First run back in my old house this morning and I’m shaking my head already.
Some calls I get. Some reasons I understand. But at some point someone has to step up and tell these callers, “Maybe you can wait.”

THE EMERGENCY

A caller states she was talking to her grandmother, got in an argument, and now grandma won’t pick up the phone.

THE ACTION

Yes. 2 police cars, a fire engine and ambulance are responding to a welfare check following a phone argument. The caller told dispatch grandma had a heart attack once and that got coded as a chest pain cardiac/severe.

As we arrived the police are coming back down the stairs waving us off with angry faces.
“This is nothing guys,” one officer says, “Grandma was mad and didn’t want to talk anymore.”

How did this call get through and coded as an emergency? We may never know. Even worse, someone out there actually thought this classified as a 911 call.
Your tax dollars at work.
Amazing. Truly amazing.

Firegeezer recently posted THIS story about a Nationalized hospital who called 911 for a man just outside their doors.
It reminded me of a run we had a few years back INSIDE a private hospital here in the states.

THE EMERGENCY

Caller states a man is having a seizure in an office.

THE ACTION

The address looks familiar on the screen and as we approach we see why. We’ve been dispatched to the hospital. The engine and fire ambulance crew (They don’t transport, but staff a dual medic unit, don’t get me started) are milling about in the lobby trying to find out where to go. We finally make contact with security who leads us up to their office where they say a man is having a seizure.
All the while we’re hearing “Code orange, third floor. Code Orange, third floor.” I ask security what that means and they say it’s the hospital’s code for a medical emergency within the hospital.

Hmmm…where are they?

We’ve all been in the ER when a code blue is struck somewhere else, the attending and a couple of nurses grab a predetermined kit and go.

On the third floor we meet our “patient.” He was caught by security wandering near the pharmacy storage rooms in a secure area of the hospital and has been detained awaiting police arrival. When he was searched they found numerous narcotics and the man then said, “I ‘m having a seizure” and fell to the ground.
It was on this call that I learned a little about “maintaining self image.”

Ever seen people on TV pick up an arm, drop it and say, “He’s dead!”? What are they doing? Nothing. The trick there is to drop the hand over the person’s face. If the hand falls and hits them in the face, they’re likely out cold. When the hand magically falls away from the face on repeated attempts, the person is consciously keeping their hand from hitting them. They are awake.
Unconscious people are not able to hold their eyes shut.
Another one, and back me up or call me on this one fellow care givers: Never have I had an unconscious person cross their ankles and leave them there.

So here is our new buddy, ankles crossed, eyes held shut and the hand amazingly missing his face every time when my partner leans down and whispers in his ear. One eye just barely popped open, saw me and went shut again.

We were taking him down to the ER on the cot when we finally met up with the ‘Code orange’ team. They were furious they had not been alerted of the event sooner. They learned of our situation from the engine driver who luckily went in to flirt with the staff. Turns out that only the ‘code blue’ alerts are heard in the ER. Makes perfect sense, right?

The physician got the quick report and took a look at him.
“Did you do his feet like that?” No, he had them like that on the floor as well, crossed.

When security told them what the guy was caught for, they almost turned red.

I followed them to the ER where they did everything by the book. The big, painful book.
IV access was obtained 14g in the AC.
Gag reflex was confirmed by yankauer tip insertion.
Rectal temp was taken to ensure accuracy of reading.
Body was exposed to examine for trauma secondary to seizure activity.

It was when his pants were coming off that he reaced down to keep them on. Suddenly aware of his situation.

“What did you whisper when you were down there?” I asked after we had left.
“I simply said, ‘Your fly is open.’ and he wasn’t expecting that. Every man instinctivly wants to check.”

I still use that line and it still works.

We’re racing to back up a BLS engine who reports PD has a man experiencing a diabetic emergency. Under their guidelines, combined with the officer’s, E.T. will also be needing transport.

THE EMERGENCY

PD has made a traffic stop and found a patient in distress. A BLS unit has requested an ALS response.

THE ACTION

Ever been watching some kids play, something happens and you say, “Oh they just don’t know any better.”
That phrase came to mind on this run.
*Disclaimer. I have the highest respect for anyone who chooses willingly to help others. I do not see my self as above other caregivers, just specially trained to handle certain situations that others are not. When my skills are needed, I use them, but I understand that a good Paramedic must first be a good EMT. And good EMTs I like.

This crew had their hearts in the right place. Much like the team of civilians forcibly restraining a man so the AED can analyze him, they’re trying and they get credit for that.

Our patient was stopped by police after rolling through a stop sign and has told the officer the odor on his breath is because of a diabetic condition and could in no way be alcohol or liquor. Following his guidelines he activated a code 2 response for an eval more or less to get the “Nope, he’s good to go to jail” clearance.

