Well, that sucked.

When we get dispatched to a call we have 90 seconds from the time the alert tones go off to get dressed, get on the engine, and get going.  From that point we have four minutes to arrive at our destination.  The ambulance company doesn't have the same rules.  For one, the ambulance could be coming from anywhere: a staging location, the hospital, another city.  It all depends on how many units are available at the time of the call.  They also have a priority dispatching system which means an ambulance responding to a lower priority call may get diverted to a higher priority call and a new ambulance dispatched to the original one.  We always go Code 3, lights and siren, but the ambulance may only be coming Code 2, following all normal traffic rules.  Unfortunately I wasn't paying enough attention to the priority level of my ambulance when this call came down.

We were responding for an elderly female with abdominal pain.  Abdominal pain can mean a million different things and the severity of the pain makes all the difference in how quickly and aggressively we treat it.  My patient was in a lot of pain.  Also, it was new onset pain so something was definitely going on.

 

I knew I had to give this woman some pain relief. She already had a fentanyl pain patch on and had taken a percocet and she was still hurting.  I set about trying to get an IV established but this woman had extremely papery skin and only the tiniest of spider veins.  She apologized and said she knew that they always have a hard time getting a vein with her.  I guess I was pretty focused on finding a suitable site for access (mostly by braille) and wasn't paying attention to the radio traffic.  I felt what I thought might be a good enough vein, though I couldn't see it, and went for it.  Miraculously, I got the welcome flash of blood in the chamber that meant I was in the vein but it collapsed immediately and I could not advance the catheter even the slightest amount.

At this point I heard my captain say, "Oh wonderful".  I asked what happened and he said that our second ambulance had just been diverted. Damn, I hadn't realized they weren't coming code 3.  I told my captain to upgrade the new ambulance.  That's when I found out that my new ambulance was coming from over twenty miles away.

I wound up having to give this woman a morphine injection into the muscle which unfortunately takes much longer to take effect than if it were administered into the bloodstream.  She was also a diabetic with horrible circulation, so really I knew that this was almost pointless. I fished around on her other arm for IV access with no luck. I gave her another injection before the ambulance arrived forty minutes after the initial dispatch.

I knew it wasn't their fault and I was just mad at myself for not thinking about the response code from the get-go.  If I could have gotten the IV it might not have been so bad, but overall I just felt pretty useless.

Sucks when that happens.