Ambien

"Ambien is a hell of a drug, Peter."

I had two calls in a short period of time involving the sleeping aid Ambien. Neither involved the often reported sleep walking or sleep driving or other strange behavior, but both had powerful effects.

The first call came in as an elderly female who was breathing but unconscious. When we arrived we found a slight old lady laying face down in her very narrow hallway. She was actually conscious enough to mumble at us in response to my questions. It was very difficult to understand her answers, though. I was able to find out that she had indeed taken Ambien. After stepping over her and checking her for injuries (the hallway was very narrow, she pretty much took up the whole space), my firefighter and I started to roll her over. She mumbled again and this is what we heard, "Tell them.....tell them...I have...AIDS". Both of our heads snapped up and we stared at each other, both thinking, "No. She didn't really say that did she?". I asked her to repeat what she had said. She mumbled her reply again, "On the stove....tell them...I have...eggs". Ohhhhhhh eggs, no problem, we'll take care of that. We loaded the patient on to the gurney and I went to check the stove. There were no eggs in sight but there was a pot of water sitting on an unlit burner. I guess she only got that far before the Ambien kicked in and she wound up on the floor. It reminded me of a comedian I'd heard riffing on Nyquil, "the nighttime, sniffling, sneezing, coughing, wake up shivering on your kitchen floor medicine".


With the next patient it wasn't quite so obvious. This time we found a large woman in her thirties to forties in bed totally unresponsive. The odd part of it was she wasn't lying in bed. She was sitting on her bed cross legged (indian style) and leaning forward over her lap. I tried to wake her up to no avail and proceeded to try out some other tests to rule out the cause of her stupor. I checked her blood sugar and her pupils, all while she was sitting there not responding. I was getting ready to administer Narcan (to counteract the effects of narcotics) when her 7 year old daughter informed us that she sometimes "takes too much medicine". We began a search for medications and found Ambien in the nightstand drawer. Another mystery solved.

So, if you want to sleep through the night try valerian root, if you want to sleep for a couple of days, try Ambien.

Skil-less Saw

As a relatively new medic I responded to a call for a "man bleeding from the hand". Okay, easy enough to treat, all BLS skills. Our update however, informed us that the patient had taken his finger off with a skil saw.



That changed things a bit because I had never been on an amputation before. The veteran, non-medic, firefighter on my crew immediately responded, "Oh great, that means I have to go and find the finger." That lightened things up for me.

As we pulled up on scene we saw a man in the driveway with a towel wrapped around his hand and, fortunately for the firefighter, the man's wife holding a small tupperware container. She had a look on her face of almost bemusement and wonder which I can only assume was born out of a lifetime of picking up after whatever 'the idiot did this time'. As we had surmised, she had the finger wrapped and on ice in the tupperware exactly as it should be.

We sat the patient down on the tailboard of the engine and I examined the man's wound. I can't really predict how I would react in this man's situation, but I hope I would keep it together a little better. He proceeded to completely lose his s**t and freak out when I took the towel off. He had sliced off his middle finger without damaging any of the others, not sure how he did that. He started repeatedly screaming, "It's gone! It's f***ing gone!" while staring wild eyed at his hand. I had to resort to the tricks we use when treating children, namely distraction and covering the wound as soon as possible. My captain stepped in and started asking the patient questions about his date of birth, phone number, address, medical history, etc, anything to keep him talking and looking away from his hand. I bandaged the hand and wrapped it up like a large mitten so the patient couldn't see the missing spot. An I.V. and a little morphine later and he was relatively calmer.

The patient was taken off to the trauma center where hopefully they would send him off to have his finger reattached. His wife had done exactly the right thing (wrap the part in gauze, put it in a plastic bag, and place the bag over ice) and it was a pretty clean cut so the odds were in his favor for reattachment. And if it didn't work out, he could always make one of these:

The Worst

Some people, in their macabre sense of curiosity, will ask me "What's the nastiest call you've ever had?" I assume their expecting a tale of a motorcycle dragged under a semi or something like that. Something they can imagine and something they can handle. I've seen plenty of dead bodies, bones sticking out where they shouldn't, suicides, car accidents, people run over by BART trains, etc. However, I wouldn't say I've had a truly gory call (though my perspective towards what is truly gory is probably a bit skewed). What comes to my mind when asked that question are the calls that are just plain disgusting. I've only had a handful of calls in my career that caused me to dry heave (I distinctly remember each one) and I've never actually thrown up on a scene. This call was the closest I've come (stop reading now if you have a weak stomach):

