Thursday, April 29, 2010


I have an addiction other then ambulances. It's bad. I can't stop and might need professional help. It keeps me awake at night. I start getting sweats when the weather starts to warm up. I forget to do my chores and my wife gets irritated at my total lack of concentration and attention as soon as the water gets over 55 degrees. My other, other true love is bass fishing. I can't get enough. I spend every spare day doing it in the summer and and every other day dreaming about it. And if you are sitting there thinking I am nuts, then you have never tied onto an 8lb bass on 4lb test line. It's easily the most exciting thing on the planet. I don't normally eat them, I like to throw them back to get bigger. I have several secret bass fishing holes that I wont tell anyone but my kids where they are. I have cultivated the same love in my children. My oldest daughter, who is 13, out fishes me somedays, don't tell her I said that though.

Being a lowly paramedic with a family I don't have much money. But the job's not about the money now is it. The result of being poor is that I don't have a decent boat, just a plastic coleman canoe. It's nice when we're sneaking into a private pond or lake somewhere that's full of stumps and debris. But the trade off is a boat that is not very stable. It rocks with every bump and if you and your fishing buddy don't have a good center of gravity it can be downright dangerous.

It was a beautiful summer evening several years ago. The sun bathed the whole world in that soft golden light that magically happens right before it drops beyond the horizon. The air was just the perfect warmth, having given over the heat of the day and the mile long pond we were on was still as glass. The birds, the crickets, the fish jumping and rolling...everything was, well, awesome.

We had been fishing for a couple hours and landed several nice bass and many, many small ones. My cousin, Brandon, our friend Ryan, and me. We had a half rack of decent beer left and life just doesn't get more sweet.

Then someone has to pee.

One thing I learned early on about my canoe is that it is not a good idea to try to pee off of it. Not a good idea at all. Unless you brought an extra change of cloths. My canoe only has 2 seats, one in the front and one in the back. So Ryan, having lost the rock, paper, scissors, was crouched on floor in the center of the canoe. He was a good sport about it though and only called us names for a little while.

Coincidentally it was Ryan that had to go.

"Guys, I'm not kidding I gotta go. Go back to the shore."

I glanced at him irritably, "No man, we're a half a mile from the launch area, and fishing's just getting good."

"Besides," Brandon joked, "If you don't stop rocking the boat you're going to scare the fish, ya nub."

Ryan waved his fishing pole menacingly at me, the large bass hook dangerously close to my eye. "I......HAVE.......TO........GO........PEE!"

I nearly stopped fishing, no I didn't. Did you really think I'd stop for something as trivial as this?

"Ok," I said. "I know, we'll get next to that log over there and you can get out and go. I do it all the time, in fact I've used that same log." Keep in mind, I have never done this it just seemed like a good way to get him to be quiet so we could continue fishing.

"I dunno man, that seems like a bad idea." Ryan eyed the log with suspicion.

"No, it'll be fine, I do it all the time." I tossed my spinner bait next to some particularly dense weeds. Gotta be a fish in there.

Brandon smirked, "Seriously, quit being a girl and just do it."

Finally Ryan agreed so we sidled up to the log and Ryan stood, the canoe rocking a bit. The log in question was a medium sized log that looked like driftwood, with a thin mask of dried algae on top of it. Ryan precariously put one foot on the log, swayed a little with his arms out and transferred his weight all the way onto the log. It held.

Brandon and I continued fishing not even sparing Ryan or the log a glance. Ryan started taking care of business.

What happened next has been hashed and rehashed over and over. Ryan swears I did it on purpose but I maintain I was just trying to help. Out of the corner of my eyes I noticed we were starting to drift away from the log on Brandon's side of the canoe. With Ryan perched on the log I didn't think it would be a good idea for us to move away from it. So, while still fishing, I stuck out my leg over the side of the canoe and tried to pull it back to the log with my foot. Now dried algae gives excellent traction, but if you get it wet it reconstitutes to it's slimy, nasty self.

The extra weight of my foot on the log was enough to plunge it four inches underwater, turning the top of the log to snot.

Ryan yelled, "HEY!" Still trying to finish peeing.

I cast again, trying to get that big daddy bass.

Ryan's foot slipped on the log. He got it back up and the other foot slipped. Brandon adjusted his drag and kept reeling. Again Ryan's foot slipped and his other one soon followed, he looked like he was trying to dance a slow jig on the log for a minute, arms started to waver a little.



All of the sudden his feet started sliding at the same time and he began to look like a logger spinning a log under his feet, shouting and carrying on. Needless to say he now had our full attention. His feet were moving in a blur and eyes popping out of his head, arms flailing wildly. I quickly surmised that this was going to end with someone getting wet and that it wasn't going to be me. My foot was still on top of the log and in an act of total self preservation I pushed as hard as I could, kicking the canoe away from the log, and coincidentally pushing the log out from under poor Ryan. He plunged into the water between the canoe and the log. In an effort to save himself he grabbed the canoe with one hand and the log with the other on his way down.

The canoe listed alarmingly to the side then went completely over onto it's side, water pouring into the boat. Brandon and I dropped our poles and scrambled over the opposite side in an attempt to balance the about to sink watercraft.

Now take a moment to consider this sight. Ryan is half in the pond, holding himself up with one hand on a submerged log and the other on the side of the canoe which is now underwater. Brandon and I are perched on the top of the side of the canoe, screaming at Ryan to let go.

He did.

The canoe violently righted itself, catapulting Brandon and I into the drink. Luckily the water was only chest deep.

So there we stood, nipple deep in brackish pond water, staring at each other, the canoe gently floating away, as the sun set over this wonderful little fishing hole.

Many minutes passed before anyone spoke. It was Ryan.

"Damn, I need another beer."

