Tonight is the premiere of another new EMS oriented TV series -- Trauma -- which is on at 9:00 PM EST on NBC. At that hour I will likely be reading "Brown Bear, Brown Bear What do you See?" and "Good Night, Moon" to my twenty-month-old daughter in hopes that she will finally close her eyes and drift off to sleep so I too can finally lay my head on the pillow, stretch my tired body and get myself some sleep before the alarm goes off at five and I have to head back in to work for another 12-hour day.
Zoey made her own first trip to the ED yesterday after falling and cutting the inside of her lip. She was fine -- I think the trip was more for her mother (who works at the ED) to get some assurances that everything was going to be all right. (I sense my fearless daughter who has to do everything her older sisters do will be a frequent ED visitor in years to come as she learns to ride bikes and climb trees.) Before I could even get to the ED, I got a call that she was okay and headed home.
Earlier that day I took care of a little girl only a year older than Zoey who got her finger caught in a door and had her finger tip torn off. No bone, just the whole nail and half the tip -- a degloving I guess you'd call it. We packed the tip in ice and I gave her 2 mg of morphine IM for the pain and dutifully went a very easy lights and sirens to the hospital in hopes that they would be able to sew it back on.
I later did calls for an old man who was feeling dizzy because of some new medicine, yet he was zipping about his apartment with his walker on wheels when we arrived and then for a woman post car accident who the police officer thought might have a head injury. The accident was in the parking lot of a fast food restaurant. The woman was struck while backing out. Low speed impact, but enough to knock one side of her bumper off. She was 80-years-old and had had her seat belt on, but when she told the officer she was too shaken up to know what happened, he thought head injury and so called us for an evaluation. She didn't appear hurt, and said she didn't want to go to the hospital, but I couldn't quite get her to focus on the refusal discussion. She had a heavy Italian accent and her command of English was weak. She clearly said she did not want to go, but when I advised her to go to the hospital (we are required to advise everyone to go if we are called), she then felt she had to go and became quite upset about what she was going to do with her dog, a small terrier she held in her arms as she walked about outside the restaurant in the light drizzling rain. She kept asking me about what would happen to her car and explaining the accident and who was at fault and did not seem to understand that my role was that of a paramedic and not the police officer who was busy trying to get a tow truck for her car and writing up the paperwork seizing her driver's license. I tried several times to get a proper refusal, but she really wasn't focused or competent enough to understand. Long story short, we waited with her in the rain for a hour until her nephew finally came and confirmed what I had thought all along -- that this was indeed the woman's norm.
Not the most exciting day, but not necessarily atypical. I do some pretty good calls in the town I work, but I doubt many of the average ones will qualify for Trauma's TV script. It has been a year now since I worked in the city. I've done a dozen cardiac arrests, but of them only a handful weren't asystoles who we worked for 20 minutes and then called on scene. No shootings or gory stabbings (There was a big drive-by shooting last week near the city line with three victims -- but it wasn't on my shift).
I do respond to quite a number of traumas and hardly a day goes by that I don't give someone morphine. But my traumas are not helicopter or spectacular multi car crashes. I see hip fractures, broken shoulders, wrists, ankles and back pain from low falls. People getting old and tripping, losing their balance, etc.
Aside from the finger degloving, I don't think I've gone lights and sirens to the hospital in over a month (and even at that there seemed no urgency at the hospital to sew the finger tip back on). Our rules on lights and sirens are pretty clear these days -- only use lights and sirens if in the time you save going lights and sirens the hospital will be able to do something for the patient to make a difference in life or limb that you cannot do yourself.
My trips in are make them comfortable, pop in an IV, put them on the monitor, and chat while I enter their information and my assessment into the computer, making sure to apologize for the bumps in the road.
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I plan a post this week about the "science" surrounding the Golden Hour and some new research about ambulance response times.
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postscript:
After writing the draft of this this morning, I took a nap (I'm allowed to sleep from 600AM until 800 AM), then was awoken by the tones and I immediately cursed myself because I knew by writing how I so rarely go lights and sirens, I would get payback for it. Sure enough, a man with advanced COPD and extreme anxiety and claustrophobia -- a terrible combination. I used or tried to use the following airway devices -- cannula, nonrebreather (neb mask, neb mouthpiece, ETCO2 cannula, neb mouth piece minus the duo neb (the albuterol was making him more anxious he said so I just went with humidified water), CPAP. Everything met resistance from him. He said he was a mouth breather so a cannula wouldn't work. He refused to have a mask over his face. Everything was too much or too little oxygen. I started with a combivent, gave some Solumedrol and ended up having to call for orders to give Ativan to calm him down and lower his 02 demand as he was going so worked up he was desatting. Halfway there, I had my partner put on the lights and sirens. The Ativan didn't kick in until the ED, but even then they had to give him more Ativan and were even considering intubation as I was leaving because the patient was still getting so worked up. A real EMS call, but not one likely to be written into a TV script.
