Smokers, gotta love em!

My rescue company was on a call with the private ambulance at a convenience store in a near by district. The call was entertaining enough with a drunk patient who could not get their head around how they ended up on the floor. When one of our frequent flyers walks by (without making eye contact). She is well known to ems providers in the neighborhood for shortness of breath calls. She also has a laundry lists of medical problems mostly related to smoking. Today while shopping, she is carrying a medium sized oxygen cylinder (not designed to be a portable) and a oxygen concentrator. She has a nasal cannula in her nose and a nebulizer in her mouth. The neb is completely empty of any albuterol,saline or any other medication. The clincher? She is bying cigarettes! (inner dialogue) So about what time will you be calling for shortness of breath?

If your erection lasts more than 4 hours.....

Where I work we have a heavy rescue squad that is equipped with all the heavy rescue tools you can think of. Second in line for heavy rescue is our ladder companies. A couple of these units together are capable of some extreme rescues. They were called to the Level 1 trauma center the other day for a man who was being flown in from a nearby town. Apparently this individual thought it was a good idea to use a heavy duty commercial grade bearing race as a cockring. Once the desired affect was achieved it was realized that removal was impossible. I am sure this individual waited a good long time before seeking medical attention. This was possibly occuring since the night before. Small town hospital called for an air ambulance after the small town ER ring cutters didn't make a scratch. Our crews were called to the trauma center after additional failed attempts with manual ring cutters. Hydraulic cutters were not an option, (ouch) so last the FD heard the pt was being prepped for a manual drainage (syringes) procedure that will likely result in scar tissue and varying degrees of dysfunction. Poor bastard.

How do you know when you have had too much to drink?

So we met one of our local "urban outdoors men" the other night at a very convenient 2am. Our outdoors man was found to be under the influence of alcohol. I was surprised as well. Being the consummate professionals that we are, we initiate a thorough assessment. And as we are performing a mostly rhetorical interview with our pt, we notice there is a quarter in his right ear. So I ask our patient if he knows that there is a quarter in his ear. I assumed this was an appropriate question for this gentleman. He opens his eyes and looks at me like I have second head. He slurs at me the quarter is to indicate when he has had too much to drink. Obviously being new to this procedure I ask for more information and he was nice enough to enlighten us. The quarter in the ear remains until the wearer's gait becomes so unsteady or rapid contact with Terra firma, the quarter falls out indicating terminal intoxication. Now this is where the details are a little fuzzy. I was unable to learn if the indication is the sudden absence of the coin or the sound of the quarter hitting the ground. Or if the wearer has reached this level of intoxication, how are they supposed to hear or notice the quarter? And if you only have a quarter in one ear, what happens when you fall on the other side? Apparently this procedure was in the experimental phase and our researcher did not have the quantitative results at time of print.

Halloween 2009

So at about 230 in the morning last night during the full moon, we get dispatched to a motor vehicle accident. As we approach we find 2 trucks with severe damage from an apparent high speed head on collision. We arrive and make our way over to the truck with the most damage and find a female driver with a broken femur unconscious behind the wheel. The engine crew is talking to a beligerent guy from the other vehicle. We extricate the female patient from her truck. She goes with the first ambulance to the truama center. As the engine backboards the male driver, he goes unconscious. So he obviously also goes to the local trauma center. As we pick up the scene we notice a few odd items in the street. The first arriving private ambulance has left all their backboard, airway and oxygen equipment on scene. The police officers are talking about both drivers are likely drunk drivers. (Which is unique that they hit eachother instead an innocent family)And the last item strangely noticable in the middle of the scene? A squished dead black cat that was involved in the collision. Halloween, full moon and a black cat? You just can't make this up.

Ah thats better!

