ReadyMedic

Ice Storm Part 2...

2009-01-28T11:47:00.009-06:00

911 Paramedic Call:

We had just finished dropping an elderly couple off at the shelter when we got the next call; a 58 year old woman having a massive heart attack. She had a significant cardiac history, and dispatch said things were looking bad for her.

We arrived on scene to find the patient short of breath, sweating profusely and complaining of severe chest pain. She was extremely pale and cool to the touch.

The Treatment / Results:

We loaded her into the ambulance and put her on high flow oxygen immediately. Her blood pressure was 78/40, her heart rate was 42, and her respirations were 30. None of these vital signs were within normal limits. I started an IV, but could not give her nitroglycerin or morphine for the pain because her blood pressure was too low, and these drugs drop the pressure even more. We also don't give nitro if the heart rate is below 60. We did give her fluid boluses to try to help her blood pressure.

Her lungs were not overloaded with fluids, and there wasn't much we could do for the shortness of breath. We did need to quickly get her heart rate higher and hope that the blood pressure increase would quickly follow.

We don't like to give Atropine for a slow heart rate if it is a true heart attack, because it increases the hearts oxygen demand, thereby causing the heart to be oxygen starved even more. The only option was to hook her up to a temporary external pacemaker.

After we got her heart rate up with the pacemaker, the blood pressure came up somewhat. External Pacing can be painful, but still, morphine was out of the question.

We started toward the hospital. My supervisor was leading us in with his jeep, cutting trees from the roadway as we got to them. The family was following behind in a Chevrolet Suburban.

We had been on the road with this patient for 2 hours when her blood pressure started to drop dramatically. I then had to give her dopamine to bring her blood pressure up. She was dying and we couldn't get her to the hospital any faster.

At last, we come to a tree that we could not drive under. The ambulance was too tall and the tree was too high to reach. What now? We are stuck and our patient is critical.

I made the decision to move the patient to the family suburban; move the cardiac monitor, drugs, and oxygen. I had to leave the comfort of the ambulance and the backup security of my partner. I had to trust total stangers to get us to the hospital safely.

Fortunataly, the Suburban was able to drive under the tree and get us safely to the hospital. The hospital had the Cath Lab set up and waiting for her arrival. She was in the Cath Lab within 10 minutes.

Wrapping It All Up...

My partner, however, ended up off the side of the road in a snowbank with a fender bender. We did eventually hook back up, in another ambulance, and headed back to the war zone.

The patient did survive the surgery in the Cath Lab. However, due to damage to her heart during the 2-3 hour delay, she had significant heart damage. The last I heard, she was placed on a transplant list and transferred to a Little Rock hospital.

During the hectic days of the icestorm, I saw compassion, cooperation, and heroics like never before. It is a shame that we have to wait for a disaster to help our fellow man...

More Later...
Ready Medic

Ice Storm Part 1...

2009-01-26T23:23:00.006-06:00

911 Paramedic Call:

I was talking with my family tonight about the big ice storm that we had in 2000, the day after Christmas.

I went in to work early that morning. Since it was snowing pretty hard, I wanted to make sure I got there so the off-going paramedic could make it home. None of us were prepared for what was in store for us next.

The Problem:

Right from the get-go, the calls started pouring in. The biggest problem wasn’t necessarily medical problems, it was electrical outages. A shelter was set up and we had to pool all of our resources together to transport the elderly from their homes.

Another problem we faced was the residents that required home oxygen. Most patients had one manual tank, enough to last approximately 24 hours. They had to be the priority. But everyone seemed like a priority to me, they were all freezing.

We had 3 ambulances moving residents for 48 hours straight. We would strap them to a backboard and attach our belts to the backboard to drag them to the ambulance. We didn’t dare risk letting anyone walk. We could hardly walk ourselves.

We soon became exhausted, cold, wet, tired, and hungry. We couldn’t change our circumstances. We couldn’t get out, and no-one else could get in. We were trapped in a retirement community that was full of hills and trees. Soon, the trees started to snap like twigs. The roads were completely covered, impassable.

