Big Time Wrestling

The North County wrestling tournament that leads to the State Finals has been held at our local high school for the past few years. I was working overtime in that district and the captain suggested we go check it out. Some kids from his hometown were wrestling there too. It is a huge event with six matches going simultaneously in the big gym and another four to six in the smaller gym. Each match is only six minutes long and then another two wrestlers step up. The place is a zoo with athletes, coaches, parents, runners, officials, etc. Just watching these kids and taking in the whole scene made me realize that high school wrestling really is a subculture unto itself. On a side note, I was surprised at how many of the wrestlers had tattoos, meaning they had to have had parental permission since they were under 18. Just interesting.

We were watching the matches in the big gym and had found a place to stand and watch that was somewhat out of everyone's way, though barely. After witnessing these kids go at it with everything they had for a little while I commented to the firefighter that we should have brought our gear in with us, or at least some extra gloves. He smiled and said, "We should have just brought the morphine".

Sure enough, within about ten minutes, the radio piped up with "Engine 47 respond to the high school for an EMS". We looked around and didn't see anything going on around us. We got the update that it was in the small gym and that it was for a dislocated elbow.


We headed out to the rig to get our gear. As we worked our way down the crowded hall the firefighter said, "Told you we should have brought the morphine". The next thing I heard from behind me was what I can only assume was some wrestler's mother exclaiming, "Morphine?!".

In the small gym it was easy to locate our patient since he was on the only mat without an active match going on. His elbow was obviously dislocated and he stated his pain level was at an 8 out of 10 but he still refused pain medication. Gotta hand it to the male high school athlete, nothing was going to make this guy lose face anymore than his injury already had. He could tough it out. I'm sure in the hospital when it came time to pop his limb back into place, though, he would change his mind about those pain meds. We splinted his arm, put an ice pack on it, and turned him over to the ambulance crew.

We returned to the big gym and watched for awhile longer before leaving to go get fuel and dinner. At the rig I found that the ambulance crew had been nice enough to return our splint to us, which was fortuitous. A little while after dinner we got toned out again for "EMS at the high school, dislocated elbow". This time it was in the big gym. Same scenario as last time: obviously dislocated elbow, refusal of pain meds, splint and an ice pack.

The event was winding down and the final match was taking place so we stuck around to watch it. In the morning we found our splint in our mailbox. The ambulance crew had once again returned the splint to us, saving us a trip out to the hospital to retrieve it. Those ambulance guys are OK.

The Little Things

Sometimes it's the little things that can get you re-invigorated. Today it happened on a medical call.

I was on the second day of a 72, meaning I was going to be working for 72 hours straight. Our normal tour of duty is 48 hours, but I was going to work an overtime shift on my first day off. I had done a really tough workout on my first day and we had spent several hours drilling and training on the second day. I was tired and sore and not really looking forward to working an additional 24 hours. We had two medical calls already but the ambulance got on scene before us on both calls. The first was a 'nothing' medical and the second a decent car wreck. The lady on the nothing medical was staying with a relative and didn't know the exact address, but she took three stabs at it anyway, not one of them being correct. The only reason the ambulance was on scene at the same time as us was that we spent about ten minutes driving through the apartment complex going to each of the incorrect addresses she kept supplying.


There wasn't much in the way of patient care on either call though, so it was just as well the ambulance got to take those.

Just after dinner that evening we got toned out for a 70 year old woman not feeling well and vomiting. Didn't sound too promising. On arrival we found a non-english speaking woman in bed. Her daughter stated that her mother had fallen three days ago and had been weak ever since. She did not see a doctor after the fall and did not want to go to the hospital now. The daughter said that her mom was not interacting with her the way she normally does but couldn't really explain it any better than that. After some questioning it was determined that the woman was diabetic and that the vomit and her last bowel movement had been very dark in color and like "coffee grounds" which is indicative of a bleed. What was causing the bleed I didn't know.

I checked the woman's blood sugar and it was 'Hi' which is what the monitor reads when the glucose level is off the chart. I told the daughter to explain to her mother that she was indeed going to the hospital. We can't fix a high sugar problem in the field and the coffee ground emesis was troubling. I then began looking for I.V. access.