So after a dry spell the ghetto once again delivers a story worthy of the blog. Sometime in the middle of the night (maybe 2 am) last night we get a call for a woman complaining of abdominal pain. We arrive at an apartment building and before my partner can park the truck, there is a woman walking up to the truck. She also has her 7 yo daughter in tow. The woman is our patient and as I open the door she asks if she can go to the hospital. I ask why and she just repeats herself. When pressed futher, she advises us she doesn't want to talk about it. Strange.Ok, I am thinking what am I supposed to tell the ambulance and what are they supposed to tell the ER???She notices the transport ambulance arriving, she hops out of the rescue, asks if her daughter can remain with us for minute. I cautiously agree and watch as she makes tracks into the ambulance and closes the door. Stranger by the min. The ambulance medic returns and says the daughter can join her mom in the ambulance. Once the kid is gone he tells us the story: Apparently mom was enjoying some "self satisfaction" time with a sharp object(?) and cut herself (suprise). The injury apparently resulted in some moderate bleeding. That should be an intersting conversation when the daughter (hopefully later in life) asks about the time they had to go to the ER in the middle of the night.

uneventful in the ghetto

The Ghetto has not been providing many humorous stories lately, so here's a regular ems story:
Last week as I arrived to work and before my first cup of coffee, we got sent to a active labor call. NOT a favorite of mine. I am hip to the miracle of birth aspect but its still messy and gross. When we arrived, mom had already given birth to a very small baby boy right on the carpet. Nobody in the house spoke English and worse nobody was doing anything for mom or baby. Estimated gestation 30 weeks. He was less than 2 lbs, very blue and we gave him an APGAR of 2. Someone had tried to clamp the cord with a piece of plastic shopping bag for some reason. Some quick BLS and rapid transport to a NICU facility appears to have had a good outcome for baby boy. We arrived with a pink oxygenated little guy who appeared to have no ill effects APGAR 7. Its been a week now and last I heard he is still doing well. coincidentally the ambulance medic was working one last shift before she went on maternity leave. So she was very glad to see our little guy did so well.

If you're crazy and you know it clap your hands...

So in the ems system I work in, there seems to be an unusual amount of psych / suicide threat calls. Those unfortunate enough to have to put up with the clawsen system, you know this code as a 25B. These calls are usually a patient who for a number of reasons has made some sort of suicide threat and requires a supervised ride to mental health. Well another sign the call is going to be less than emergent is when dispatch advises "PD is already on scene and scene is secure." Our brothers in blue have a habit of offering evaluations to everyone they meet and therefore, generate a fair amount of non emergent calls for us. So, the other day we receive this call for a 25B. We drive over code one (no lights/siren)and as we park here comes a police officer. This is one of our newer rookie cops and he appears to be a little pale. He is talking fast to my partner on the other side of the rescue. As I come around the corner of the truck, my partner tells me to bring the trauma bag. I am sure I gave a strange look but grab the bag. As we walk up to the apartment the pale faced cop tells me that the patient has cut off her ear lobes. I confirm this with my partner as we enter. We immediately find our patient who is bleeding profusely from (you guessed it) both ears. Inspection reveals that she has cut off both ear lobes and they do not appear to be in the immediate area. My partner doesn't flinch and goes to work applying bandages and dressings to her ears I ask her a few questions. When I ask why she did this, she tells me it is her birthday today. And every answer is followed by a disturbing evil laugh. When I ask what she used she tells me her mom's scissors. Ha ha ha. She tells me that she needs psychiatric cheeseburgers. ha ha ha. The answers get a little more disconnected so pale faced cop and I go looking for the missing ear lobes. As I am searching through several trash bags full of bloody tissues I realize that this is my first expierence searching for body parts. I start recalling several stories told by my coworkers involving all types of searches for all types of appendages. The second and third trash bag we located in opposite closets and contained ear lobes. Since we are in another room, just for fun I turn around and wave them at pale faced cop before I place them in a small container for the ride to the hospital. Cop left. The patient had given herself this very special birthday present several hours before we were called, so I doubt they are re-attachable. My final question was what psychiatric disorder, if any, she was diagnosed with. He response: Rob Zombie. this response was followed by more laughing and talk about cheeseburgers. She goes to the hospital with private ambulance and we clear for another nearby call. As we respond to this other call my partner and I realize that Rob Zombie is playing on the radio. Couldn't make this up if I tried.

Do you remember: Don't pretend to be dying when youre not?