The first true emergency came in. It was a 58 year old female having a massive heart attack. She had a cardiac history and we knew we had to get her to the hospital, which was a 30 minute trip on a good day. What happened next was incredible.

I am going to continue this story in Part 2…

More Later…

ReadyMedic

Diabetic 911...

2009-01-25T21:17:00.030-06:00

911 Paramedic Call:

(This post is dedicated to my Aunt Abbie, who died from a diabetic related heart attack in 1988. She fought the good fight...)

We had what we call a frequent flyer that lived right behind our station. Her home health aide would usually find her near comatose and call 911.

She was an insulin dependant diabetic, in her late 50’s. She was a very pleasant woman when her blood sugar levels were normal, but not when they were low. This is a condition termed hypoglycem ia.

Hypoglycemia can make a person very mean and violent. The case was no different on this day, but we had learned to expect that when we went to her house. If the hypoglycemia is not quickly remedied, it can lead to

seizure, coma, and death.

The Treatment / Results:

We found Mrs. Griffin on the floor, kicking and yelling for us to get the **** out of her house and leave her alone. Normally we don’t restrain a patient against their will, but we determined that she was not of sound mind to make that decision.

I knew all we had to do was start an IV and administer one ampule of D50 dextrose, and she would snap right out of it, like some kind of miracle potion.

I was going to hold her arms down from above her head while my partner started the IV. The lady was fighting us tooth and nail. As soon as my partner made the IV stick, the woman head butted me in the nose, causing a faucet of blood to pour onto her face.

Now, I have a busted nose, and she is feeling better! When she came back to her normal mental status, the poor lady ran to her bathroom and got a wet rag to treat my nose.

Wrapping It All Up:

She felt terrible for what she had done. I had no hard feelings because I knew it was out of her control.

Fortunately, the nose wasn’t broken, but it was darn sore for a few days, just in time to go back and visit Mrs. Griffin once again…

Diabetes is a dreadful disease that affects millions. Diabetes can also cause a host of secondary problems that can eventually lead to limb loss, neuropathy, heart disease, blindness, kidney failure, and eventually death.

Do you or someone you know suffer from diabetes? Please tell us your story.

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ReadyMedic

EMS Abuse...

2009-01-24T22:26:00.012-06:00

911 Paramedic Call:

I was sitting in front of my warm fireplace tonight, and I got to thinking about abuse of the system in EMS.

I am not generally one to complain about the “grunt” runs that we make, I know that it comes with the territory. But after years of working, I have a different perspective on the issue.

So many ambulance companies have a subscription service. Basically, you pay somewhere around $30 per year to be a “member” of the service. This does not mean that you have free service, just that they write off anything that the insurance doesn’t pay. It is a way to build loyalty among the patrons.

Most subscribers want to get their $30 worth, even if it means calling an ambulance for a non-emergent situation.

Point in Case:

At the time I was working in a rural retirement community. We had 3 ambulance stations, each approximately 8 miles from the next one. I worked the front station. We got a call for a respiratory distress in our area. Upon our arrival, it was actually an ingrown toenail.

It was a gentle, elderly woman, with a loud, obnoxious husband. He insisted that she be transported to the emergency room. We smiled, loaded her up, treated her kindly, and transported her 30 minutes to the nearest hospital.

In the interim, while in the ER with the toenail lady, a call came in for another woman in TRUE respiratory distress, only one block from our station. At the time, the 2nd ambulance had just left on another run, leaving only the 3rd ambulance available, which was 16 miles away. 16 miles can hurry on the interstate, but not on country roads. It took 23 minutes to drive from the 3rd station to the 1st station.

While waiting for help, the lady went into respiratory arrest. Our dispatch called for the fire department personnel to first respond to the scene. When the ambulance crew arrived, they were giving her artificial respiration's and she was in critical condition.

Wrapping It All Up:

The woman survived, but stayed on a ventilator in ICU for nearly a week. I believe that earlier intervention with bronchodilators could have possibly eliminated or greatly reduced her stay in the ICU.