Tuesday, April 27, 2010

Electrical Therapy

Part of our jobs as paramedics is to use electrical therapy to convert heart rhythms from chaos to something conducive to life. What this means is that I get to use my handy dandy heart machine to intentionally blast electricity through a persons chest wall in hopes of saving their life. I know, crazy that I get paid to do this. Most of the time the patients are in cardiac arrest during the process of electrical therapy. Every now and then though, someone can be in a rhythm that needs changing and they are still conscious. Which as you can imagine leads to interesting results.

We were toned to the local prison in our neck of the woods for a 32y/o male complaining of a rapid heart rate, no history. We called en route and hit the lights. This particular place cannot allow multiple units in and out for obvious reasons so we always respond alone. I was a fairly new medic, out to save the world and light on practical experience, but ready to face whatever the world could throw at me. The call sounded relatively boring to me. We arrived on scene and found our patient resting comfortably with an IV already in place. He was alert and oriented, vital signs were great, skin color was pink/warm/dry. His only complaint was a slight dizziness, nausea and a little vomiting, and of course a heart rate of 180. The monitor showed narrow complex tachycardia. Fairly stable. I took report, we loaded him up, which is always interesting when the patient is shackled hand and foot. My partner hopped up front and I hopped in back with an armed officer from the prison. I asked the patient if this had ever happened to him before and he said no. I did a 12 lead and got out the adenosine. Adenosine is our first line med for stable narrow complex tachycardias. It interrupts AV conduction and resets the heart, so to speak. It also must be given very fast since the half life is about 15 seconds. The body metabolizes it very quickly and if it's not given fast enough it won't reach the heart. So I told the patient what to expect, maybe some chest pain, shortness of breath, strange feeling in the chest, yada yada. I slammed the med in the bottom port close to the patient and followed it with a syringe full of saline from the second port up. The patient turned pale, then gray, threw up, in the bucket thank God. Then he started sweating and gasping. I glanced at the monitor and his rhythm had changed to a wide complex tachycardia with a rate of 260. This rhythm is very dangerous and usually not far from death. I may have pooped myself a little. He was now bobbing around listlessly and said "I don't think that helped."

Holy crap! I need to shock him. Being that I had never shocked an alert patient before I shied from the proper treatment which is to just spark him and I instead grabbed some versed to premedicate him. Versed is a med related to valume that makes people forget. I hit him with 5mg IV. Then shrugged and gave him 5 more. In retrospect, that was a lot of freaking versed. At the time I was more worried about him remembering my name being that he was about to get out of prison and all. I grabbed the hands free shocking pads and threw them on his chest and hit the sync button. The sync button synchronizes the shock with the heart rhythm, if we just go shocking alive patients we risk what is called R on T phenomena, if the shock falls on a T wave it will most likely kill the patient. Then I told him I was sorry and hit the print button on my monitor and pushed the shock button, smacking him with 100j.

All hell broke loose.

The patient convulsed violently. He screamed like he was dying and tried to jump off the bed, momentarily forgetting his shackles. That failing, he threw his puke bucket across the ambulance at me, screaming profanities and trying to hit me. My heart was pounding and my eyes must have been as big as silver dollars.

While stomach contents dripped from the ceiling, I looked at the monitor, normal sinus rhythm rate of 84 and the patient is once again pink, warm, and dry. It worked!

As things settled down in the back I am suddenly aware of hysterical laughter coming from the prison officer. He is rolling back and forth in his seat laughing so hard he couldn't talk.

"That hahahaha that hahahaha, that was the (snork, cough) hahaha, funniest shit I've ever hahahahaha, ever seen! HAHAHAHA!"

I didn't quite share his enthusiasm for what had just occurred. By the time we got to the hospital the patient didn't remember the ride or even who I was. Interestingly enough he was due to get out of prison soon, so the prison wouldn't send him to get his, until then, undiagnosed WPW fixed(WPW or Wolfe-Parkinson-White is a hereditary heart defect that causes what's called a re-entry pathway, making people prone to really fast heart rates and making adenosine, the med I gave, really dangerous to them). I ended up getting lots of practice on this guy since the prison wouldn't fix him. I sparked him 3 more times before he got out, though things went a lot smoother each other time.

Monday, April 26, 2010

Dogs, Round Three

It was a beautiful spring day. The birds were out, the sun was bright, and the trees all had new growth heralding the oncoming season. I was working with Angie who was my regular partner for a little less then a year. Angie is a fiery red head with all the stereotype that entails. She is smart, tough, and very outspoken and a bit of a flirt. We had been having an average day running 5 calls and it was around 3pm. We got toned for 23 y/o male shortness of breath, history of anxiety. Pretty straight forward call. En route we were warned by volunteers on scene to watch out for R.A.L.s, this means Rottweilers At Large, our code for big unfriendly dogs near the scene. Angie got a little anxious, we shared an apprehension of other people's dogs.

Once on scene we saw what they meant, two full sized doberman pinchers were running around our ambulance barking and growling. We had a short discussion in the rig over who was getting out first and I lost the paper, rock, scissors. I'm sorry, I know, this was not chivalrous, but I'm telling you I don't like big dogs, especially dobermans. I rolled down the window and yelled at them and that didn't work, so I crawled in the back and got my drug box thinking I could hit them with it if I had to. So I composed myself and took a deep breath. One, two, THREE! I jumped out and charged the dobermans. They growled and barked but went back to their own yard. Angie then hopped out and we started our long walk up the driveway.

About halfway up my traitorous drug box chose that moment to spring open and dump all my gear onto the ground. I had forgotten to lock it on the last call. Angie told me to go up to the house and check on the patient and said she would be right up. I looked back toward the yard containing those evil canines and asked her if she was sure. Yeah, go ahead. She glanced down there too. I took of without her.