We were called out on a medical aid for an elderly woman down-unknown medical, no other information. Apparently the police department had been called out to do a welfare check on this woman because she had been out of contact with family/friends for a couple days. When my crew arrived on scene we were greeted by grim faced police officers out on the lawn. As we entered the house an officer told me my patient was in the kitchen and that she was, "covered in shit". This would prove to be an understatement.

I knew it was going to be bad before I even got around the corner into the kitchen (smell) but I couldn't have predicted what I was about to find. What I saw was an elderly woman face down on the kitchen floor lying in a small lake (about 3 feet wide by 4 feet long) of vomit; or so I thought at first. As we got closer I discovered it was actually feces. The puddle stretched from above the woman's head to about her waist, which didn't make any sense. At least not until I realized that she had actually been vomiting feces (also known as copremesis caused by a bowel obstruction and also, I've learned, the name of a band I won't be listening to). Now, I can handle vomit and I can handle feces (I have kids and pets), but vomiting feces...that got me.

The quick thinking firefighter on my crew ran to the woman's linen closet and grabbed every towel he could find and threw them down around the woman giving us something to at least step on. I must admit, I hesitated, but he jumped right in and held the woman's head while we rolled her over. I later nominated this firefighter for EMT of the year. When we rolled her over her wet, soiled, impregnated hair whipped around his forearm and stuck there. It was at this point that his dry heaves started. All I could do was stare at him and plead, "Don't." And then of course, mine kicked in. Our patient had apparently been down on the floor for quite some time, she was cool to the touch but conscious enough to talk to us...well, berate us actually because the police officers broke her window to gain entry. Okay, priorities people, seriously. You've been lying on the kitchen floor for over 24 hours vomiting fecal matter and you're pissed at your rescuers for forcing entry into your home?

We set about cleaning her up enough to do even a cursory examination. At this point the patient's home health care nurse showed up. This woman did us the biggest favor of the day by finding a scented candle on the kitchen table and holding it out for us. The firefighter and I would alternately lean out and 'take a hit' from the candle, hold our breath and dive back in.

The woman's vitals were surprisingly decent so thankfully there wasn't much to treat right away. When the ambulance arrived we basically had to burrito wrap her in chux and highway blankets for transport to the hospital. I do not envy the rest of the ambulance crew's shift, I can't imagine that smell came out easily. As for us, we set about decontaminating ourselves and all of our equipment and trying in vain not to relive that call for the rest of our shift.

This kind of call serves, to me, as a good example of the things we in EMS and the fire service are expected to do. People say no one in their right mind would run into a burning building when others are running out. But, who wades into a lake of shit to take care of a stranger who spends her time chastising you for something you didn't even do? We are called out for every type of thing imaginable. Whatever situation a person finds themselves in that they can't handle we are expected to mitigate somehow. We'll go on doing our best to do so, but I can honestly say that I'd gladly run into a dozen burning buildings before I ran that call again.

The Show Must Go On

Nothing interrupts church.

We have a few churches in my district and I've run a lot of calls on Sunday's for church goers who are overcome, ill, or even dead. The one common element of all these calls has been that the church service hasn't stopped, even when a group of firemen are doing CPR on the floor in the aisles. It's an odd thing to work a call in a church while services are going on. I actually find it harder to do my job than if everyone stopped and stared at me while I worked, I'm a lot more used to that. In churches I feel like I need to be quiet and not disturb anyone. It takes me out of my normal flow.


Normally when the Fire Department comes on scene we take control of it. We are in charge. People who are making it harder for us to do our job are made to leave (even if it's their house), we control what a patient does or doesn't eat/drink/smoke etc, we decide if they go to the hospital (whether they want to or not), if they are out of control we can sedate them or restrain them, we stop traffic and shut down businesses. It took a long time for me to get comfortable taking over someone's life decisions but I'm okay with it now.
More often than not we try to move the patient out of the Nave of the church and into the lobby where we can talk and work at normal volumes, but this is not always possible and sometimes we have to work wherever the patient is. I guess I'm just not comfortable shouting out to the priest/pastor/preacher to be quiet while I gather some information, especially when they haven't even paused when we came into the room.