So the address goes out for crappy address apartment #70. On the way over we start kidding if it is the same person. Well lo and behold its the same apartment. We joke about the brand new door,frame, and paint before going in. Our "patient" is face down in a bucket of vomit again talking about how she is so weak that anytime she stands she passes out. So I ask: "who unlocked the door?" She responds that she did, but right after that she meant after that she passed out. Right. My partner and I ask her if she remembers us. She looks up and mummbles something and goes back to her semi consciousness. So just like last time she is attempting to detox without medical supervision. Also just like last time she is able to walk down the hallway and down the stairs in between her semi consciousness act. We also notice the manager (large woman)running around in a panic with her keys in hand. See she was quite upset last time that we did not search the complex for her apartment, notify her and then wait for her to walk to the office to retrieve master keys and let us into apt #70. It seems like everyone learned the valuable lesson: 911 is for emergencies and the FD operates as such. Wierd huh? Back to our patient in the ambulance the semi consciousness act had run its course and during the assessment we were told: " I just don't want to talk anymore, can't you just take me to the hospital?" Another happy customer!

PD gag

Sometimes to break the monotony, we mess with the cops a little. Not too long ago the rescue and ladder truck were dispatched to a heroin overdose, with of course PD. On this paticular call the officers assigned were both female.
The call was in fact another heroin overdose. The needle was still in our friends arm and he was unconscious. For those not in the know, heroin (opiate) depresses your body's desire to breathe. Our friend on the floor was breathing about 2-3 times a minute. The magic cure that our friend needed is a drug called Narcan. It blocks the opiate receptors negating the opiate's effect and restoring the drug addict's desire to breathe. Well one downside to ruining our friends high, if administered too fast, the narcan can cause projectile voliting.
So in this paticular apartment the 2 officers were standing in the living room and our friend was lying directly in the path to outside. The rest of the room was occupied by furniture and of course the big screen tv. Since all our equipment was opened and our friend was being attended to by several firefighters the police officers were blocked in this tiny living room.
As we are caring for our friend who is still unconscious after the first round of narcan, the medics begin a discussion concerning a possible repeat dose of narcan and the desire to avoid any projectile vomiting. As we are having this discussion we notice that female officer number one has turned away from us and is now facing a plant. Female officer number two explains that her partner is very sensative to vomit and also has the distinct honor of an over active gag reflex. Well that a whole bunch of info you do not want a bunch of smart ass firemen to have. So we start talking more about vomit: the smell, the consistancy, the recognizable food pieces, the sound it makes hitting tile etc. With no means of escape female officer number one is now gagging and dry heaving into the plant. When she turns around attempting to threaten us she is a palish green color , tears in her eyes and she is unable to speak without gagging more. We are laughing so hard half of us now have tears in our eyes. So now everytime we see female officer number one, no matter the scene, we make a few gagging noises just to watch the color drain from her face.
And yes we were still bagging our pt and administering enough narcan to save our friend from himself one more time.

Guts?

I won't go into details on this one. But a couple of weeks ago had a run that was an extreme example of the evil that exists in some people. One of those calls where the details will remain with me for a long time. A call that reminds me of other calls that were similiar in nature. It was the call that comes every now and again to make sure we have what it takes to continue this career path. Intestinal Fortitude.

In broad daylight?

So there I am sitting in the front office of our fire house. The front office is a lot like a fishbowl with 3 walls consisting of mostly tinted glass. Directly in front of the fire house standing next to the dumpster is a woman we have met in the past. We know her to be a prostitute addicted to meth. we will call her meth ho. She starts talking to a guy on a mountain bike. ( yeah I laughed about the bike too) As she is turning on the ho charm, meth ho begins pointing like a crazy person different directions. Then I realize she is pointing behind near by buildings and walls. I am thinking there is no way she is going to do this in broad daylight, is she? Along side of the fire house is a church with some side exits facing the front office. One of these exits has a 3 ft wall around the steps. And sure enough meth ho motions the bike guy over to this little alcove on the steps of the church. But bike guy doesn't know what to do now that he is there. So he is standing straight up looking around like a groundhog. (must have been his first time.) Anyway meth ho frantically motions for him to get down. Meth Ho remains on the corner for a little while looking around before scurring over to the church steps. 3-4 mins later both parties emerge from the alcove and quickly go in opposite directions. Crazy huh? Well about 20 mins later meth ho is over at the drug houses (also seen from the firehouse) spending her hard earned money. Everyone should work in the ghetto. Its just that entertaining!