The first engine on scene is BLS and the EMT assigned to it either misunderstood the chief complaint or never covered diabetes in EMT school. The patient is munching on a bag of Reese’s Pieces candies and in our system only Paramedics can take a blood sample for a glucose level. They have assumed that eating the candies is a sign of a diabetic emergency because, really, who eats those things like…candy?
So the call goes out for an ALS backup.

As I approach the car where the patient is still sitting, he’s pulling the NRB aside to munch on the candies. Before asking for a report I reach over and grab the candies and place them atop the car.
“No snacking.” I tell him as I ask the EMT for a report.
The snap of the stethoscope as he forcibly placed it over his neck was almost comical as he began to fumble through a report much the same way the doctors at the clinics do when they call us.
All the while the patient is alert, oriented and nervous. Three things diabetic emergencies seldom are.
I clear them from the scene and kneel down to speak to my patient.
“Hi there, what seems to be the trouble?”
“I have a blood sugar problem, that’s why my breath smells, it’s not alcohol.” He says with not a slur, but with concentrated effort to avoid a slur, which is quite more obvious. All I could think of was E.T. eating those candies and am now waiting for my patient to say his name is L-E-AAA-T. He never did.

“Oh you have diabetes. OK, Is that Type A or type B diabetes?” I ask, baiting the hook.

For those of you not on the job, there are two types of diabetes, Type I – Insulin dependant and Type II – Controlled by diet and exercise. Any diabetic knows exactly what type and treatment regiment they are on. Back to the show.

“Oh, Type A and it’s bad.” He responds, biting the line and I’m not letting him go. I do enjoy catching the intoxicated in half truths and watching them get frustrated to the point of telling the truth. I find it helps truly assess their level of consciousness and teaches them that we know what we’re doing.

“So Type A, huh?” I look to my officer who slows down the ambulance to code 2. “What’s with the candies? Trying to fool the breathalyzer?”
“Noooooo,” escapes his lips, “My sugar is low so I need the candies.”
“I thought the odor on the breath was from Diabetic Ketoacidosis, a high blood sugar, which means you’re only making it worse with the candies, but you already know that being a Type A Diabetic, right?” I tell him as I’m confirming the vitals given by the BLS crew. Then a normal blood sugar reading beeps below me and I show it around the crew like a card trick.

Altered folks tend to look at you confused or stare past you, clues that the brain and the eyes are not communicating, but this guy is looking around the car. He’s trying real hard to come up with an answer. At least 30 seconds pass.

“I’ve got a bad bowel and need to get to my doctor’s office.” Couldn’t have been more out of left field.
“What?” I say slowly placing the stethoscope around my neck.
“You heard me, bad bowel, what do you know about that?” He left out ‘Mr Smartypants.’
“I know that’s not a reason not to take field sobriety tests or any other exam the police deem necessary.” I stood, thinking I had him, but you know my clientele, they know the law.
“I want to goto the hospital.”

I let out a long sigh and eyed the candies on the hood of the car. As the ambulance arrived I gave my report and the Medic did his best to talk sense to the driver as we were sent back in service.

As I walked away I heard the EMT from the ambulance say, “Are you going to finish these or should we leave a trail so you can get back to your car in a few hours?”

I stopped in the middle of the street I was laughing so hard.

OK, that wasn’t the exact dispatch, but we’re getting there. Recently I’ve been sent to the “Broken hip/fall” and the “Abdominal Pain food poisoning” which are amazing deductions from a caller with no training, a call taker with minimal training and a computer system that doesn’t have those options. Someone had to go out of their way and change the dispatch criteria. But I digress…

I’m not a big fan of EMS fads myself, but STEMI at least usually gets the Doctor’s attention when you arrive at hospital. I haven’t seen a difference in treatment yet, nor in time to lab, but boy do they start falling over each other when you say STEMI. The title got your attention, didn’t it?

THE EMERGENCY

A man’s family has called stating he has chest pains.

THE ACTION

Stop me if you’ve heard this one. Mid 50′s man has an argument with the wife, then goes out to do some yard work. Comes back in a few minutes later pale, diaphoretic and holding his hand to his chest.
We’ve all had this one. His limb leads are clean. I,II,III have no changes so naturally we’re looking at ASA, nitro, MS if needed, O2 and a lights and sirens return with an early radio call. I don’t care if his fairy god mother appears and tells me it’s not cardiac, this guy’s having the big one.