What is your take on EMS abuse?

More Later…
ReadyMedic

Truck In The Creek...

2009-01-23T12:39:00.010-06:00

911 PARAMEDIC CALL:

It was a cold, drizzly morning; 26 degrees on the thermometer when we got the 911 call; “Truck overturned in the creek”.

Upon our arrival, we comprehend the seriousness of the situation. We have a pickup truck turned upside down in the water, the young man still trapped inside.

We didn’t have fire assistance on rescue calls at the time, so off I went into the water to try to get the door open. I have never been so cold in all of my life. The door was jammed, the window rolled up, and we had access to only one side of the truck.

The Jaws of Life would not reach to the door, so I asked for some hand tools. I did manage to break the door window with a window punch. Now I could reach him and I felt his head and face. Very eerie!

When I tried to pull him out, I became aware that his legs and feet were pinned beneath the dash. I could not do anything else at this point except to call for a wrecker to get there as quickly as possible.

This all took place over a period of about 2 minutes, so a huge amount of time wasn’t lost. Also, we had the cold on our side. The hypothermia is providing some temporary protection to his heart.

THE TREATMENT / RESULTS:

We still had high hopes that the wrecker service would save the day. When they arrived and pulled the truck from the water, we realized that it was all in vain. We removed him from the truck with a severely broken neck, incompatible with life.

WRAPPING IT ALL UP:

We gave our all and a young man still lost his life. Speeding was a contributing factor to this accident.

Do most young people believe that they are truly invincible?

More Later…
Ready Medic

4 Year Old Skull Fracture...

2009-01-22T12:17:00.013-06:00

911 PARAMEDIC CALL:

The most frightening call we have as EMS providers and as parents is the call to the critical injury of a child. We can’t seem to think as rationally as we normally would. Time gets into some type of fanatical warp. We somehow pull ourselves together long enough to help the child, then fall apart when the day is done.

Four year old “Tommy” and 9 year old “Abe” were playing in the back yard of their home. Abe wanted to be able to golf as good as his dad, and Tommy wanted to play hide and seek. Abe was swinging his golf club as hard as possible, just as Tommy stepped out of the bushes. The golf club (a heavy driver), struck Tommy in the forehead.

When we arrive on scene, Tommy is sitting in his mother’s lap, he’s not crying, just looking up at us with no fear in his eyes. This would be an excellent finding in an adult, but not in a child.

THE TREATMENT / RESULTS:

We take cervical (neck) spine precautions before we remove a wet rag from his head. To our shock, the entire frontal section of his skull was missing. The opening was the perfect outline of the golf club. I don’t know exactly at this point if the section of the skull is imbedded or actually missing. We load him onto a pediatric spine board and rush him to the ambulance.

Andy is conscious, but not seemingly alert. Our treatment includes spinal precautions, high flow oxygen, an IV of Normal Saline, and a cardiac monitor. Treatment at this point differs for children. His heart rate initially was roughly 72 beats per minute. This is very low for a young child. His blood pressure was elevated and his breathing was erratic. This is a phenomenon described as Cushing’s Triad. This is usually a sign of increasing intracranial pressure.

I used bag-valve mask to assist his ventilations and increase his heart rate. Each time I would assist, his heart rate would increase. I had to do that a little at a time, because as soon as the heart rate increased, so did his activity level. He remained in this condition throughout the trip to the ER.

WRAPPING IT ALL UP:

When we arrived in the ER with him, the staff called in Angel Flight out of Little Rock to fly him to Arkansas Children’s Hospital. We do know that he survived, but we never heard anything further.

Hold your children tight, your lives’ can change forever in a moment…

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ReadyMedic

Golf Cart Leg Amputation...

2009-01-16T13:22:00.007-06:00

911 PARAMEDIC CALL:

Do you think drinking and driving a golf cart should be illegal? Here is a story that will make you think twice about drinking on the golf course

It was one of the hottest days of the year, 103 degrees by early afternoon, not abnormal for Arkansas.