Parking brake only works when you use it

The first morning of our 48hr shift is a busy one. We have a lot of paperwork, rig checks, daily routine and some maintenance issues to attend to. The other day we were in the middle of this routine when a large, older white man walks through our employee parking lot and straight into the station. He stood out on account of his skin color but also he was wearing coveralls. I was near the door so he approached me and asked if anyone owned a toyota truck. I had to think about it, but I remembered the station captain owns an older 4runner that could pass for a pick up with a shell. I advised the visitor who owned one and asked why. He replied in a tone that let me know he was less than impressed with whatever had happened: "because it just hit my truck!" I look out the back of our station and almost one block away, in the neighboring parking lot that is on the other side of a street; is the captains truck wedged in between the rear wheels of a large semi truck. Apparently our beloved station captain had forgotten to put his truck into gear or set the brake. I will skip the response that we got from him when we told him. But his truck had reversed out of our station parking lot (without hitting any of our trucks. remember this is shift change so the lot is packed.) crossed the street, made a gentle turn to access the driveway and across the parking lot that is a full city block. We thought it was hilairious. He wasn't impressed. He was even less impressed with one firefighter who chocked the 4runner once it was returned to its original starting spot.

Dont pretend to be dying to 911 when you are not

So I get a call for a 6D1 to some crappy apartment. For those of you lucky enough not to use the Clawsen system that is a shortness of breath call and the D part means its important. Well enroute dispatch tell us that the pt is advising they might pass out from fatigue and the door might be locked. My partner and I are about to arrive on scene when our "medically trained" dispatch advises that they have lost contact with the caller (pt) and can hear agonal respirations in the background.So being a fire medic unit when we arrive on scene I am able to grab a set of irons as well as our ems packs. As usual at all our crappy apartment buildings, there are a lot of people just milling around in the courtyard. These people, when asked a question usually respond with "huh?" And tonight was no exception. My partner and i ask 2 different people the location of apt 70 and we both get blank stares in response. Luckily we find apt 70 and began banging on the door. Well when you make this much noise late at night in an apartment complex where no one has jobs, all tenants come out to investigate. As my partner and I begin to force the door using the irons ( flat head axe and haligan tool) I hear several people yelling from the courtyard "Someone call the police! Those 2 guys are breaking into that apartment!" Luckily PD was soon on scene to field any citizen complaints. I guess the fire department trucks, clothes, tools etc were hard to see.
We force the door open (with some damage to door and frame). And once we locate our dying agonal patient in the back bedroom she is face down kneeling over a bucket. Before a question is asked the dying patient turns her head toward us and asks: "you guys just broke down my door didn't you?" Turns out our "patient" was detoxing from booze and was vomiting. When asked why she didn't answer the door, she replied she was too weak. But to get to the ambulance stretcher she had to walk out of her apartment, down the walkway and down a flight of stairs. At this time all the wondering tenants were close enough to offer their assistance. Some were even dropping names in an attempt to gain access to the scene. good times

I'm back!!!!

I have returned from my FMLA (paternity leave)still in one piece. Mom and Baby are doing well. Baby was born at 7lbs 8oz and now tips the scales over to 10lbs plus. She still is waking 1-2 times a night. The wife is tired but she is doing a great job especially when I am at work for 2 days. The 4 yo older brother loves his little sister. He is acting out a little, but its hard to tell if it is from the new addition or just 4yo boy stuff. I have returned to work so the blogs will resume! Thanks for reading my therapy!

Baby is here!

The newest addition to the FFPM family arrived this weekend. So I have taken a few weeks off of work. I could substitute stories from work with stories of a newborn, but I fear that I may scare away some of the followers. Maybe I will anyway, depends on how tired I am.
Until then I'll try to find something else to entertain my small brain.
I hope the ghetto will still be there when I return.

Oh man, Marvin shot himself in the face!

We get dispatched to a gun shot wound (GSW) call. Enroute the police notes come up on the computer and it says the patient shot himself in the face while attempting to shoot his "girlfriend". Upon arrival we find a guy who has in fact been shot in the face. He is also stuffed into the extra cab of a truck in the parking lot. Strange location since that is not where he was shot. As we are pulling him out and getting ready to rapidly transport to the trauma center, I am watching an exchange between the police and a woman. The woman is screaming that if he (the pt) lives she wants to press charges. The story is something about he came over to collect "rent" from her. I am pretty sure "rent" is code for profits made from prostitution. When he threatned her with the gun a struggle ensued and he shot himself in the face. As we were transporting the pt to the hospital we all started talking about the scene in pulp fiction when Vincent shoots Marvin in the face.

