “He’s standing and in the middle of the street, approximately 10 feet northwest of our van.”
A few more minutes of trying to talk this man to the curb and no result.
The blue lights pull up and an officer I recognize gets out and immediately our friend Baldy is moving.
“Get out of the street you idiot!” calls the officer and Baldy jumps onto the curb and the car begins to pull away.
“Oh no you don’t” says the other officer who steps infront of her car, “You’re getting onto the curb too, this is stupid.”
He said it. He gets to say what I want to say. Unfair.
And we’re still laughing 2 hours later. I imaging the officer ended their meeting with, “Now shake hands and say you’re sorry.”

Finally getting to the good stuff on our busy day from long ago.

Nothing pleases your pal Happy Medic more than a family member who has been to Medical School at the scene of a call that has no emergency component. I wonder if they’re forgetting all that expensive schooling or if they just get confused when it’s Mommy who wants help.

THE EMERGENCY
A man has called saying his mother is complaining of general weakness.

THE ACTION
We have a code on our forms I know by heart. No Not PDAL – Alcohol Intoxication. It’s the other catch all – GMWD General Medical Weak/Dizzy.
I’d say a third of my clients fall into this giant hole of a classification including my new friend ‘Erma.’

A quick aside for those following along at home. When I use the name ‘Erma’ its more about describing her and her situation than just keeping her name private, if I could even recall it. No, Erma is an old teaching tool my Paramedic mentor Beemer used to describe my now favorite kind of patient: The elderly female with numerous general complaints that don’t seem to add up to much, but none of the signs explain the symptoms and vice versa. You need to put on your Sherlock Holmes hat and get to work asking all sorts of questions just to figure out what makes sense and what is Alzheimer’s poking through.

So back to the Erma I met today. Erma’s son, the Doctor, is concerned his Mother has been neglecting herself and her health and requests we take her to the not so local ER for an eval. I love it when an Doctor tries to tell us what is going to happen at the scene. They are welcome to make recommendations and offer guidance but the minute they stop asking for things and start ordering things is when HM let’s the lawyers in.

“May I see your Physician’s ID, Doctor?” I ask when he tells use we should be starting an IV on the patient who is now wandering the house looking for her coat.
“Why do you need that?” he asks taking half a step back.
“I’m required by law to confirm you are indeed a Physician, then I must radio to my Physician at the hospital that you are taking over care at the scene. Only then can I work as a Paramedic under your license.”
He looks from me to my partner, who looks up with a blank look and simply nods.
“Do your job, she needs care.”
“From what we’ve been able to record when she’s not evading us, Doctor, is that our services may not be needed in the capacity you expected. I’m more than happy to take her in to be seen, but please understand we have strict protocols in place for a reason and I’m simply following them.”
“Then what protocol are you following now?” Ah, the point where we have to classify her into a pre-determined square has arrived. If I answer “Altered Mental Status”, protocol calls for meds. If I answer “Stroke” I need to start a line and leave quickly.
Without missing a beat I tell him, “Assist a Citizen.” The back door left open by those who have come before me which allows us to wiggle when needed.

“That’s unprofessional, I want to talk to your supervisor.” He points to me as if a referee will jump out and declare him the winner of our little confrontation.
“Fire Control, this is Medic Van 99, I need a Paramedic Captain at this location.”
He can’t believe I did it. I called his bluff. I know I have all the cards on this one and he was hoping I’d take the easy way out and just throw Mom in the van and go.

The Captain arrives and pulls me outside to get my situation first. Just inside the door the son tries to push the Captain around.
“I’ll have you know your people here need to learn to follow instructions.”
The Captain stands tall. “May I see your ID card please, Doctor?” and I smile.
“I don’t see what the deal is here. Take her to the ER. I’m a doctor.” He’s starting to pace, a clear sign of frustration.
“Until you can ID yourself as a physician and speak with our online Medical Control Physician and assume licensure of my Paramedics, they operate under standing orders and from what I can see we don’t have what your mother needs.”
“And what’s that?” The son asks.
“A family to help her through a rough patch. Medic 99, you’re in service.” He says over his shoulder and we await confirmation of the order. I want to jump out from behind the Captain screaming, “Take that Doctor Boy!” doing some king of victory dance, but i don’t.
“Control this is Captain 99,” he speaks into the mic,” Medic 99 is in service on a No Medical Merit, I’ll be on scene for a few moments assisting a citizen.”

We cleared and monitored the radio waiting for the recall of an ambulance so we could jump the call, saving another crew a lot of frustration. We ran into the supervisor the next shift and he informed us the son wasn’t actually a Medical Doctor, but just a PhD in mental health.
A good thing for his mother if he ever takes the time to help her out.

One of my favorite calls is to the local dialysis clinic. These folks are having their blood removed, filtered, and put back in, all while sitting in a giant chair either watching TV, knitting or sleeping. But what happens when they don’t want to wake up?

THE EMERGENCY
The RN at the dialysis clinic has called stating the MD on the other line, wants a person transported.

THE ACTION
We’re familiar with the facility and the staff and most of the customers are familiar. Today’s customer is sitting in the chair, asleep.
“Have you filtered her yet?” I ask the technician, getting the standard answer: “I don’t know.”
She’s standing there, in her paper gown, gloves, mask and goggles, but has to retrieve the file to see if she’s been filtered yet.
“How long has she been here?”
“Not long, maybe 15 minutes.” she tells me flipping through the file.
“So is it safe to assume she has not been filtered yet?” I ask, getting no response. “So what’s the emergency?”
“She won’t wake up.”
I reach down and gently shake her arm calling her name no louder than I’ve been speaking to the nurse. Her eyes open and she looks at me, confused.
“Is it time?” and she begins to remove her jacket.
“Won’t wake up? Did you even try to wake her?”
“I am not permitted to do anything but connect her.”
“So you can stick the needles in her shunt, but not shake her to wake her?”
“No.”
“Get me your RN supervisor now.” I point to the nurse’s station where she retrieved the file. A clearly overworked nurse walked over with the weight of folks above who ask too much and folks below that do too little.
“I didn’t even know she called you guys again. I’ll handle this.”
We made sure the woman in the chair didn’t want or need us and we left. I’ve been back since and the nurse is gone, but the technicians still call us to wake the sick early in the morning. Hopefully that RN has moved on to greener pastures.