Heart Stopper

There is an abnormal heart rhythm known as SVT (supra ventricular tachycardia) that is potentially very serious. This rhythm is very rapid and requires a huge amount of work by the heart to maintain. There are a variety of ways to combat SVT, with and without medications, and in the case of someone whose body is no longer compensating for the extra workload on the heart we treat it with electricity. We didn't have to go that far this time fortunately.

We responded to a call for a 65 year old female with a rapid heart rate. When we arrived this woman was sitting in a chair telling us that she has a history of SVT and has tried valsalva maneuvers, a cold shower, relaxation and nothing has brought her heart rate down and now she is getting really tired. Her heart was racing at about 220 beats per minute. She said this had been going on for about three hours now. Yeah, no wonder she was tired. That's like running a marathon. She immediately asked if we carried Adenosine (the ant- arrhythmic drug we use to combat SVT) on the truck, so she knew her stuff and knew what was going to happen next. She wasn't happy about it though.

We laid her down on the floor and established an IV so we could administer the Adenosine. Adenosine causes a transient (brief) heart block in the AV node (pacemaker) of the heart causing a cessation of the irritability and allows the heart to essentially reset itself. In layman's terms: we stop their heart and hope it fixes itself.

We generally don't explain it to people that way of course because that is just a little bit alarming. We also don't tell them how horrible it feels when it is administered. Imagine going from 220 bpm to 0 in a couple seconds. It's like your heart hit a brick wall in a Ferrari. We usually say, "This may be uncomfortable for a minute". This lady knew what was coming and asked me to hold her hand when we did it. Fortunately I have a two medic crew and was able to do my part and hold her hand at the same time. Adenosine is so fast acting and has such a short half life that it has to be pushed rapidly as close to the IV site as possible and immediately followed with a saline push from the next available port in the IV line. So, two syringes pushed one after the other into the IV line. My firefighter pushed the drug and I pushed the saline as this woman tried to break my fingers with her kung fu grip. I watched the monitor as the time ticked by, ten seconds, no change, fifteen seconds, no change. Damn. I guess we will have to go to a second dose. But just then her grip tightened, which I didn't think was possible and she let out a painful moan. I watched the heart monitor drop from 220 down to about sixty and back to 120 and finally level off at about 94 bpm.

She said she could feel the slam of the Adenosine all the way through her body. It felt like hell, but it worked. The ambulance arrived just as we were finishing pushing the meds. We had the IV done, drugs administered, and rhythm converted for them which just left them transport to the hospital where our patient would be monitored for a few hours to make sure her heart remains stable. Sorry guys.

Another Snapshot

We go on a lot of calls where we show up, provide some basic (or advanced) medical care, pass the patient off to the ambulance and go back to the station, no big deal. But, what most people don't see are the little interactions and the behind the scenes actions, often above and beyond the usual call of duty and more personal or just plain different.

I was recently working a 72 which means I picked up an overtime shift at a different station and then went right into my normally scheduled two day tour. The overtime shift was at a station I had only worked at once before which meant that I wouldn't know where I was going when responding to calls and would be relying on the officer and the MDC (mobile data computer) to navigate. It just so happened that on that day the entire normal crew was off on vacation and myself, the captain, and the firefighter were all on overtime and neither of them had worked there before. This was going to be an adventure.

We ran a handful of medical calls and somehow found our way to the addresses without incident. The toughest one was when we got called to a huge apartment complex down an obscure side street late at night. The residents had evacuated the complex and the sidewalk and street were just full of people. We located the apartment that caused the problem and determined that it was just a pot on the stove that had created enough smoke to set off all the alarms. My crew aired out the apartment, reset the alarm, and cleared the building for re-entry. I was down at the engine and was approached by a woman who stated that her elderly mother who uses a walker and lives on the third floor was falling asleep and couldn't get herself upstairs. They did not have a wheelchair so we said we'd help. We wound up carrying this woman from the curb, into the building, and into the elevator for the ride to the third floor. We then carried her from the elevator to her apartment down the hall and got her situated on the couch.The family was very grateful and we gave them some advice on what to do in the future, sheltering in place versus evacuation if the circumstances allow, etc. That's the kind of stuff no one ever sees but means so much to the people we serve.

The next day we were called out on a medical call and on our way there a lift assist call came in on the same street several houses down.They dispatched the next districts engine to cover the lift assist. Instead of tying up two engines my captain decided we would handle both calls simultaneously. I dropped him off at the lift assist address (hoping it wasn't somebody he couldn't lift by himself) and drove on down to the medical call. The medical turned out to be a gentleman having a full on, no joke, legit stroke. It was nothing that I couldn't handle with just the firefighter and myself but it was serious. My captain returned quickly, having handled the lift assist himself, and was able to get all the patient info for me before the ambulance even arrived. It all worked out without a hitch, but that was a new one on me - one crew, two calls, same street, same time. Done and done.

