Life Is Fleet-ing

Being at the water rescue house has its perks some days. This year we were assigned to be part of Fleet Week. Several other agencies and ourselves were assigned to create the perimeter for the flyover zone in the bay, keeping any other vessel traffic out. Basically we formed a large rectangular floating blockade. It makes for a long 6 hours on the bay, basically station keeping (maneuvering the boat to stay put against the tide and current) and keeping vessel traffic moving in the transit lane. But it is absolutely the best seats in the house for that show.

 

The jets are flying right over you and less than 400 feet in front of the boat as they scream across the water. None of our pictures or videos do it justice but we were close enough to smell the jet fuel when they passed by.

And my god is an F18 Raptor LOUD!

At one point they brought out a 747 and had it banking turns around Angel Island and flying right over the GG Bridge. When that thing first made its turn over the bridge I just hoped that it was part of the show. Otherwise I was about to be intimately involved in what would undoubtedly be an infamous incident when a 747 crashed into Alcatraz.

I honestly don't know how people spend months at sea because 6 hours on the water in the sun is seriously tiring despite how much fun it was to take part.

So, after we got back to the station and cleaned up the boat, got everything back into service, and picked up some dinner I was really hoping for a quiet night.

But...
shortly after dinner we got a medical call. En route to the call we got the update that it was for a full code blue for a male in his mid forties.
Wait did they say 43?
Yep. They did.

We arrived to a frantic and distraught woman who pointed us to the living room where our patient was sprawled out over the ottoman. He was pulseless and not breathing. We moved him to the floor and went to work. His wife/girlfriend(?) was able to keep it together long enough to tell us that he had some kind of heart condition that had apparently already taken another of his family members about the same age a year before.

He was in asystole from the get go. We got the Lucas on for compressions, dropped an ariway and started breathing for him, I got an IV and started pushing meds. The ambulance arrived and went for
an ET tube. The ambulance medic got the tube and we had already run two rounds of meds and some just in case meds as well when the ambulance medic supervisor arrived. We had already decided to transport due to the patients age and the fact that he could be an organ donor. Normally a patient that is in asystole from the beginning gets cpr and three rounds of medication and if there is no change or improvement then we call it and declare a death in the field.

The supervisor agreed and we moved to the ambulance where I took over bagging the patient (rescue breathing for him). I had to move his head back to neutral and saw that there was  blood running from his mouth down into his ear. I told the ambulance medic and began to suction. My guess is that his tongue got nicked while putting in the tube. The tube was good still so it wasn't compromising our work. Just meant that I spent the rest of the ride bagging and suctioning out blood.

He was pronounced dead in the ER before we had restocked and left the parking lot.

The next morning we got on the boat and headed back out to the bay to watch jets and biplanes and 747s go screaming over our heads again. It's not quite as thrilling on day two but still really cool and maybe there was a just a little more appreciation for a beautiful day spent on the water as part of your work day.

(Missing Man formation)

Mr. Hughes And The Hipsters

You meet and care for all sorts of people on this job.

 

 

This tour the first response of the day was for a male subject unable to move. When we arrived on scene our elderly and bearded patient was standing outside his front door leaning on his cane. Well, unable to move seemed a bit of a stretch since he made his way out to the front and closed the door behind him. I would learn in a few minutes that I was likely to be very glad that he met us outside. As it was the first thing I noticed was that he was barefoot and had Howard Hughes toenails.

 

Like this except pointier and more dragon like.

He said that he had arthritis really bad and that he couldn't walk. He slid down the stairs on his belly to get to the door and then get outside. He said he had no other complaints but my observation was that he was pale and didn't smell great. We got some vitals and realized that he was extremely sweaty and had a rapid pulse. He was so sweaty that the ekg lead stickers would not stick to him at all. We undid his sweatshirt which turned out to be the only thing he had on to wipe him down and try to get the leads to stay. It was at this point he stated that he had not had a shower in over a month and "could we tell?". Well yes we could. 

Even wiping him down didn't do the trick and I had to hold the leads to him in order to get a reading. His heart was racing along at over 155 but he had no cardiac complaints at all and no cardiac history.

When the ambulance arrived we had a moderately tough time getting him to shuffle his way to turning around and then get on the gurney because he couldn't really bend which also explains why he can't take care of his toenails. His heart was still racing and the ambulance crew asked again if he had any cardiac or other significant medical history. Again he said no. As they wheeled him away I asked the overlooked obvious question: "When was the last time you saw a doctor?" His answer was, "Six years." Well there you have it then. 