Saturday afternoon at the gay bar.

So like I have mentioned, I work in the "seedy" part of town. I have been assigned to my station since August and for the first time for me, we were dispatched to the gay bar for a fainting episode. The comments from the rest of the house start before we get to the truck. So we respond and pull up in front of the bar where The Village People are flagging us down. Not the actual Village People Group, but a few bar patrons that resembled the group. One member had a very impressive mustache. They all follow us in to the bar. My crew consists of 2 men and 1 woman. The female on our crew was prepared to protect "her boys" until an aggressive appearing lesbian made eyes at her. Apparently at that point we (boys) were on our own, as she was scared for herself. As we make our way around the bar, we are attracting some attention and a bar patron tells us that the patient "is a large man". For the first time ever in my EMS career, I was hoping for an overweight patient. Anyway we find our patient lying on the floor and was not feeling very well. His head being supported by a little skinny guy that was happy to remain in place as long as he was needed. The patient was; by his estimation, approximately 500 pounds. Well, the auto BP cuff (yes we are that lazy) does not fit his bicep so it is attached to his forearm. The auto BP cuffs are notorious for being inaccurate (but yet we are still too lazy to use the manual one) The reading comes back BP 100/60. The heart rate 28. Possibly inaccurate but it was confirmed by the pulse oximeter. Ah ha!! I think I know why our patient had passed out. So, possibly due to lack of blood flow our patient will not follow commands or allow us to assist him up. He insists on doing it himself. So Mr. 500lbs with a heart rate of 28-30 struggles, grunts and sweats himself up to kneeling. With some more grunting and a lot of sweating he attempts to stand. In the middle of this impressive effort to get to the gurney, our patient's pants fall to his ankles. And of course, our patient was not wearing any underwear. A large group of bar patrons are looking on and I don't know how embarrassed our patient was, but we were a little uncomfortable. The female of our crew was frozen with her mouth hanging open. Her only statement about what she saw later was " It was just so ......... big. I have never... It was just so big" I think she will be scarred forever. Luckily the other member of our crew was kneeling down directly behind our patient (eye to eye if you will) and as much as he did not want to, he reached down and restored a little dignity to the call. Remember our little helper? He was very determined that someone take his phone number down and provide it to the patient. Apparently they had just met and things were going well before the fainting spell. So as we were trying to render care and closing ambulance doors this guy is demanding us take his phone number. The medic who actually wrote it down got some grief for taking it down. Things went pretty well after that and we delivered our very nice patient to the ER alive and well.

Whoever invented the "Nurse Advice Line" should be kicked in the face.

So, last shift was exceptionally quiet. Except for the unspecific sick call. We had several cases of flu symptoms over a few days and " I called the nurse advide line and they told me to call 911" stories. You could call these "nurses" with a runny nose and they will tell you of the possibility of CSF leaking from your skull and to call 911. Nobody would notice if they had been replaced with a monkey and a parrot. The monkey would answer the phone and hold it up to the parrot(nurse), who would squawk "call 911". Completely useless.

The other excuse for a ems taxi ride from last shift : "I wouldn't have bothered you guys but I don't have any gas in either of my two cars." Just the reason EMS exists.

And lastly, the "I'll pay fpr it, I have madicaid / medicare." I usually respond (in my inner dialogue) No, that means I'll pay for it.

Drunk girls will stab you

So, while my crew and I were busy wrestling a naked overdose guy who shot himself in the leg because the fence was talking to him; a nearby crew had to respond to a stabbing call in our district. The intoxicated girlfriend stabbed the boyfriend in the chest - not too unusual for my district. The unusual part was when the engine had to respond back to the same address later that night for a pregnant female with abdominal pain. This "pt" was very intoxicated and the cool part was she was in police custody for the stabbing. So yes, the DRUNK pregnant female stabbed her boy friend in the chest with a kitchen knife. it was probably over the last beer. Good times

Sibling rivalry

So just before midnight on Valentine's Day we get toned out for a stabbing assault. We arrive to find private ambulance medic in full blown panic. But to her credit she has already loaded the patient onto the gurney and we are on our way shortly. After all, we are the tow truck, not the mechanic. So the transport goes well and we deliver our unconscious female patient alive. Strangely enough the female patient was stabbed by her sister. In front of both of their kids ages 4-6 years old. I just wonder what the argument could have been to make someone stab their sister several times.