Almost to the house I looked back one more time and saw Angie on the ground picking up my gear and casting surreptitious peeks down toward the yard that was now devoid of the giant monsters. Wonder where they went. About then I noticed the Fire Chief sneaking up behind Angie with a malicious look in his eyes. He saw me and put a finger to his lips. Shhhhh.

No way. He wouldn't.

He did.

He reached down and grabbed her leg tightly giving his best doberman impersonation. Angie screamed and suddenly became epileptic, seizing across the gravel driveway yowling like a growler on a fire engine. And did a somersault. Landing on her booty. She froze for a second, eyes impossibly wide and jumped up and swung. She caught the Fire Chief in the chin and leveled him. He flew over backwards and struck the edge of the driveway, helmet knocked clean off his head.

In the house I attempted to assess this poor man and his anxiety attack and I could not stop giggling. To the point he asked the other responders if I was always like this. I HAD to tell him the story. Calmed him down and he laugh too, with Angie glaring holes in the back of my head.

When asked later the Fire Chief said it was totally worth it and he would do it again.

Asleep at the wheel

Being a paramedic on my 3rd recert and having been a full-time EMT and firefighter before that I have worked a 24/48(1 day on, 2 days off) or a Modified Detroit(1 on, 1 off, 1 on, 1 off, 1 on, 4 off) or some variant of that for most of my adult life. It was not new to me as my dad was a career firefighter as well, it's our way of life. Also I am married and have three children, two of which are still in grade school. So as you can imagine sleep can sometimes be hard to come by. Especially when on a double or even a triple(72 hours) shift. As a result of this I have developed the ability to sleep at will, anytime, anyplace. And I mastered the skill of power napping between calls. Places I've been found sleeping include: couches, beds, chairs, floors, my own car, someone else's car, once a kitchen floor, the passenger seat of the ambulance parked in the apparatus bay, found by the oncoming crew(mega-rough night, 22 transports in a 24 hour shift, my personal record), in front of the computer, in front of the TV and I know there are more, I just can't think of them now.

Sleep deprivation does amazing things to the mind, and often hilarity ensues. I once read a study that said sleep deprivation works on the human mind in almost an identical fashion as alcohol. The study showed that people who were sleep deprived had very similar reaction times and decision making skills as someone who was intoxicated. Kind of scary isn't it.

I was working with Mike, kind of a big burly teddy bear. You know the type. Big guy, talks tough, gruff and short at times, but really is a big gentle bear, wouldn't harm a flea. We were getting our booties handed to us in a bad way. We were on call 17 for the shift and it was 3am. We had just gotten to sleep and I suddenly heard talking on the radio. I had not heard the tones and we were about to miss a call or get a second tone. That's embarrassing to say the least, not to mention bad for PR and life safety(note: this is not something I can ever remember happening to me and I was not about to let it). I jumped out of bed and ran to the rig, opening the bay door and sitting in the passenger seat.
And I waited.


Waited a little more.

I jumped up and ran into the day room where I could hear Mike snoring away. "MIKE!!!" I yelled, "Get UP NOW!!, WE HAVE A CALL MAN!!!"
Mike jumped up choking on his own saliva, eyes popping out of his noggin and intellectually said "WHA? HUH?"
"Call Man, let's go!" He and I ran into the app bay and hopped in the rig, he fired the ol' beast up in time to hear the short report for the other medic unit. The call was not for us. Mike slowly leveled his very irritated gaze in my direction, anger oozing from his pores.
I said the first thing that came to mind. "Great drill Mike, Let's get some sleep buddy."
He got out of the ambulance and slammed the door and stomped off to his room and locked the door, all without saying a word.

The scariest one ever, I woke up in the bad part of town. Where we go to ODs and assaults. When I say I woke up I mean my first conscious thought was, I'm standing in the cold next to my ambulance in the middle of the night. Where am I? I looked at my partner and asked him as much and he shuddered and told me, then said "Dude, you drove us here."

We work in an area that covers a city but we respond all over the county and cover several volunteer fire departments. Sometimes we have up to an hour for responses. So my partner, being the blessed woman that she is, would let me sleep on the way to calls and wake me up when we were close. The other part of that deal was that I did the extra paperwork that would normally fall to her. This night I happened to be working with another partner who we'll call Deb. Deb was a part timer and a fairly level headed EMT and had been in the trade for a while. She could be relied upon(sometime I'll tell the story about how I accidentally super glued her fingers together). So she knew about my arrangement for sleeping on the way and had no problem with it. In our a response area there is a river that floods frequently. We normally know about it ahead of time and take precautions. This particular day, due to rainfall and high tides it had flooded and we did not know about it. So I was dozing on the way like normal and Deb, unaware of the flood state came careening around the corner and found the road to be covered in about 4 inches of standing water. Since she was going 40mph and had no stopping time we drilled it. I was asleep and was rudely jostled awake by the sudden speed decrease, it felt like the ambulance was stood on it's nose. Deb screamed, I screamed, and there was water all over the windshield. I knew what had happened, oh yes I did. She had gone into that great big river we are always rescuing people out of. In my suddenly adrenaline, enhanced, synaptic firing I knew I was dead. The spot where I imagined we were, the river runs 12 feet deep. And before I could stop it my fears exploded from my mouth. "You B----! You killed us!"
The water flowed off the windshield and we could see, the ambulance picked up speed as we left the large puddle. I then recognized the road and where we were. I could hear Deb giggling. I looked at her, heart still pounding and feeling all jittery from the adrenaline. Deb giggled again. She looked at me and said "What was that mister paramedic?" Fits of mirth and more giggling. "What did you just say?" luckily we were on scene soon and I didn't have to hear much more about it until later.

To this day it is still a saying around the station.

"You B----! You killed us!"