As soon as I put the tourniquet on I could see this was going to be tough. Thin, papery skin and no visible veins at all. I let the tourniquet and gravity do their work and thought that just maybe I could feel the slightest hint of an AC (ante-cubital vein in the crook of the elbow) or possibly it was just wishful thinking. The ambulance arrived and I gave the paramedic a rundown on what we'd found and what I was doing. In just that small amount of time I had totally lost any trace of the AC. I still felt like I knew it was there even though I couldn't see it or feel it anymore. I don't like to go "fishing" for I.V.s, that is, stick the needle in and move it around jabbing repeatedly in the hope of lucking into a vein. It's painful for the patient and just not a great technique, though sometimes it is the only option. I really felt like I knew there was a vein there though and I told the ambulance crew I would give it one try and then hand the patient off to them. I tried to, as a wise old wizard once said, "let go my conscious self and act on instinct". I slid the catheter in and was immediately rewarded with that flash of blood in the chamber that confirmed I was in the vein.


We attached the I.V. bag and it was flowing like a champ. I secured the line and we got the patient to the gurney and off to the hospital.

The I.V. wasn't going to save her life, there were no medications to give in the field, but she was going to need them soon and she would need the IV. It was just very satisfying to have so smoothly succeeded at the difficult stick. I used to pride myself on my I.V. skills in particular, the more challenging they were the greater my success rate, but I haven't had a lot of practice lately. And just that one small success completely raised my spirits.

Bring on the next 36 hours, I'm ready and I want to go to work.

Bringing A Knife To A Gunfight

Well, we got our first double homicide of the year.



My district is known for its share of assaults and crimes but it’s not what we normally expect when we respond to this particular apartment complex. We arrived and followed the police to an upstairs unit. As soon as I walked in the front door I encountered a male in his twenties on the living room floor wearing only boxers and multiple stab wounds. The police said there was another victim in the bedroom and my firefighter went to check on him. I don’t know if this is the case for everyone (if you've ever had the experience), but just about any fireman can pretty much tell if a person is dead when they walk in the room. I can’t explain it, you just know. This guy was dead. Of course, if his physical condition doesn’t cooperate with your from-the-door assessment (rigor mortis, lividity, other obvious signs of death) you have to initiate resuscitation efforts anyway. I checked for rigor and there was just enough stiffness for me to determine death in the field.

I quickly moved into the bedroom to check on the other victim. This one was a male in his early thirties who was fully dressed and slumped unnaturally in the corner of the room. He was also obviously dead with what appeared to be at least two gunshot wounds. He too had just enough rigor to be called dead in the field. I hooked both victims up to the EKG monitor to confirm asystole and printed out the strips for documentation.

My job as paramedic was done and now it was time to try my hand at amateur crime scene investigator. From the way they were dressed and the positions of the bodies I decided that the apartment belonged to the man in the boxers and the other man was an acquaintance or intruder. The men argued and the intruder grabbed a knife (or had one already) and attacked the first man who then ran to the bedroom. The intruder pursued only to find the man had retrieved his gun from the bedroom and took two shots to the chest. The first man then tried to go for help but only made it as far as the living room before collapsing and bleeding out on the floor.

So, even if you bring a knife to a gunfight, you can still tie. That’s how I saw it anyway.

Taken To Heart

Well, I've had an interesting week for dealing with toxic substances.

First, as part of our departments yearly physical I had to take a treadmill ekg stress test.


The test went fine but then the doctor informed me that there were some changes in my ekg during the test. He said that at the level I was running at there is a great tendency to get false positives so he wasn't too concerned. However, the follow up included running the test again, this time with an I.V. in my hand and an irradiated, myocardial specific, imaging agent injected into me while I ran. This was followed by fifteen minutes of laying under an imaging machine while it took pictures of my heart to examine the blood flow and make sure I had no blockages. The technician looked at the results and said, "Wow, you're zeroes across the board. All good. You don't have to come back." So, it's good to know that my heart is perfectly healthy, I just wish I didn't have to waste an entire day off being subjected to tests and substances that really shouldn't be in my body.

I went to work the next morning and we were sent to another district to do some make up training on search and rescue that my firefighter had missed. The captain and I had done it already but there was no one to swap out with the firefighter so, we all had to go.