Our next medical call was for a 50ish year old woman who was feeling dizzy. She was home alone with her 80-something year old non-english speaking mother. She had no other symptoms other than feeling dizzy but her ekg revealed frequent PVCs (an irregular beat caused by an irritable heart and a potentially bad sign). The ambulance arrived but the patient didn't want to leave her mother alone in the house. The mother was visibly upset by the whole situation. A phone call had been made to the patients daughter who was on her way, but still about 15 minutes out. Our patient needed to go to the hospital and really shouldn't be waiting around. We told her to go with the ambulance and that we would stay on scene and look after the mother until the grand-daughter arrived. There was still a language barrier but we sat on the couch with her, brought her tissues, and got her some tea while we waited. The granddaughter arrived and informed us that she also didn't speak the native language but I'm sure the familiarity would be a better comfort than the three strangers smiling at her in her living room.

The last example came on the last day of my 72. We responded for another man possibly having a stroke. When we arrived he met us at the front door saying, "Oh man, I tell ya, it's unbelievable". I asked him to step out and have a seat on the bench that was on the porch. He just stood there and said again, "Oh man, I tell ya, it's unbelievable". I asked him again to come out and sit down and this time he did. I asked if he had called us and if there was anyone else at home. He looked at me and earnestly said, "Oh man, I tell ya, it's unbelievable". We assessed him for stroke (arm drift, facial droop, slurred speech) and cardiac symptoms and he was negative for either one.

I did a quick search through his house and only found a few random pills on the table but nothing of much use. Fortunately a neighbor came over and told us the patient's name and that he did indeed have a stroke history. We asked the neighbor if she knew who called and she said she didn't know but that the patients daughter had just driven away. Huh????

I continued to try talking to him and only got one of three phrases in reply, "Oh man, I tell ya, it's unbelievable", "long time, a long time", and "it doesn't win". He was otherwise gentle and compliant although definitely anxious and repeatedly trying to stand up. My firefighter was able to keep him relaxed just by holding his hand while I finished my assessment. She continued holding his hand and talking to him until the patient's daughter appeared again. In a case of rather bad judgement, this woman had called 9-1-1 for her father with a stroke history and then left, driving her ten year old son home because he was "feeling scared". This man has neighbors who know him well enough to know his medical history and care enough to come over and help us out, she couldn't have sent the kid next door to their house or said go in the other room and watch t.v. for five minutes while she stuck around to help us take care of her obviously sick father?

The decisions some people make, oh man, I tell ya, it's unbelievable.

Some Like It Hot

"Engine 51 respond for a citizen assist. Elderly female says burner on electric stove won't turn off."

First thought: Why not just unplug it?

Doesn't matter, we are here to help so we headed out. On our arrival we discovered that this 90 year old woman was apparently some kind of house sitter and that it was super hot in the house.

 

 I put on gloves and headed straight to the stove where I found all four burners on High and a whistling tea kettle still sitting on one of the burners.

I moved the tea kettle and put it in the sink and then simply turned all the burners off. The lady exclaimed, "Well how come they just popped up for you?" I think she just turned them the wrong way to hot instead of off but they were the kind that you had to push down and turn so maybe she just wasn't pushing down. Who knows? In any case we shut off the stove and checked the hood and cabinets above to make sure nothing above had overheated. All was clear and the captain began getting information from the woman for the report. I walked out of the kitchen and underneath a ceiling register that just blasted me with hot air. I mean hot.

Now, I thought it was hot in the place because she had the stove cranked but that was nothing. I told the captain and we went and checked her thermostat. It was set to 90 degreees! Four stove burners on full and the thermostat set to 90. We showed it to her and set it back down to a reasonable temperature for her.

As we were wrapping up and set to leave we noticed the door from the laundry room to the outside was open. We asked if she wanted us to lock everything up for her before we left. She said no and that she would get it later. She had that door open because it was hot in the house.

She was a very nice lady and very appreciative, but these folks might want to reconsider who they have house sit for them in the future.

Mother May I

For those of you who work in the field, the title of this post has an entirely different meaning. You see we have standing protocols we follow for different types of medical emergencies. They are guidelines with some room for paramedic judgement but most of the time to step out of protocol we have to make base contact and get permission from the ER Doc to do so, "Mother may I". This call was different. This time someone was asking me for permission.

We responded to a call for a lift assist only, no medical needed. My district has a lot of elderly and infirmed citizens and when they fall, or slide out of bed/chair/walker whatever, we go and pick them up. They aren't hurt but just don't have the strength to get up. Dispatch informed us that the patient would be in front of the residence. I figured this meant it was an actual fall but sometimes people just have trouble transferring from the car to wheelchair and need assistance.

When we arrived we found an elderly woman lying next to her side yard gate with a neighbor supporting her right leg. I asked what happened and she told me that she fell and that she thinks she cracked her hip. So much for the lift assist. I told my captain to get an ambulance coming right away. I sent the firefighter into the house to get some pillows and padding to prop her leg up so the neighbor could let go of her leg. Turns out she was bending over and lost her balance and fell, landing right on her hip. She had no other injuries but was in a lot of pain anytime her leg was moved.