Wednesday, April 21, 2010

Dogs, Round Two

It was a beautiful spring day. The sun was shining, there was very little wind. We had only run a couple calls. The world was good. About lunch time I decided to make some of my special tuna fish for dipping crackers in. My mouth was salivating with the thought of that tuna. I grabbed a can out of my locker and opened it, then went to squeeze it into the sink to drain it. When I did this, for some reason, the contents under pressure squirted out and down the front of my uniform. My class "Bs" had to be changed and I had tuna juice down the zipper part of my pants. I uttered a few choice expletives and went to change my shirt. I was going to have to run home in the ambulance to get new pants though. Luckily I lived close to work.

Part way to my house the tones went off for altered level of consciousness, patient hallucinating. We went in route, so much for a change. We arrived on scene to an elderly gentleman standing on his porch yelling at the barn wall about naked people and that they needed to get dressed decently. My partner and I calmed him down and explained that there were no nudists prancing about. Then we had to figure out why he was like this. Halfway through the assessment his phone rang and it was his son who explained to us this was not like dad and he had a recent medication change. The med happened to be morphine. Well, the vitals all checked out, SPO2 was good, blood glucose was good, heart rate and blood pressure was fine and he didn't smell like alcohol. So it appeared to be a straight forward reaction to the morphine. I elected not to give him any narcan since his respiratory effort was fine and he was alert, if not oriented. Plus he had a history of narcotics for chronic pain, the last thing I wanted to do was put this poor guy into withdrawals.

We got him loaded into the back of the ambulance and my partner was doing a few things before we left so I was standing outside BSing with the volunteer firefighter/EMTs when the guys son showed up. We hadn't been able to find a list of his meds so the son went in to get it. On his way back out he let a moose out of the house. And I mean moose. The dog was an over sized great dane. The thing was huge, you could strap a carriage to it and be towed around. I felt a little nervous apprehension at his sudden release from the house but I pushed down my gut instincts and continued to BS.

All of the sudden out of the corner of my eye I see the dog running at me head on. It was at a full course gallop with me in the inevitable path. I had only a fraction of a second to respond and my body just wouldn't listen to my mind on such short notice. The dog ran between the firefighters and straight to me, he put his head down like a charging bull and caught me right in the crotch. At that point he tossed his head up, effectively lifting me off the ground and sending me flying backwards. I landed on my back with the wind knocked out of me and the next thing I new the dog was digging and licking at the tuna juice in that oh so embarrassing spot. I was frantically pushing the dog and trying to get him away, but he was too strong. Finally the guys son stirred from his disbelief enough to grab the dog off of me and started apologizing profusely. I got up, dusted myself off and looked around. Everyone of the volunteers was standing frozen in place with their mouths wide in shock. The son was still apologizing when my partner leaned out the door of the ambulance and said, "It's alright, he has that effect on all animals."

I decided it was now time to leave as it is impossible to regain your dignity after an incident like this.

Saturday, April 17, 2010

On Dogs

Now I've been a little afraid of dogs for as long as I can remember. I think it stems from this little yipper dog my grandma's friend used to own. The memory is very vague I couldn't have been much older then three and I remember that dog barking at me and biting me every time it was over, I don't remember it hurting but I remember it biting. When I was about eight I got bit on the butt by a doberman pincher and it drew blood. So me and dogs have not been the best of friends(I have gotten over this fear and own two big dogs myself now).

So dog story number one. We were toned out to back pain close to quarters right at dusk. When we got on scene it was pretty dark. The patient was located in the daylight basement on a mattress on the floor. I knew the patient and she was in obvious pain, sweating, laying flat, high blood pressure and pulse, all the things that tip us off to this ones not just trying to get drugs. Plus I knew her and she wasn't the type. So I decided to get an IV and give her some morphine before we moved her, for her comfort. I got down on my knees at the patients level and started setting up for my IV and talking to the patient. While I was doing this the lieutenant was looking for an easier way out then the switch-back stairway. I heard a bark and then the Lt said "OH S---!!"

So I looked around and didn't see anything alarming, the Lt was out of sight around a corner and had opened a door to the back yard. I didn't see any dogs so I figured he had just shut the door. I got my line in and started some morphine and then noticed that all the responders were up against the far wall, looking at me. No warning. That's when I noticed the hot breath on my neck. I slowly turned my head and found myself, literally nose to nose with a huge rottweiler. The patient started assuring us that the dog was nice and would not bite, however, I was not convinced. Seriously, there was six strangers in this dog's house and they were surrounding this dog's mama who's laying down moaning with pain. If that's not a recipe for getting eaten I don't know what is.

I calmly and nonchalantly attempted to befriend the dog, looking like a hero to the other responders...ok, really I said "nice dog" and it came out as a squeak. And then I heard this deep, baritone, rumble emanating from the dogs chest, and my stomach flipped over and threatened to upend my dinner. I found myself wondering what I'd look like if I survived getting my face torn off, while trying to precordial thump myself to restart my heart.

About that time I was saved. Saved by an eleven year old girl who walked in and saw the dog growling 1 inch from my nose. She grabbed the dog by the collar and berated his behavior while dragging him back to the yard without even a little fear. He gave me the stink-eye until he was around the corner.

I said the only thing that came to mind. Calmly I looked back to the patient laying on the bed and said, "Wow, what are you feeding him, his breath was awful!"

The guys thought it was hilarious that I was "saved" by an eleven year old girl and that she made me look like somewhat of a sissy. I heard about that for sometime. Interestingly enough those same guys were up against the wall from the time the dog walked in the door until it was dragged out.

Monday, April 12, 2010

To Code or Not to Code

To code or not to code, that is the question. Per my protocols and most teachings for EMTs and paramedics across the US, trauma deaths are just that, deaths. If someone is the victim of trauma and their heart and breathing has stopped there is somewhere around a 99.99% chance they cannot be resuscitated. At least that's what the studies say. The story I am going to tell though is about a woman who beat the odds.