When we arrived at the drill site we were informed that one part of the training, the SCBA confidence course, was to be left out because they weren't allowed to train in the building we had used before. OK. Turns out this was due to a probable asbestos issue. Of course, I had already done this drill once - in that building. Wonderful.


Next we moved on to the classroom portion and later we were taken out to a burn room for some hands on practice. As we stood in the burned out metal building discussing the search techniques we were to use that day we kept hearing a beeping noise. My crew had recently been issued a new kind of mask with a special communications system and we thought one had been left on. It was turned off and we continued. The beeping also continued. We traced the sound to a guy on the other crew who was wearing a personal radiation monitor. Our resident hazmat tech looked at it and decided that the unit had a battery problem and disconnected it. Problem solved. We went about the training and were ready to swap stations with the next group who had just arrived. As we were gathering our gear to move out someone on the new crew's radiation alarm went off. Great. OK, now something was definitely going on. This was no battery problem, there was radiation here somewhere.

My crew moved downstairs and left the other crew upstairs at the burned out metal building. When we got to the bottom of the stairs, however, I stopped. "Hold on", I said. I called up the stairs and asked the firefighter if his alarm was still going off. He said no. I told my crew to wait there for a minute and went back upstairs. And just as I thought might happen, when I got within about ten feet of the guy, his alarm started to sound.

It was me!

The radiation they injected me with the day before was setting off everyone's alarms. Now, I had read up on the substance they put in me after the test and it is harmless, akin to normal background radiation levels just a little concentrated. It stays in the system about 24 hours. I wasn't really worried about it. For the rest of the day, though, I kept laughing because every time I walked by someone their alarms would start chirping.



I later heard a story of a crew who had a similar experience. One of the firefighters had had the same test the day before and set off the alarms when he got to work. The firefighter and engineer knew right away what was going on but didn't tell their captain. They made sure the firefighter stuck right by the captain and when the captain's alarm would go off they convinced him that he must be irradiated. They went so far as to tell him he needed to be shielded to protect the rest of the crew and they wrapped him up in a wildland fire shelter, basically a tinfoil sleeping bag. I'm not sure how long they let him stew in that bag, but I heard there are pictures. I just bet there are.

They Just Keep Rolling Along

There are some regulars and chronic 9-1-1 abusers that you just hate rolling on and there are others who you just kind of sigh, shrug, and do whatever you can to help. It's amazing and sad to see these people year after year surviving things you imagine would kill most people. Some you watch just deteriorate over the years but somehow keep hanging on.

One guy in particular, I've been running calls on for just about my entire ten years in the department. He has been homeless most of that time. He started out riding a bicycle around town and now he's in a wheelchair having lost parts of his feet to frostbite and gangrene. He has been, alternately, a source of amusement, a real pain in the ass, and a real filthy mess. It all depends on how intoxicated he is and where he's been living for the last week or so.

(Yeah, that's about right. No joke either.)

But, he absolutely loves the fire department and routinely comments on how we have saved his life numerous times. He always gives us a big thumbs up and a smile whenever we see him. I don't know if there is some kind of reverse Stockholm Syndrome thing at work here, but we seem to go above and beyond the call of duty for this guy on a regular basis.

Today we were called out in the pouring rain for him again. It turns out all he needed was a broken wheel on his wheelchair fixed - and called 9-1-1 for it. We could have lectured him on that and gone back to the station. Instead, we grabbed some tools and sat down on the sidewalk in the pouring rain and reassembled his wheelchair for him. That's one of the things I do love about my department, that willingness to go above and beyond without hesitation. I know a few cities in the area that would treat this guy horribly and blow him off unless he was in true crisis. But, not us. It might be a nasty job, and usually is, but we are going to do right by our citizens - whoever they are. And that makes me proud.

Without Pride Or Prejudice

One of the (many) reasons firemen like being firemen and not cops is that for the most part people are glad to see you when you show up and you get to help them when they need it most. Not that cops don’t help people too - they do - but even the innocent feel uneasy around cops and the guilty can be outrageous pricks to them. We get our share of abuse too, but it’s nothing like the cops get.