We assessed her injury and obtained vitals. I then established IV access in preparation for pain meds. I knew it was going to hurt like hell when we had to move her. I adminstered the pain meds and I could tell just by her voice and reaction that they were kicking in but she still had pain to be sure. I told her we ready to move her and that we would do our best to make it quick but that it was going to hurt. She said, "Alright, I understand. But, is it alright if I curse?".  Now that's a lady, huh? We laughed and told her she could do whatever she wanted to.

We rolled her to the uninjured side to get our scoop stretcher under her and she responded with, "Shhhhiiiiiiitttttt". We got her loaded up and on her way with no further distress. It just cracked me up that she asked permission to curse. She was a very sweet lady and I hope she heals up quickly.

Persevere, Improvise, Adapt, and Overcome

Sometimes I’m amazed we all stuck with it.  

I got hired in a group of three.  Of the two other guys one was my age (30) and the other a year or two older.  Our orientation was plagued with incidents, injuries, and ill advised training practices.  Looking back, I understand what they were trying to accomplish, but almost nothing worked out like it was supposed to.

The first day we reported to training we were met by the newly appointed training chief who was holding three brightly colored tie dyed t-shirts.  Wait, let me go back a step.  The normal uniform for PT is a blue t-shirt and shorts with the department logo on them.  As a means of instilling a goal in us, we were not allowed to wear a department t-shirt during orientation - we had to earn it. Instead we wore plain white tees and department shorts.  The Chief passed out the tie dyed shirts to us and told us to put them on.  He then took us on a three mile run around the city.  

                  

Now, we were firefighter recruits in pretty good shape, but not one of us was a “runner”.  This would prove important as the training wore on.  Apparently, the point of the tie dyed shirts was to instill in us the fact that everything we do is in the public eye and that they are watching our every move - we’d better get used to it and respect it.  Toe the line, someone is always watching.  

It really was not a big deal to us.  No one felt stupid wearing the shirts, we just didn’t really get it immediately.  But the message was driven home much more forcefully when the Chief got called on the carpet by his bosses for subjecting the new recruits to what someone else viewed as “hazing”.  So it was true, someone is always watching.

We were told that every morning, before 8 a.m. (the official start of training) we were to run this course together (the three of us) in less than 30 minutes.  So, taking three non-runners and having them run three miles a day on hard city streets before a day of puling hose and throwing ladders, etc. eventually took its toll on one of my classmate's knees and he had to stop running.  That left just two of us to do the run which would later become known as the “Bataan Death March” by the other line personnel.

                 

Shortly after the knee injury we got our first day of live fire training.  We would take turns advancing a hoseline into the burn room, feeling the heat, staying low, putting just enough water on the fire to darken it down and then let it build up again.  As we went in time and time again our gear and our gloves became wetter and wetter.  On the final pass, my, as yet uninjured, classmate felt his hand really heating up inside his glove but he wasn’t about to say anything and be dubbed the weakest link.  He was the last one to go through so the Chief told him to advance all the way in to the burn room and put the fire out completely. In the process of doing that, so much heat was generated that the water in his glove turned to steam and literally boiled his hand inside his glove.  He came out of the burn room and pulled off his glove along with a pretty decent amount of skin.  It looked something like this:

                       

The paramedic on the crew we were with that day treated the burn immediately and the Chief threw him in his car and drove him off to the hospital.  He didn't get pain meds until they reached the hospital and it was not a pleasant ride. Needless to say, the Chief heard quite a bit about that one too.

With one hand and nearly one knee out of commission the chiefs had to rearrange the entire training schedule and do anything and everything that wasn’t manipulative first.  With the burn to the hand, my classmate wasn’t even supposed to sweat so he couldn’t do the morning run either.  I asked the Chief if I was supposed to report early and still run by myself.  In a frustrated and somewhat defeated tone he said no.  It was supposed to have been a team building exercise and it wouldn’t serve any purpose for me to run alone.  So the morning run became a thing of the past.

In the long run, we all passed and moved on without permanent injury. Although, the rest of our orientation was not without further incident. But that will be a story for another day.

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.

Nice Save

My captain's wife and kids were out on a campout while he was at work with us. A little while into the shift he got a message from his wife that they couldn't find his youngest kids stuffed rabbit. It turned out it got left in the car that he took to the station. This was a very sentimental and important bunny and instead of just calling back that it got left behind he decided to go a different route.

We proceeded to take a series of pictures of the stuffed bunny helping out at the firehouse and taking part in all of our activities. The bunny in the gym lifting weights, sitting on the engine going to a call, wearing eye protection and holding wrenches while laying on the creeper to work on the engine. Best of all, we cut the fingertips off of a medical glove and put them on the bunny's hands so he could scrub toilets like a good firefighter. We even got a picture of the bunny flowing the big deck gun during one of our drills.

All these pictures were sent with a message to his kid, from the bunny, saying that the bunny forgot to say he was spending the tour at the firehouse with daddy during the campout. It was a big hit, the kid was no longer worried about the bunny and they anxiously awaited what pictures would be sent the next day.

Nice save Cap.