I'll run many more church calls in my career I'm sure, but I don't foresee any of this changing.

This One Is Ours

Sometimes it's tough to get the story straight. For us, there are many things that have to take place, correctly no less, for us to get dispatched to an emergency call. The emergency has to be properly reported for what it is - smoke, smoke and flames, smell of gas, etc. The caller has to know the proper location of the emergency - correct address, proper cross street, north bound or south bound on the freeway, north or south of the exit, etc. The proper units to be assigned have to come up on the CAD (computer aided dispatch) and be sent on their way.

My department's communications center also serves other cities and jurisdictions and we hear their dispatch and radio traffic along with ours, which can occasionally be confusing. The other night, we heard a call come in for the neighboring city at a location right on the border of our two jurisdictions. There was some debate over which side of the line it was on. The call was for a fire so my firefighter and I went out on to the balcony of our station and looked out in the direction of the border. Yep, we could see a column of smoke all right. Couldn't tell how far away it was though, or on whose side.


Unfortunately, the other city's department is a little, shall we say, stand-offish and doesn't like to include us unless they have to. So, we figured we weren't going to get to go play on this one. However, we started hearing more radio traffic stating that the location was actually an abandoned store well within our city limits and that the original call was only for smoke seen in the area (see what I mean about getting the story and the location straight). Our battalion chief radioed to strike a first alarm and send our units to the new location.

The closest unit was on scene in about two minutes and reported a commercial structure fire with flames blowing through the roof. We all knew this building to be abandoned and in fact when they closed up shop we were allowed to train there, cut up the roof, and pretty much wreck the place. This was a large building with some serious accessibility problems - locked up chain link fencing all around, locked roll up metal doors for entry, and a large debris field all around it. We were ordered to "put the stick up right away". I drive the aerial ladder truck ('quint' really, but we're not going to talk about that) and that meant that I got to go to work. I positioned the truck so we could raise the ladder and attack the fire from above with about 1000 gallons a minute flowing down onto the roof.


I put the stick up, secured a water supply, and my firefighter climbed the 75 foot aerial and manned the nozzle at the tip. We had pretty good knock down of the fire from up there. By the time the other crews were able to make entry into the building we had a great deal of the fire put out. We shut down so the crews could safely get inside, search the place, and extinguish the rest of the fire.

There was a lot of hose pulled to attack the fire and even more to supply the two rigs flowing water, so we were on scene for quite a while loading hose and cleaning up. For not actually fighting fire up close, I was surprisingly dirty when it was all said and done. It made for another very late night with very little sleep, but I'll take that any day. If I have to lose sleep, I'd rather it be for this kind of call and not something ridiculous.

Right Place - Right Time

We seem to be starting a new trend that I hope continues for us - getting good calls en route to or returning from training.

A lot of our classes and drills take place at our headquarters training tower or the classroom at another station, both in different cities. We have to go out of service and drive out to the other location, usually about 20 plus minutes away. On this first day we were scheduled to go to a class on report writing. That didn't promise to be much fun and none of us were really looking forward to it. We were on the freeway about 4 or 5 exits away from our destination when my captain said, "Is that smoke up ahead?" Off on the right hand shoulder ahead of us we could see a growing plume of white/brown smoke. I turned on my lights and started moving over that way. As we got closer, we saw that there was a car pulled off the freeway with a growing fire in the engine compartment.


Now, we were going to class and so were dressed in our Class B uniforms (wool pants, button up shirt with badge, and station boots), so when we pulled in front of the burning car we all had to jump out and change into our turnouts. It really only takes a minute to dress but it's an awkward thing when you're used to being ready to go the minute you step off the rig. Once we were dressed, we pulled a line to the car and the firefighter went to work on the fire.


I brought the captain tools to pry into the engine compartment so the firefighter would have a more direct access to the seat of the fire. The fire didn't get a chance to really get going and was out in a matter of minutes, although it did take most of the water in our tank to do it. On the freeway, obviously, there are no hydrants, so you have to make do with the water you carry in your tank.