The flip side of our role as nice-guy-helper is the fact that all of our patients must be treated equally, with the utmost professionalism, sensitivity, skill and caring. Unlike cops who have a little more leeway when it comes to dealing with the unsavory element, I can’t tell a dirtbag he’s a dirtbag and deserves what he got whether I think it’s true or not.



My job is to care for the sick and injured, no matter who they are or what they’ve done, without pride or prejudice. Training and professionalism can make this easier but sometimes it can be hard to stomach.

I had this experience recently.

We responded to the recovery center for an assault victim. Inside we found a woman in her thirties who told a tale of being abused by her boyfriend. According to her, he didn’t want her to go to work because he wanted her to stay home and get high with him. They argued and he proceeded to beat her up and throw her into the shower and then onto a pile of power tools. She was very shaken and upset, obviously. She didn’t look like your usual strung out drug user either and, bad choices aside, we definitely felt for her. The ambulance arrived and took her off to the hospital.

The police then called us over to the adjoining parking lot where they had apprehended the “alleged” abuser. He had cut himself with a box cutter and his arm was bleeding. He, on the other hand, looked like a strung out drug addict dirtbag. Having just heard the woman’s story, I now had to turn around and tend to this guy and his wounds with the same level of care and compassion as I had treated her. Truthfully, it is always counter-productive to treat patients rudely because they respond in kind and it makes the job so much harder when patients are uncooperative, but at times like this it gets hard to play the caring helper role.

Maintaining composure and professionalism does pay off in the long run though. It turns out I had treated this guy before when he broke into someones house believing it to be the abandoned flop house these guys shoot up in. That house was next door, the one with the peeling paint and plywood on the windows - can’t miss it. I asked if he remembered me and he did. Because I had treated him reasonably before he was cooperative and respectful to me while simultaneously being a jerk to the cops. I cleaned and bandaged his wounds and sent him off to the hospital in a second ambulance (a different hospital than the first patient of course). And I’m sure it’s not the last I’ll see of him.

Hopefully it is the last I’ll see of the ‘girlfriend’.

Diabetics

I love diabetics.

That probably sounds awful, but let me explain. Diabetic emergencies are calls that most medics kind of enjoy, at least I do. It's one of the occasions where we carry all the tools and medications in the field with us to make a big difference right away. You get to start I.V.s and administer medications; it's a true ALS call. And we all want to practice the skills we've been trained to perform, right?

We got the call at 0300 last night and dispatch told us we had a 30 year old male unconscious, intoxicated, and diabetic. I thought, well, this one could go either way. Either he's hypoglycemic and I can do something dramatic about it or he's just drunk and I'll poke him with needles and see if he wakes up, hoping he won't puke on me.

We arrived and the patient's girlfriend led us into the bedroom where the patient was unconscious in bed, unresponsive to even painful stimuli (hard sternal rub). If you're wondering what that's like, try having someone take the knuckle of their middle finger and give you a "noogie" right in the middle of your breastbone. Make sure this person knows that you will probably punch them in response.

My patient was extremely diaphoretic, having sweated through the sheets around him. His girlfriend was really scared but, to her credit, held it together and gave us all the information we needed. She told us he was diabetic and had been at a beer festival all day, capping it off with a few shots of Jaeger. She knew what meds he took and told us she checked his sugar earlier and it was at 60 and twenty minutes ago it was at 30. I cannot tell you how important and helpful it is to have a good historian on a medical call. When the family and/or friends can't supply the right kind of information we have to go into what we refer to as "veterinary medicine" mode. That is, you have a patient you know nothing about and can't communicate with.


This patient's girlfriend told me everything I needed to know and I was able to go to work right away fixing this guy's problem.

I checked his sugar with our glucometer and it was low enough to just read "Lo" on the machine, meaning it couldn't even register a number. My firefighter got vitals and oxygen going while my Captain flooded an I.V. line for me. I put the tourniquet on his arm and his veins just started popping up. The needle went right in no problem and the line was flowing great.


A patent I.V. is essential when giving a patient sugar because dextrose is necrotic, meaning if it gets into the tissues and not the vein it will kill the tissues it contacts. While I was starting the line, my firefighter got the D50 (intravenous glucose) ready for me.