What sticks out on this run for me was the home remedies that were attempted before we arrived. He speaks no English so the 12 year old is telling us of the elaborate treatments that were attempted. The circular bruises on his chest and abdomen are from a suctioncup type remedy called Fire Cupping that uses pressure to move deep tissues. It did not move his infarct. At least not in the direction they were hoping for. (photo from flickr search for fire cupping, not of patient)

They rubbed enough tiger balm ointment on his chest to send one of the firefighters searching for a window to open in the tiny living room. I caught a whiff of it as we were LEAVING the station there was so much. Wiping that stuff off is just bad, it gets on your gloves, then you touch the bags, you get the picture.

It was downstairs in the ambulance as we got the IV going and more nitro, we ran the 12 lead which showed the infarct right where we thought it was, anterior moving septal. And still no changes in leads I,II,III or our treatment.

As we arrived at the ER, 12 lead traces in hand, the staff was scrambling like never before. Active chest pain calls are always priority, but now that we call them STEMIs everyone runs around like that scene from the movie Airplane.

I hand the 12 leads to the Doctor who takes a cursory look and sets them down. She turns to a nurse and says, “Get a 12-lead on him as soon as possible please.”

I picked it back up and handed it to her saying, “For comparrison. That’s why we’re doing this whole 12 lead in the field thing, right? To help you?”

“That’s a bad trace and your electrodes could be better placed.” Funny, the computer in the machine seemed to like it. I decided to refresh my skills by watching the technician remove my…hey wait…he’s using my electrodes. The Doc takes the print out, which looks eerily familiar and tells the desk nurse to call the lab and tell them they’re on their way.

Whole time was maybe 3-4 minutes and no one likes this Doc anyway, but what is the point of printing out those anterior leads if they are to be ignored?

Some Docs don’t even ask for it, just take our word. Once we were even met in the parking lot by the lab team and went straight into the lab to transfer. That was weird.

But what made this event less stressful and more hilarious was when the Doctor finally got around to looking at her patient, just before they moved him.
The suctioncup remedy which left the ring bruises on his chest now showed giant bruises all over his torso wherever they moved the cups. She stopped in her tracks, reached out for my arm and asked if we had beat him.

“Not this one, I don’t think.” I said, looking at the ceiling.
“No we beat the old lady and the kid, not him.” My partner said, walking back to the rig.

A local street fair is closing up shop and the weather is getting cold. That was when a 19 year old presents to the event medical staff with quite the unique chief complaint.

THE EMERGENCY

A 19 year old male reports chest pain.

THE ACTION

We knew the area would be busy, but the event folks have their act together and get us quickly in where we need to be. On the way a supervisor is telling me not to laugh when the man relays his chief complaint. He’s also telling me because of the way it was reported, he had to activate us.
What was the complaint?

“I drank, like, 2 of those 5 hour energy shots and now I feel jittery.” As he says it he rubs his chest. I looked to the event supervisor who held his arms up as if to say, “See, I told you so.”

Our friend has a variety of stories he hasn’t put much thought into, the same stories we hear day in and day out.
“I’m here with some friends, but they left me here.”
“My brother lives just over there but he kicked me out.”
“I can’t call anyone, my phone is dead.”

And he went on and on.

The check out checks out, but he insist on “Getting checked out.” I find myself giving the ambulance crew the same story I got from the event supervisor and I had to smile.

As he climbed in he asked the golden question. “How much will this cost me?”
Before I could answer, the EMT on the ambulance looks him up and down and says, “Well, somewhere between $1200 and $2800 depending on tests.”

“But I don’t have any money.”

And the doors closed and he drove away, still with 8 hours of energy to go.

The baby boomers are getting restless. Some of the older ones have re-examined thier lifestyles and are making changes for the better. More exercise, better diet, quit drinking. But what happens when your body won’t fall asleep?

THE EMERGENCY

A man has called stating he may have an anxiety attack.

THE ACTION

It’s after midnight and our new friend meets us at the door in his pajamas and a robe. He shuffles into the house and has a thick Irish accent as he describes the emergency. He’s afraid he may not fall asleep.

For over 50 years he was a heavy drinker, so much so that he often passed out at night instead of falling alseep.
Since visiting the doctor a few weeks ago and quitting drinking, he now has trouble falling asleep. Tonight his sleeping medications are not working and he would like a shot (medicine, not booze) of some kind to help him sleep.

“Have you tried watching baseball?” I asked him and he laughed.
“I’ve tried everything my friends. Warm milk, pills, a bath even, but noothin’ (the accent) is makin’ me the wee bits of tired.”
“Well, I can sing you to sleep. That’s about as far as we can go unless you want a ride to the hospital.”
“Oh no, no hospital for me. I was just hoping for a shot or a new pill or soomthin’.”

He escorted us to the door and apologized for calling so late.
“Had I known I’d be so much trouble earlier, I’d a had a shot or two (not medicine).”

Amen.