It was an extremely busy day. We were on the way back from our third trip out of town and countless 911 calls. It was pouring down rain, and I mean dumping. Right at dark, around 19:30 hours my partner ambulance for the day got toned to an MVA almost near our north county line, this is a 45 minute drive with the lights on.

The short report sounded bad and there was two patients so we went in route too. It took us 50 minutes to get on scene and the whole time we are hearing reports of power pole on top of vehicle, can't shut down power, one patient is unconscious and can't reach her, etc. Sounded like a bonified grinder.

We arrive on scene to find four volunteer fire agencies(with multiple rigs and personnel) and my other medic unit all staged a little away from the accident. A large 70s pickup had gone head-on with a power pole and the pole had smashed the roof of the truck almost flat to the dash. The mechanism of injury was very significant. The other ambulance crew gave me a briefing, explaining that the wires were still hot and for some reason the power company had not turned them off yet.

So we waited, and waited, and waited. During this time the driver, who was entrapped woke up and began yelling at us.

"Help me! HELP! I think my girlfriend's dead. HELP!" And then he would reach up and grab those high voltage power lines. We kept yelling at him to let go and put his hands down but he only listened for a minute then did it again. It was still pouring down rain and despite my good jacket I was soaked through and evening turned into night.

Finally we received word that the lines were shut down and we could proceed. The other crew took the driver and I went to the passenger. It took the hydraulic spreaders to open her door, and the roof was caved in over the top of the windowsill area on the door. After popping the door I saw the patient was in bad shape. Her crotch was on the floorboard area with one leg going straight up past her head and the other lodged in the dash. Her head rested against the seat where ones booty would normally go. It was very dark so I couldn't get a proper assessment inside the truck so I made the judgement call of life over limb and had someone help me get her out quickly and onto a backboard.

Once outside the truck I could see that her skin was gray, she had no pulses and no spontaneous respiration. Per my protocols I could have called her right then and she would have been a statistic in the trauma studies. However, I had a really gun ho group of EMTs and they all grabbed the backboard and ran her to my ambulance. I hopped in the back and saw that my brilliant, EMT-IV partner had set up the monitor, two full IV setups, and all my intubation equipment.

My partner hooked her up to the EKG while I dropped a quick tube, no gag, no vocal chord movement, so I didn't need my induction meds. Went in easy. About then my partner look at me and says "Heart rate's 40!"

I said "No, PEA at 40 get ready to do CPR." By that time I noticed I had poor bag valve mask compliance and only the left side of her chest was rising. She had a tension pneumo-thorax, or a collapsed lung that had built up pressure and was stopping her heart from beating. I grabbed the iodine and a 12g needle and performed an emergency needle decompression. The amount of air that shot out the end of the catheter was more then I've ever seen before or since. But the patient's color immediately started improving and the bag valve mask compliance was easier as well.

"Ok, heart rates in the 120s now." My partner informed me. I checked a pulse and sure enough she had bounding pulses with that. I told my partner to get up front and not to spare the ponies. We couldn't get a helicopter because of the rain so we transported 45 minutes to our local hospital.

On my head to toe I found the patient had contusions to left anterior chest, bilateral femur fractures, bilateral tib/fib fractures and multiple cuts and bruises. The patient was flown to a trauma center later and she recovered nearly completely. Albeit after a lot of physical therapy and time in the hospital.

Would I have worked her if not for the EMTs? Who's to say. I was with in my right to call her, she met the criteria for Traumatic Death In The Field. I will say that from that day out I have looked at each situation very carefully and if there seemed to be any chance at all I go for the gold.

Saturday, April 10, 2010


If ever you are sitting around bored and wondering what to do let me recommend one of the most exhilarating experiences of my life. This experience rates very high on my list of things that are exciting but not to be repeated, once is enough. Oddly enough it happened to me twice. I am getting ahead of myself, let me start at the beginning.

Several years ago I worked for a busy ambulance company. We ran all day and all night, normally leaving me exhausted on my first day off shift. I don't remember what day it was, just that I had gotten off a shift at 8am and was very tired. I drove forty minutes home and crawled into bed as my wife was getting up. We were newly married, had a five month old son, and couldn't afford much. The result was that we lived in a rather drafty three bedroom mobile home on my parents property. Over the course of the winter some mice had decided our trailer was warmer then the bushes and they moved in. We had put out poison and most were dying now so our little friend problem was getting better.

Sometime around noon my wife woke me up because she had to go to work. Our son was sleeping and I had the house to myself until he woke up. Now, I like to eat. When I have time to myself I frequently make something really good to eat. That day I decided that I needed chicken. I fired up the BBQ and cooked a piece of chicken breast for a sandwich. My mouth was watering. I was crossing my fingers that my son would not wake and interrupt this spiritual sandwich moment. Hey girls, guys are like that, if you want to win them over learn how to make good sandwiches.

Let me tell you about this sandwich. I started with a large chicken breast, basted it with BBQ sauce while cooking it. I then put it on a hamburger bun with mayo, BBQ sauce, lettuce, and a ton of cheese which melted it all together. It was too tall to take a bite. This was the grandfather of all sandwiches. I poured myself a large glass of cold milk, sat down on the couch, and hit the power button to turn on the TV. My eyes glazed over as I took in a huge breath through my nose, the smells of the sandwich making my anticipation almost unbearable. I almost got a bite.

Scratch, scratch, scratch.

I stopped and turned my head, did I just hear something?

Scratch, scratch, scratch.

Yup, I most certainly did. I should have sat there and ate that awesome sandwich. I should have ignored the sound. I should have, but I couldn't. There was something furtive making noise where there should be none.

Scratch, scratch, scratch.