I pushed the amp of D50 and waited. After about twenty to thirty seconds I tried the painful stimuli again and my patient started moaning. Within a minute he was talking to us, knew where he was and what was going on. Gotta love that sugar.

Most of the time, once we've performed an ALS intervention (like the I.V.) that means the patient is going to the hospital. With diabetics it all depends. Once you've fixed their sugar problem they are essentially back to normal. Now, the glucose we give is fast acting and doesn't last long, so the patient needs real food and drink to keep his levels balanced. If someone is there to make the patient food and make sure they eat then we can sometimes let them stay home. This patient didn't want to go with the ambulance to the hospital, so his girlfriend got him a burrito, water, and orange juice and we left him in her capable hands. Before we left though, I had to remove the I.V. which is something we almost never do.

So, problem solved we headed back to quarters where I would lie awake in my bunk for the next hour trying to get back to sleep. I'm glad I could help, but the 3 a.m. calls are the worst. If you're lucky, you've been asleep for only about 4 hours and have to get up in three more. That is, if you can get back to sleep right away.

No Lifeguard On Duty

Ahh, summertime, backyard swimming pools, and the indestructible teenage boy. Well, not today it seems.



We got called out to the back yard of a house near our station. The house had a swimming pool in the back and a handful of young teens were home alone and messing around in the pool. When you’re a teenage boy, almost any idea sounds like a good idea and anything is possible. Today, the idea was - “who can jump all the way across the pool?”. Our first contestant is 15 year old Jeremy, let’s see how he does.



Ohhhh, sorry Jeremy, so close.

Our patient had leapt across the pool, landing straight legged on the lip of the other side. He had a huge avulsion on his heel and had fractured his femur.


Fortunately he was able to pull himself out of the pool after falling back in. He held it together pretty well too, even when we applied the traction splint to pull the overlapping bone ends back into alignment.

The ironic part of the whole story was that he was all set to start his summer job in about two weeks - as a lifeguard.

I Can’t Believe I’m Doing This

There were a lot of times early in my career where I thought to myself, “I can’t believe I’m doing this”. To this day I occasionally get that feeling but more often I think, “I can’t believe I get to do this” which is a testament to a proper career choice. But, there were plenty of “I can’t believe I’m doing this” moments. I think my most dramatic example of this was a call for a beauty salon fire in my second year with the department.

Now, firefighters are pretty jaded by the call of “Respond to a fire alarm at such and such address”. If it’s not followed by reports of smoke and flames seen it’s usually nothing. So when we got toned out for a fire alarm in the next district over at 2 in the morning none of us thought it would be much of anything.
The first in engine arrived and saw some water leaking out from under the front door of a beauty salon and upon closer inspection realized that there were flames still burning on the counters and the sprinkler heads were discharging.

We were the second in and we caught the hydrant and brought a water supply to the attack engine. They had already extinguished most of the fire and so my firefighter and I were sent around back to shut down the sprinkler system. We found the shutoffs and cranked them down and made our way back to the front of the building. The attack crew was still inside the salon and we were assigned to check the occupancies on either side. We forced entry into the unit on the left and checked it out. Some ceiling tiles were missing and some drywall was broken inside. It looked like they were doing some remodeling. We moved on to the unit on the right. The same story in that unit, no fire or water damage but it looked like they were remodeling.

Crews were starting to mill about now as the emergency was over. So my firefighter and I decided to go check out the fire unit. It was dark inside and had about a half inch of standing water on the ground along with a lot of shattered mirror pieces from the walls above the workstations. The sprinkler heads were still draining making it hard to see very well. Just as we were making our way around a corner two members of the attack crew came quickly past us carrying a body. It was too dark to see and they passed us so quickly that I couldn’t tell if the victim was one of us or not. Before I could move to help them the rest of the crew came around the corner and the firefighter in front slipped on the broken mirror and went down. I swear he fell faster than gravity, right onto his SCBA bottle. That had to hurt. I reached down to help him up by grabbing his SCBA strap and he started yelling, “Take the girl, take the girl!”. I hadn’t even realized he had been carrying a child out of the building when he fell. I immediately took the girl in my arms and started making my way outside. I didn’t know if she was alive or dead. All I could picture was the firefighter at the scene of the Oklahoma City bombing with the baby in his arms and thinking, “I can’t believe I’m doing this”.