The best part of the call was the fact that it took place in a neighboring department's jurisdiction and by the time they showed up on scene we already had it all under control and got to send them back to their station without them getting to do anything. This particular department is known for their tough guy/cowboy attitudes and often don't play well with others, so it was nice to poach one of their calls.

The very next tour we had to do our monthly performance drill at the main tower and on our way back home to our station we watched a truck lock up it's brakes in front of us and traffic come to a halt. Off in the distance, we could see ambulance lights and just then another of our department's rigs went past us on the left hand shoulder of the freeway. They run on a different radio channel than us so we hadn't heard about the accident through dispatch. We lit it up and worked our way over to the shoulder and followed the engine in. What we found when we got there was a three car accident with one of the cars flipped on it's roof and two people trapped inside. The first crew on scene was deploying the Hurst tools (or Jaws of Life) and we took responsibility for one of the patients inside.

My firefighter crawled through the broken rear window and held c-spine on the driver who was laying flat, face down, on what was once the ceiling of the car and was now the floor. I talked to the patient through the side window while the other crew pried the doors off so we had access to the patients.


We were able to get a backboard slid under the patient and pulled her out on it. The ambulances were already on scene, so we did a quick "strip and flip" (cut the patients clothes off to check for injuries front and back) and loaded them up for transport to the trauma center. Neither patient we pulled out of that car seemed to have any obvious major injuries, which was surprising considering the condition of their car, but we don't often get to take part in a really good auto extrication.

We helped clean up leaking auto fluids and swept up debris from the wreck before being released to go back to our station. We all agreed that we need to start leaving town for training more often if these are the kind of calls we're going to get.

Yes, We Still Do That

I was just thinking about getting ready for bed when the phone rang. The captain must have picked it up in his office because it only rang once and I didn't pick it up in time. A minute later the intercom came on and the captain announced, "We're getting a call".

I slid down the pole and met my captain by the printer. I asked what we were going on and he smiled, shook his head, and said, "The cops need assistance....with a cat stuck in a fence". We spent the drive over to the call trying to figure out how a cat gets stuck IN a fence and what the cops expected us to do about it - fire up the chainsaw? get the 'jaws of life'? We figured we could just crank up the siren and honk the horn - that usually gets cats moving pretty quick. I was hoping it was a chain link fence and perhaps the cats head was stuck and we could just snip a couple wires and be done with it.

When I pulled up on scene, I grabbed my leather rescue gloves, hopped out and met with the officer on scene. He too was smiling and shaking his head, apologizing for bringing us out for this and explaining that he just couldn't get the cat unstuck. He led us to a fence separating two apartment buildings and there was what appeared to be a magical floating cat. The cat had apparently tried to jump the fence and got one if it's back legs caught between the boards and then slid down, completely wedging itself between the boards.



The leg was obviously broken and pretty mangled and the cat was literally hanging off the fence by it's back leg. Someone had placed a chair against the fence so the cat could get his front paws on it to take some of the weight off his leg.

We knew we couldn't come near this thing with a power tool or it was going to go ballistic, so we decided on brute force muscling of the fence. Since I was the only one who thought to bring gloves I was designated as cat wrangler. I held the cat up by the scruff of the neck and tried to keep it from going nuts while the rest of the crew went around to the other side of the fence and pried apart the two boards. The cop had a box waiting and when the boards were pulled apart I immediately set the cat into the box. Of course the box had no lid, so I was stuck keeping the cat pinned to the bottom of the box so he wouldn't then tear me to shreds.

My captain found an igloo style cooler nearby and we placed the cat inside, tore the cardboard box up and used it as spacers below the lid for air entry and duct taped the cooler shut. It worked great. There was plenty of room for air to get in but the cat couldn't get out. Use number 1002 for duct tape - cat rescue transport.



The cop put the cooler in the back of his squad car and drove him off to the local 24 hour emergency vet.


In the 'no good deed goes unpunished' category, my captain did follow up that night to see what happened to the cat. The cat was put down by the vet. It turns out that he had a spiral fracture to the back leg, was a feral, un-neutered male with missing front teeth, evidence of many fights, and........SCABIES.

I proceeded directly to the shower and then threw everything I was wearing in the wash.

So, yes, the fire department still goes out to rescue stuck cats. It just doesn't always turn out the way you'd hope.