New one by me............

So we get a call in the middle night....Why do most of the ridiculous calls come in the middle of the night? Anyway, we get a call for a POSSIBLE seizure. Most conscious adults can identify a person having a seizure. So we arrive to find our "patient" sitting wide awake and alert on his couch. Even tough Mr. Patient (age 47)answers enough questions to be orientated he indicates that his wife or mommy will be answering all the questions. So wife tells us there was no real seizure, he woke up preaching. So there it is... the call to 911 because an adult was preaching.
Wife tells the 4 paramedics in the room that last time she had to call for preaching the paramedics advised there was nothing wrong and left. Then he (the patient) got worse! Not knowing how the preacher could get worse, I asked for clarification. Surprise! There was no clarification, last time the preaching got worse! Right. You know they wanted to be transported by ambulance to be evaluated in the emergency room for uncontrollable preaching. Of course mommy had to come along to supervise.

Call 911 for.....bus money?

Seizure call at burger king. We arrive and initially have trouble finding anyone who is or was seizing. Then we notice a man in his 30's waving frantically over his head. As we approach I make note that the man is sitting in front of a piping hot whopper meal, supersized. We make contact and since he isn't pointing to anyone else, we ask: Are you the seizure pt? He responds yes. Me: what can we do for you? Him: I had them call you. Me: Ok we are here, what can we do for you? Him: I am fine. Me: Is there any emergent medical complaint that we can help you with? Him: No I am fine, I was wondering if you could take me a couple of miles? Me: no, we don't do that. Him: If you could just give me some bus money I'll be ok. Me: You appear ok now with your 5 dollar whopper meal in front of you. Him: Could you just give me a lift home then? .......................... Thats when we just turned around and walked out.

I love my job

So, last shift was brutal. the second night (48hr shifts) about 3 in the morning we get sent out for a sick call. They never put these calls on the recruiting poster for ems. My partner and I are so tired I think it took us 5-6 mins to get out of the station. We find the low income apts and arrive about the same time as our private ambulance company. We find the one bedroom apt and discover the occupants of apt#49 have converted the living room into a second bedroom, where we find our "pt". We ask the 75 yo woman her chief complaint and medical history. She responds she has no relative medical history but her teeth have been bothering her for over a week now. We ask if there is another complaint that may have justified a call to 911? She responds: no. Ambulance medic advises insurance may not pay for a non emergent complaint. She responds she has medicare / medicaid and she demands the ambulance transport. Ok here ya go, ambulance transport to wait in the waiting room for hours. Congrats.

Question about EMS abusers?

do you need to be shot in the face?

The call is a GSW. Stand by for PD. Fd gets clear to come on in and all we find is a bunch of cops running around with AR-15s out and a girl on the phone outside the trailer. FD asks the cops about the GSW and they advise they have not found the shooter yet. Fantastic. So glad you advised the scene was secure for EMS. So FD asks the girl on the phone about a gun shot victim. She points to the trailer and says: "I think shes in there". After asking some cops to move off of the steps, we make entry and find a young woman holding a towel to her face. She moves the towel and she is indeed shot in the face. Does not appear to be serious and vital signs are "normal" During the normal course of treatment and questioning she advises she just started using meth a couple of months ago. I couldn't help myself, I asked "So, hows that working out for you?"

yes I am a paramedic firefighter

So the call goes out something about a drug over dose. Its 4 in the am and I am not awake. My partner and I respond and find a person down and obviously incapacitated. Unusual for where I work is its not an opiate (heroin) overdose. I call and ask the engine to bring in the suction. I was not aware that the engine had to wake up the driver and now are lost behind some dead end streets and barricades. The LT on the engine asks me to repeat the request (buying time) 3 times while they are touring the outside perimeter of this neighborhood. The patient is still down when the ngine and ambulance arrive. In fact she is down enough to require intubation prior to movement. As I assemble the needed equipment the ambulance driver turns and looks at me, and asks " have you ever tubed anyone before?" I only mummble something about once or twice. Turns out he wanted the tube.