When I got outside it was still dark. I looked around for the brightest area to work in and decided on moving into the parking lot under a street light. Another firefighter paramedic joined me while someone else ran to bring us equipment. There was another crew working on the man they’d pulled out first. I still couldn’t see who it was. I laid the girl down on the ground. She was wearing pajamas that were burned at the knees and several other spots. The first thing that struck me was that my daughter had the same pajamas. The girl’s burnt hands were covering her face and her hair was all over the place. I pulled her hands away from her face and was amazed to see that only her forehead and chin were burned but the rest of her face was clean, protected by her hands. I asked her name and age and was shocked and incredibly relieved when she opened her eyes and answered me “My name is Anna, I’m 7”.

The other medic and I immediately went to work. We cut the pajamas away and we each started an I.V.. As we started to put the burn blanket on her the skies opened up and it started dumping rain on us. Unbelievable. The blanket was just disintegrating in our hands. I was now cursing myself for moving into the parking lot instead of staying under the overhang outside the shop. Fortunately the ambulance arrived right then and we got the girl loaded and on her way to the hospital where she would make a full recovery.

Chips, dips, booze, and meth. Are you ready for some football?

This year, I worked on Super Bowl Sunday. It’s one of those days where it could be absolutely crazy or totally quiet. This year was pretty quiet. At least until after the game.

We had shopped the day before for our football food and dinner (chips, dip, guac, salsa, burgers, and brownies) so we didn’t need to go out. We did go out and do some pumping evolutions in the morning, more drafting practice in preparation for my quarterly evaluation. Drilling on Sunday? On Super Bowl Sunday? Yeah, that’s just how we roll.
So now, barring any calls we were all set for the game. We had been up a few times the night before so there was a good chance at least one of us would be asleep in their chair if the game didn’t stay exciting. Turns out that was me, but just for the start of the third quarter.

Surprisingly enough, we got through the game without interruption and even started dinner before the calls started. A series of drunk calls from the post game celebrations. Nothing like having your dinner interrupted by vomiting patients and then trying to return to it.

Our evening culminated with the meth addict who had supposedly been up for three days. He was shirtless, very agitated, wild eyed, and in handcuffs. He responded to questions with a series of guttural growling noises made through clenched teeth. I suppose it is possible he was possessed but I didn't really check for that.

Psst, Hey, I'm downstairs.

Sometimes it’s just not your day. Today was not my Captains day. My regular Captain was off and they had to mandatory a captain to work the shift. It was a captain I knew well and looked forward to working with even though he wasn’t thrilled to be mando’d.

We got toned out right away for a strange smell in an apartment, possibly electrical. When we arrived at the apartment and knocked no one answered. We knocked louder and still no answer.
The captain called dispatch to get the phone number of the reporting party. He called and a woman answered saying yes she had called 9-1-1 but she was at work now. Odd. She said her husband is home but he is a sound sleeper. My captain asked what bedroom he was in and she told us it was upstairs in the back.

We went around to the backyard and saw a sliding glass door off of the upstairs balcony. Now, we could have put a ladder up to it and just knocked on the window but no one really wanted to risk getting shot by a startled home owner. I climbed up onto the fence to see if perhaps a bottom floor access was available. It wasn’t. So, my captain decided to resort to the tricks of a twelve year old boy who has snuck out to see his girlfriend at midnight and throw rocks at the man’s window. He picked up a couple of pebbles and attempted to hit the slider. He kept missing and the stones were just bouncing off the rails of the balcony. I politely reminded him that for this plan to work he actually had to hit the window. He replied, “This really isn’t gonna be my day is it?”. He picked up another pebble and lobbed it up...at which point the sliding glass door exploded. I’m not kidding, I’ve never seen a window shatter like that. The entire thing blew out and came down in a billion little pieces. I realized I was still sitting on the man’s fence and didn’t want to appear to be the guilty party and jumped down just as a very sleepy looking man poked his head out of the large vacant space where his slider used to be. My mortified captain said, “First, I’m sorry. Second, you’re wife called us.”



