Just as my head was settling into the pillow after a Haz Mat call and much needed shower, the lights come on and the tones drop for the ever popular bystander diagnosis of “Possible heart attack.”
As I move towards the buggy radio comes over the speaker in the large bays, “Control to units responding for the heart attack we have an AED activation nearby.”
Of course it isn’t a cardiac arrest case, or even a heart attack as we piece together a story of exhaustion, stress at home and a few missed meals (replaced with some hard alcohol) and the assessment continues.
I’m gathering a history and the story from the witness while my medic team is preparing to run a 12 lead since we have reports of a near syncopal episode. They’re thorough…at least when I’m nearby.
As the ambulance crew arrives the familiar blue BDU pants, shirt and stethoscope of a Paramedic intern come into view and I prepare to give a report. This is a good case for an intern. I’ll give him the basic findings so far, vitals, then make contact with his preceptor to determine how much of a lead to give him on the rest.
I stand 6’2″, am wearing turn out pants, a radio sling and a sweatshirt embroidered with my name and title. I mention this because he approached me, saw the patient behind me about 10 feet and performed a careful side step saying only, “Excuse me, paramedics.”
I had 2 initial reactions:
First was the reactionary side of my brain saying, “Oh no he di int!”
The second was the rational brain realizing he has tunnel vision, just like I used to, and wants to get in there and get a report from the folks performing an assessment in real time. After all, I hear them telling him to sit still for the 12 lead.
Not a word from the intern as he pulls out the stethoscope and begins to listen to lung sounds of our conscious, alert and speaking patient sitting up in a chair.
“12 lead compiling” my Medic states less than 12 inches from the intern.
“Hi Sir, turn towards me please” the intern asks as he is again reminded to remain still for the trace. The leads on the screen look great, PsnTs where they should be, good R wave progression and I motion to my medic to let the assessment from the intern continue.
The preceptor is well known to us and he is at the doorway and flashes me a 1-5-0 on his fingers, letting me know the intern is at 150 hours on the ambulance so far. We have a complex set of hand signals that would rival Motorcop and his tactical pals. Without a word I express my displeasure with the sidestep, the lack of a primary exam or even a request for history of event or vital signs and interventions from the first crew to make contact.
He replies with a shrug and the clunky, random wandering assessment begins to draw to a close. The stroke scale test (already administered and documented) looks good, and the patient shows the intern a band aid from the last blood sugar test when the intern tells him one will be completed.
“Would you like a report from fire?” the preceptor asks, clearly dealing with this situation…again.
“Not yet, I want an unbiased look first.”