I set down the almost enjoyed lunch and started looking for the sound.

Scratch, scratch, scratch.

After several minutes of searching I found the doors to a cabinet we never used. It was at the end of the couch and we had put an end table in front of it and had not opened it for years. I pulled out the end table and slowly opened the cabinet. Inside there was a tangle of paper, lint, cloth, and fiberglass insulation. And a mother mouse and five nearly full grown babies. I grabbed a mouse trap, put peanut butter on it and dropped it inside the cabinet and shut the door.

I went over and sat down to have another try at my sandwich that was quickly cooling. I picked it up and almost got it too my lips.


I couldn't believe how fast I had caught one. I set down the sandwich and opened the cabinet. Mom had taken the bate and had perished. Well, I thought to myself, I should get the babies now before they get hungry and wander off. I grabbed an old pair of firefighting gloves and an empty round fishbowl and surveyed the situation. The babies were all together in the nest and I thought I could get them all at once. I crept up and placed my gloved hand quickly over the mice and scraped them, nest and all into the fishbowl then placed a book on it for a lid.

That was easy! I washed my hands and sat back down at my incredible, now luke-warm, chicken sandwich. Just before I took a bite I noticed movement in the fishbowl. The mice were moving. Wait a minute, it looks like one is missing. I set down my sandwich and picked up the bowl and counted.

One, two, three, four. Hmm.

One, two, three, four.

Definitely there were only four mice. The fifth was missing. I was starting to feel a little cranky at this point. I put the structural fire gloves back on and went to the cabinet saw the mouse staring at me, daring me with his little beady eyes.

Have you ever had an idea that seemed like a really good idea, and later, in retrospect you wonder how you could ever have thought such a thing? How in thinking in the moment you had come up with a plan that was not only idiotic but could become dangerous? I fell victim to one of those momentary lapses of sanity. In my irritation I decided I could probably just use the fire gloves to grab this little pain in the back side. So I tried.

The next series of events ran downhill faster then I could have planned for. I reached in with karate hastened hands, I am fast and have good hand eye coordination. The mouse went matrix. My hand darted forward with snake striking speed and that mouse jumped straight up, ricocheted off the ceiling of the cabinet, shot sideways, hit the edge and then was clear on the other side of the cabinet. My hand then reached the place the mouse had been sitting when I first started. Mouse one, me zip.

I tried several more times and the result was the same, as soon as the mouse started moving it looked like I was moving in slow motion while he virtually flew around my hand and the inside of the cabinet. I then had the idea that I could move faster if I was trying to smash him instead of catch him. So I hammered my first down as hard as I could on him. The mouse, having enough of this crazy game jumped out of the cabinet and ran under the couch.

You need to remember here, I am tired, hungry, and my sandwich is cold. I got angry. Really, really angry. I ran to the kitchen shouting expletives and voicing the many ways I was going to torture the little rodent before I killed him. I grabbed the mop and charged back to the couch. On my hands and knees I started blindly slamming the mop handle in and out from under the couch so hard I was banging and shaking the wall behind it.

In the blink of an eye, faster then I could move, the little mouse ran out from under the couch, between my legs and right up the open leg of my pajama bottoms. Yes, you heard me right. Up the pant leg of my flannel pajamas.

The human mind is an amazing thing. It stores solutions. Whenever you have a problem, once you find the answer your mind then holds it, in case you ever have that problem again. This was an entirely new experience. My heart hit Indy500 speeds as I received a massive adrenaline dump and for once I was fast enough to catch the mouse, right about mid thigh inside my pants. So the mouse is screaming inside my pants and I'm running Mach Five laps around the interior walls of my trailer, not even touching the ground, as my mind desperately scanned for some scrap of useful information. I have found that running in circles at top speed is a very useful way to offset the sudden energy brought on by dumping pure adrenaline into the bloodstream. I exploded out my front door, jumped and whipped my pants off in one motion and expelled that mean little rodent into orbit across the yard that we shared with my parents. My pajama pants falling onto the lawn.

As I stood there half naked and panting, heart pounding and limbs trembling, trying to grasp the gravity of what had just happened to me I slowly became aware that I was in my underpants. I glanced around, and there, across the yard, standing on his porch was my dad. Eyes wide, with a coffee cup frozen halfway to his lips. He didn't drink coffee on his front porch for the better part of the year after that. I went back inside, threw my sandwich in the trash and went back to bed(after releasing the other rodents outside). My son had slept through the whole event.

The second time it happened, yes, I had a live wild mouse run up my pant leg on two separate occasions, wasn't nearly so exciting. See, my mind knew what to do with this situation now. I felt it on my foot and then in my pajama leg. I again caught it mid thigh, then stood and took off my pants and nonchalantly sauntered across the room and out the door to release the critter. My dad did not “freeze up” this time. He simply shook his head and walked away.

My First Fire

Being with the department only a few months and having minimal training I found myself pulling a shift with my dad. My dad had been with the department since I was four and was the Lieutenant of his shift, kind of a grizzled old fire dog if you know what I mean. I don't really remember any other calls that day, before or after, all I can remember is that Buick Skylark with fifteen foot flames.

We were sitting around the station talking and the tones went off for a car fire not too far away. My heart did a somersault and I ran to the apparatus bay to don my bunker gear. It seemed like I couldn't get dressed quick enough. My suspenders got caught on my boot, I accidentally kicked a glove under the engine, forgot to put on my flash hood. The whole time my dad was laughing while he geared up.

We hopped into the engine, dad in the officer seat, the medic driving and me in the attack line seat. I put my pack on, they were mounted in the seats, and tried to slow my hyperventilation some.

Those days everything was still so new that speeding down the road in the engine, lights flashing, growler winding up, cars pulling over, put a huge grin on my 19y/o face.