We checked the apartment and found no trace of an electrical smell or problem of any kind. We alerted the BC as to what had happened and he brought us a shop-vac to clean up all the glass. The homeowner took it very well and even invited us to lunch at his restaurant (we didn’t go). When we had finished vacuuming up all the glass we noticed a crib right by the slider with a sleeping child in it. This kid hadn’t woken up when the door shattered or the entire time we were running the shop-vac three feet away from him. I guess he takes after his dad.

The Nurse is with the patient.

The tones went off and as we ran to the engine the locution (electronic dispatch voice) gave the address. We knew right away it was the health clinic. I’m always amused at going to the clinic and having doctors and nurses give me reports on patients and expecting me to make them better. Aren’t you the doctor? In the rig, my captain read off the call info from his MDC saying we were responding to a 45 year old male with chest pain and that a nurse was with the patient. When we got our update from the live dispatcher she stated again that “a nurse is with the patient”.

When we arrived at the clinic there was no one to greet us, I guess the nurses were all with patients. We stood in the waiting area, three firemen with all our medical gear, surrounded by potential patients not sure who we were there for. Someone finally came out of the hall and directed us to a small examination room where our patient sat holding his left arm and looking very uncomfortable. And there was a nurse with him. The nurse proceeded to tell us that the patient had chest pain and is Spanish speaking only. I asked the nurse if she spoke Spanish and she said “No. Do you want an interpreter?” I could only think of the old Mad Magazine section entitled Snappy Answers to Stupid Questions but held my tongue. Thank god the nurse was with the patient.

A Spanish speaking nurse came in and served as interpreter. Why she wasn’t with the patient from the get go I don’t know. We ran a 12 lead ekg to rule out serious cardiac issues and treated the patient with aspirin, nitro, and oxygen bringing his pain down from an 8 out of 10 to a 4 out of 10. He was looking considerably better when the ambulance took him away and we bid him Adios. We didn’t see the nurse again.

"No really, I'm fine"

Some people call 9-1-1 for the smallest things and you wonder what on earth they were thinking. And then there are people like this patient.

Our crew responded to a call for a 40 year old male fall victim. En route we received our update stating that it was a fall in the shower. “Great” we all said simultaneously. “Wet, naked patient. Just great.”

We were met at the door by a man who told us the patient was in the bathroom and that he had fallen earlier today and broke his “scapula”. Upon his return from the hospital the two other men living there “made him take a shower because he was so stinky”.
OK.
At this point I was expecting to see a morbidly obese man who was unable to properly care for himself. What I found was a clean, average looking, pleasant enough male standing naked at the bathroom sink with another man pressing a folded towel onto his back (at about his left scapula). He had scrapes and small puncture marks visible on his back but what struck me first was that his left knee was swollen to the size of a softball and he had large red marks running up the back of his thigh. The shower curtain was torn down, the porcelain soap shelf on the tub was shattered and there was a small amount of watery blood in the tub.

I introduced myself to the patient and asked what happened. He told me he had fallen that afternoon and broken his fibula and patella (not scapula) and that he fell again in the hospital while learning to use crutches, not his day I guess. My first thought was why are you standing on your broken leg and why don‘t you have a cast? I asked and he said it didn’t hurt and he was more comfortable standing. He had a brace for his leg but took it off for the shower.
OK.
He said that he slipped in the shower but stated that nothing hurt and that he was fine, he didn’t hit his head or lose consciousness. Good news. I slowly removed the towel on his back to have a look at his injury and as I did so I was pretty sure I could see at least a couple of his ribs sticking right out of his back through his skin. When the towel was completely removed I discovered that he actually had several large shards of shattered porcelain impaled and embedded into his back. I covered the wound with a trauma dressing and informed the patient of what would happen next when the ambulance arrived. This was the exchange that followed:

“Do I have to go to the hospital?”
“Sir, you have shards of porcelain embedded in your back. Yes, you have to go to the hospital.”
“Can’t you just take them out?”
“No, I can’t take them out, and even if I could you would still have to go to the hospital to get your wounds cleaned and sewn up.”

The ambulance arrived and after I showed them his wound they stated that they would be taking him to the nearest trauma center. The patient walked to the gurney on his broken leg and never once complained of pain or discomfort and was apologizing to us for having to respond to the incident.