The call came in for a golf cart accident. We arrived at the patient’s side, a woman in her early 60's. She had a blanket over the lower portion of her body, covering up what was to be one of the most mangled legs I had ever witnessed.

She had stopped her golf cart, gone around to the back to get a club, and WHAM! Another golfer sped up behind her on his golf cart, afternoon toddy in hand, and pinned her between the carts.

When I looked at her leg, my heart sank. Right below her knee on the left side, her leg was attached by only about 2 inches of skin. I knew in an instant that life as she had known it had changed forever.

THE TREATMENT / RESULTS:

The first thing that was done was to control the cervical (neck) spine. Next we needed to control her pain. An IV had to be established, and the patient placed on a cardiac monitor. We gave her 5 mg. of Morphine IV, and this made her pain tolerable. We then strapped her to a long spine board, with the leg splinted, or at least what was left of it, the best we could.

WRAPPING IT ALL UP:

We found out later that evening that the leg did have to be amputated below the knee. I wonder if things would be different if the offender had not been drinking and driving that day.

What are your thoughts about this? Do you think golf courses should be exempt from DUI laws?

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ReadyMedic

How In The World Did I Get Here?

2009-01-15T17:41:00.003-06:00

I can remember from the time I was about 16 years old, that I was fascinated with ambulances and lights and sirens. EMS was in its infancy, and there weren’t many classes available.

I went on to college after high school to Ole Miss on a music scholarship. I just couldn’t get into the music thing.

I did find out they had an EMT program on campus. I was so excited and went to sign up for it. However, when I went to the class, I found out that I had to be 21 to enroll. I was only 19 at the time. The bubble burst!

I went on with my life and came across another class when I was 21. The space was limited and each applicant had to be interviewed for the class. I was accepted as an alternate. The bubble bursts once again.

About 1989, the hit series “Rescue 911” first aired. I knew that I had to get into a class. I went down to the closest college, applied, and was accepted!

I completed the class and passed the state exams. I was finally an EMT!! I was hired at a local ambulance service, and I went to work, learning everything I could from those who knew the business.

I soon decided that I wanted to be a Paramedic. I headed back to college to attain my goals.

I have been a paramedic now most of my working life. It is what I know, it is my comfort zone...

What qualities do you think a good paramedic should possess?

More later…
ReadyMedic

Tennis Player Heart Attack

2009-01-15T13:53:00.009-06:00

911 PARAMEDIC CALL:

We arrived at a nice condo on the lake, about 2 blocks away. A 60ish year old woman met us at the door. She did not seem alarmed or anxious. She stated that her husband had played tennis that evening and came home with minor discomfort in his chest. "Joe" was a nice looking gentleman in his mid sixties. He had graying hair and sparkling blue eyes, and the build of an athlete.

TREATMENT AND RESULTS:

We loaded him onto the stretcher; his color was good, his vital signs were normal, and the cardiac monitor did not show any arrhythmia. I went ahead and put him on oxygen and started an IV.

As we exited through the security gates of the retirement community, it happened. I spoke to Joe and he didn't answer. I gave him a little rub on the chest with my knuckles; no response. I looked at the cardiac monitor and saw only a chaotic rhythm that could not support life. I checked the electrical leads to his chest; everything was in place properly.

He was in a deadly rhythm called Ventricular Fibrillation, or VFib. I immediately grabbed the "paddles" and charged them to 200 joules and gave him a shock that nearly lifted him right up off of the stretcher. Within just a few seconds, he opened those blue eyes, and was looking straight up at me.

His rhythm was normal now, but I needed to make sure this did not occur again. We gave him lidocaine, which is a first line anti-arrhythmic drug.

WRAPPING IT ALL UP:

Joe did not know what happened; he had no memory of the incident. His chest pain went away after the big kahuna shock. By the time we got him to the emergency room, he felt better than he had all day!We went in to check on Joe one last time after we finished our paperwork. His wife was crying, Joe was smiling, and all was well with the world once again.

Do you think it is common to revive a patient from cardiac arrest in an ambulance?

More Later...
ReadyMedic