We pulled on scene to see a Buick Skylark fully involved. This was the biggest fire I had seen up close to this point in my life, I thought everyone must be able to hear my heart doing double back flips. The flames were fifteen to twenty feet in the air, black smoke broiling up with incredible heat emanating from the car.

Dad gave a quick size up and ordered me to pull the driver's side preconnect. I did it just how I was trained. Reached up and shoulder loaded the top 100 feet of hose while pulling the bottom 100 off the bed. I zigzagged towards the car flaking hose out so it wouldn't kink. Got to the nozzle and turned giving the ready for water signal while shouting for it. Water snaked down the line making it heavier, I opened the bail a crack and adjusted my stream and looked back for my dad.

I didn't have to look far, he was packed up running right at me, he grabbed the line behind me and said,"OPEN THAT SUCKER UP!! GET THAT FIRE SON!!!"

I opened nozzle and started flowing water from about ten feet away, I heard dad laugh and say, "Not like that, like this!" And he pushed me right into the fire.

There was fire blowing around my SCBA mask, I could hear the crackling and popping, suddenly everything was very warm and my interest in putting out the fire became very vested in the fact that I now needed to get it out or burn(that's what I thought). I had the bail wide open and anti-aircrafted the inside of the car. The heat diminished drastically and the fire darkened down. Behind me I could hear my dad laughing maniacally, I was pretty sure he'd lost his marbles. After a couple minutes the fire was out, I picked up hose while my dad talked to the owners and filled out a report. I was energized, it was amazing.

Back at the station everyone was laughing listening to my dad telling the story, "You should have seen the look on his face when I pushed him right into it! I thought he'd pooped his bunker gear! Kept looking back at me like I was crazy."

But more then that, under the laughing and joking and poking fun, I could hear my dad's meaning. He was proud of his son and wanted everyone to know it.

Friday, April 9, 2010

Just another practical joke

The nature of emergency medicine is many sided. Success and failure is measured in life, limb and death. Even when you do everything right people still die in front of you. Families still blame you and doctors still yell at you. A good day is spent with people who are not having a good day. Maybe no one died but there's still grief, fear and anger following the responder from call to call. I don't even want to talk about what a bad day is like.

The result is a very stressful career that has an unbelievable burnout rate. At times even the best providers find themselves looking in the mirror wondering why they do this job. Because of this, we must learn to cope, and most of the time that shows up in the form humor and practical jokes. We laugh at things most people find macabre, we chuckle when others would be horrified. We are not trying to upset anyone, nor are we insensitive. We are just dealing with more tragedy then twenty non-EMS workers deal with in their whole life time.

Our shifts run from eight am to eight am the next day. When we are busy it's great, time flies. But when there's no calls, well, there is a saying about idle hands. Especially with a bunch of riddlin deficient, social throw backs like us. Giving us all that spare time is like giving a three year old matches. Something is going to burn and probably not the intended target.

It was a cool fall Saturday, overcast and humid. The looming clouds were threatening to explode and deluge us. And at eleven o'clock there had not been any calls. I paced around quarters drinking my one hundredth cup of coffee praying for something to break the monotony. All the rigs were checked and in service. All the chores were done. No office staff were present. My partner Mike sat in the day room studying his protocols. We were three hours into a forty-eight hour shift and I swear we'd been there days already.

In my boredom I ransacked the spare room looking for anything that might relieve my tedium and break up the day some. Then, in a box on a top shelf I found it. It was a foam rubber head. It was obviously a Halloween prop someone had put up there to save for the next All Hallows Eve. And it was a good one, in all appearances it was a severed head. It had vertebra and arteries hanging from the neck. Off set bloody eyes and open facial wounds marred it's visage. Yes! Just what I needed.

Now that I had found my freedom, where to put it? The places that crossed my mind were the freezer, my partners locker, and under the computer desk. All of these places were unpredictable though at best, my partner maybe not even needing to go there. So where to put it? When it came to me I knew I had the answer. The toilet.

Now let me explain my partner. He was a tall, large, muscular man, boisterous without much to fear and he was smart. In order to get him I had to not give away my intent and the trap had to be sprung flawlessly. He had also been known to pull a few practical jokes of his own.

So the first thing I did was sneak into the bathroom and flush the toilet a few times to make sure it was clean. Then I turned off the water at the back and flushed it again to empty it and carefully set the head in the head(sorry about the bad pun) with it's ghastly face peering upwards and shut the lid. Now it was a matter of time and the clock was ticking.

Forty five minutes later Mike had not moved from his spot, meticulously reading and rereading his protocols. This was too much, I had to get him into that bathroom. I made more coffee and offered him a mug. He thanked me and went back to studying. I started flipping channels on the TV. As soon as Mike's coffee ran low I got him some more. He looked at me funny but thanked me all the same. After another thirty five minutes of aggravating reruns Mike stretched and said,

“Man, all that coffee, I gotta go to the restroom.”

YES! Finally! Something fun!

I nonchalantly strolled into the other room pretending to grab some paperwork and Mike walked into the bathroom and shut the door. A few moments passed and I imagined him checking his teeth in the mirror (previous prank in which he had gotten green food coloring in his coffee). And maybe he scratched himself and made a face in the mirror. Then all hell broke loose. A high pitched scream emanated from the bathroom followed by clawing on the door and the door nearly being knocked off it's hinges as Mike fell out of the bathroom. He was on the floor on his hands and knees panting, his face beat red and he looked up to see me rolling in fits of mirth.

It's amazing how many laps someone can make chasing someone else around a building the size of our quarters when they still had to use the bathroom. Luckily for me I was small and fast and could run for sometime as well. Even while giggling like a school girl.