This way to the ambulance Mr. Hughes.

 

Six years since a doctors visit and over a month since a shower. This is why I was so glad that he met us outside. I can't imagine what the inside of that place looks like and I don't want to.

The following two calls were for hip problems. One lady had an artificial hip that was supposed to be basically bullet proof. Except in her case when she bent over to grab her slippers the thing popped out on her. She was handling it pretty well and I was able to give her some meds for the pain although they didn't help much.

The next lady fell in her kitchen and was very cordial and not in quite as much distress as long as she was laying still. We were able to get her up and on to the gurney without much difficulty. It was hard to say if she had done any real damage as nothing seemed out of place or unstable. But she was also in some pain when we did have to move her so I'm sure her xrays may reveal some damage.

We were able to help everybody we tended to that day but in a district with a primarily older population it can be tough seeing these folks struggle with daily tasks in their old age and especially those who lack the resources to get needed help.

A Light In The Darkness or This Little Light Of Mine

I have a terrible memory for houses. I need to see the people and then I remember why I've been there before. But when I looked at the map as I got my turnouts on I was pretty sure I'd been to that place before, but I didn't know why. It was about 8:30 at night and we were responding to a seizure call.

We pulled up to the house and I put on my hat (more on that later) and started donning my gloves. We grabbed the gear and headed to the front door. It was dark and there was no porch light on. As we got to the walkway we saw a woman moving around on the porch. She had apparently squeezed out the barely open front door and was attempting to clear a path. The entire porch was covered in trash and random things I couldn't even begin to make out. So much so that the front door was blocked - from the outside. Which begged the question: how long has it been that way and how do they get in and out of the house? Or do they?

She shoved some things aside and we were able to make entry. The inside of the house was no different. No surprise. It was a total hoarder house.

Of course the difference between this house and the one above is that in the picture above you can actually see.  The house we went into was super dark.

                   

The only light came from a single battery powered lantern.

 

The lady who had cleared the porch so we could get in mumbled something about the power being off at the moment but it was clear that it had been off for quite some time.

Now back to the hat. I wear a lighted ball cap on all medical calls in case I need both hands and can't hold a flashlight at the same time. My firefighter has teased me that I'm one of only three people in the department who bought this hat when it was approved as an official uniform item. But I love that hat and it has served me well on numerous occasions and he had to admit on this call it was bad ass and the perfect tool.

 

With the light from my hat I made my way to the couch where an elderly woman sat near a man in his fifties who looked in his seventies. He was wearing a hospital gown and was slumped over sideways with his head under the couch cushion. I lifted the cushion and started to ask him questions while my crew tried to move some of the detritus so we would have a prayer of getting him out and to the ambulance. 

I was surprised to find him alert and oriented. He knew he had had a seizure and said it had been a long time since he had one and that he was taking his meds. I got a quick set of vitals on him and asked my firefighter to grab the glucometer for me. He was oriented but I still check a blood sugar as standard precaution after a seizure. I was just getting the sugar when he stopped responding to me. I noticed his head was turned and he was staring off into space. I knew he was about to seize again. I was able to get the fingerstick covered up so he didn't bleed all over me and the glucometer put away just before the seizure began in earnest. I asked for an IV to be flooded and for my firefighter to pass me a start kit. I got the tourniquet on while he was seizing but fortunately he stopped in time for me to attempt the IV. The first vein rolled around on me but with my cap light shining down on his arm I was able to get a vein on the top of his wrist and had a solid line when the ambulance arrived. Which is when he started to seize again. The crew was setting up to administer versed when the seizure stopped and we decided to take the opportunity to get him out of there and to the ambulance and treat him there.

There was no way to bring the gurney or a stairchair or any equipment into the house so we just had to grab him off the couch and do a sit pick carry out to the gurney on the front lawn. The ambulance crew said they didn't need a rider and would give the versed in the back of the ambulance en route. So we cleared and went back to the stations.

The patient would get the treatment he needed and hopefully an adjustment to his meds to keep him from more frequent seizures. The living conditions however are another story. We can only report it to the proper agencies and hope they get some outreach assistance. There is no question that if there's ever a fire in that place we will be pulling dead bodies out of there.