Death has always been a subject that interests me a great deal. It always seems so personal, when and how we die. I've pondered about it frequently and even imagined myself in some of my patients shoes. Wondered about the pain involved, the time frames involved, the people left behind, what's on the other side for each person and so on. Maybe I'm macabre, maybe crazy, maybe a little odd, or maybe we all think about these things and just don't talk about it much. When I examine someone that I have been called to that has died I feel very interested by what I see. The pictures on the wall, the reason for their death, the position they are in, the books on the shelf, the uneaten food cooling on the table, the color scheme of the drapes and furniture, how big their TV is, etc. These things all paint a picture of the person they used to be and may even be involved directly or indirectly in their passing. Sometimes people make a statement with their deaths, other times they go unnoticed for weeks, sometimes family witnesses their demise or sometimes come home to find it.

The family's responses very greatly as well. I've had family ask me to stop CPR to preserve the dignity of the deceased. I've had them beg me to do CPR even though an untrained bystander can see the obviousness of it. I've watched people collapse in their grief, run screaming off into the woods, be totally unable to articulate any words that make sense. I've also seen sad resignation, joy that their family member is no longer in pain, and many times anger.

One facet of this job that I have studied to excel in is the handling of grief situations. It is possibly the hardest, toughest part of our job. To allow ourselves to become jaded, our hearts hardened, is not the answer. Those people left behind need us now and to deal with them effectively and to help them along in their grieving is not easy for anyone. It's the part of the job no one wants.

It's things like this, the things we don't want to do, the things we don't do often, that we need to train on the most and can have the biggest impact on people's lives. Positively or negatively. It may not be a day we remember as a responder, but I guarantee the family will remember that day for the rest of their lives.

Low I.Q. equals job security...

One evening we were toned out for to stage for law enforcement for a stabbing. After waiting a few minutes for PD to clear the scene we were called in. We parked at the large apartment complex and the boys in blue flagged us into the correct apartment. They were all chuckling. When I got inside the house I was brought to my patient. A 19y/o male with tats, nose ring, Pantera shirt, and his sagging jean shorts were now all the way to his ankles. He looked embarrassed.

I introduced myself and my partner and asked what happened and where he was hurt. He twisted around to show me the 2 inch wide stab wound to his left buttock that was bleeding through his boxers. And I kid you not he said, "My friend has a cool sword so I was like look, I'm Bruce Lee, I flashed the sword around and suddenly it stabbed me in my butt."

I informed him that the sword had not in fact stabbed him, that he had stabbed himself. The wound needed stitches but he would be ok. I looked up and noticed another guy in handcuffs and asked the cops if he was involved.

The officer laughed and said, "Nope, because it came out as a stabbing we had to clear the scene and found his buddy's pot grow in the back. Guess it's a two-fer."

It was very hard not to laugh all the way to the hospital.

How I got into the biz

How does one figure out they want a career in EMS? I came from a family of career firefighters but had no inclination of wanting to ever do it. I grew up at the station watching the guys(and gals) washing the blood off their hands or cleaning soot off their faces and gear. Laughing about the one they saved or the last practical joke they pulled. I learned to cuss, shoot pool, and even helped my parents teach CPR/First Aid all at a very young age. As I got older I dropped out of highschool and started partying, working dead end, minimum wage jobs and drifting from town to town, girlfriend to girlfriend. One day when I was 19 I was tired of that life and told my dad I would join the fire dept as a volunteer, he laughed and told me I'd have to cut off my waist long hair and quit smoking, so I did. I went to drill, met with the chief and started training. I then got cleared to go on calls as an observer. I was still unsure at this point but being bored and having no job it seemed like a good way to pass the time.

Then I went on my first call.

My volunteer pager went off and the call was way out in the woods, near where I lived. My dad said "Well, you'd better go."

So I threw on my bunker gear and drove to the end of the road while listening to the short.

"County Fire, level 3 response, 1111 Deep Boondock Lane, 19 year old female unresponsive, history of drug abuse. Patient was last seen talking about an hour ago and now RP cannot rouse her, unable to determine if breathing."

The medic unit careened around the corner and saw me waving my yellow fire helmet. They skidded to a stop and I hopped in. After a short drive we arrived at a tar paper shack in the middle of no where. The medic and fire lieutenant hopped out grabbing gear I was only vagluely aware of the use of. And ran inside. I followed.
Inside the "house" reeked of cigerettes, booze and garbage. 3 or 4 people stood around, not seeming to care about the girl on the floor. My eyes were huge and my heart pounding. All I could think was that she was dead(I only had first aid/CPR training at this point).
She lay sprawled on the floor, head to the side. Her eyes were open and glazed, and her face was purple. She was not breathing. The Lt. handed me a BVM and hooked it up to oxygen, reminding me of my training to open the airway and ventilate the patient. Her skin felt so cold as I pushed air into her and watched her chest rise. Everything was happening so fast. The medic popped an IV into her arm and gave some medicine.

"2mg Narcan on board at 21:47." said the medic.

She suddenly gasped, her color improving. Her eyelids flickered then she looked right at me, fear and alarm flashing across her face. She screamed a primal scream and launched herself in to the air, throwing me over and the fight was on. She rounded on the Lt trying to pummel him and he jumped back, falling over a chair to dodge her wild swings. The medic jumped on her, grabbing her from behind and trying to talk to her. They went down in a heap, landing next to me, kicking, biting, screaming, empty booze bottles flying. I was frozen, this was beyond anything I had ever dealt with and had no idea how to help. Then she started vomitting, and vomitting, and vomitting. Throwing up took the fight out of her and we were able to get her to the rig and transport her 45 minutes to the nearest hospital with out further incident other then her whining about ruining her high. And the medic had to start a new IV since she pulled hers in the fight.
Back at the station the medic asked me "So what did you think?"
My response..."Holy S---! I want to be a medic!"

It's been 12 years and some since that day and I have never regretted the path that was chosen for me.