We get dispatched for a report of a man unresponsive in a locked car, covered with blood. Priority One.
My partner and I speculate as we head out lights and sirens toward the address in the neighboring town, a street lined with cheap hotels, where many marginal people rent by the week.
We both think it will be a murder victim, someone shot awhile ago and only now discovered. We both doubt the victim will be fresh.
A few minutes later we get an update. Slow down to a two. It is a suicide.
We slow down as we hit off the lights and sirens. This will be a simple presumption. Put the electrodes on, run off the asystole, call the time.
It takes us another six or seven minutes to get there.
The address is not a motel, but a restaurant parking lot.
There are a half dozen police cars at least. Yellow crime scene tape blocks off the parking lot. A photographer is taking photos by a car with an open door.
Something doesn't seem quite right. Given the location of the car. How did he go so long unnoticed? Maybe the car has tinted windows? Maybe people just aren't observant?
We have to drive up on the grass to get around the police tape. I get out, and take the monitor out of the side door. I approach the car. From the rear I can see a man slumped back in the seat.
Give us a minute to finish taking pictures, an officer says, holding up his hand. I am standing back. I am hearing some conversation, scattered bits about getting the names of patrons who were witnesses.
Did this just happen? I ask.
I don't get an answer, but I get a look.
I might have to work this guy, I say. If he's dead dead, I am not going to work him, but the state says if he's fresh, he "may" need to be worked. I give "may" a certain emphasis, as if "may" to the state means work him, but too me, it means maybe, just maybe there is some gray that I can find refuge in.
The cop says nothing.
I am still standing back. I'm looking around at all the cops, the cameras, the people in the restaurant.
I know what the state guidelines say -- they say you have to work someone in arrest unless they have rigor mortis with dependent lividity, incineration, decapitation, decomposition or body transection. We all used to think there was a line in there about "injury incompatible with life," but it isn't in there. The state knows there are problems with the guidelines, and the state medical committee is actively rewritting it. I know because I have been involved in working on the draft. I am hopeful we will get the line "injuries incompatible with life" put back in where it belongs.
The committee wants to require medics to call medical control to presume. I have been against this because what happens when the doctor tells you to work the person who you have not been working, who no one has been working because he is dead. I have been a big advocate of letting the medic use his judgement following a reasonable protocol. Dead is dead.
They finally let me have access. The man has a gun in his curled left hand. His head is back against the headrest. His mouth is closed. There is a hole in the back of his head -- not exactly what I would call gaping. He is pulseless and apneic. He is not cold.
Look there's some brain, my partner says.
There is some, but not what you would call chunks, more like flecks. Like a very minor case of brain dandruff.
I hook up the monitor and attach it. The officer is watching my eyes. I look back at him.
I think he is thinking don't you even think about working this guy.
I am thinking this strip better be flat line. The last thing I want to see is a rhythm, even a agonal one.
I can picture the scene, me yanking the body out of the car, all ten of the cops, going what the f... Spectators passing out. And all hell breaking loose.
The monitor shows flat line.
I run a long, long strip, then detach the monitor leads. I write my name down a piece of paper along with the date, time and my paramedic licence number. I give it to the investigating officer. I walk back to the truck.
A supervisor has arrived and I explain the situation -- how I feel somewhat jammed up, but I am willing to take responsibility for my decision. She thinks I should call medical control just to get it on record. What if he says I have to work it? I say. The guy is dead. He's not coming back. He's been dead for at least twenty minutes.
They won't make you work it, she says. You need to cover yourself.
I call, hoping I don't get a moonlighter. I explain the situation. We were slowed down, delayed access, bullet through head, brain matter, asystole.
I'm think this is going to be something now if all of a sudden I have to go back, and say sorry the doctor wants me to work him.
Fortunately, the doctor grants his concurrence with my decision, but from his tone it sounds like he is thinking "Why are you even bothering me with this?"
It all leaves me slightly uneasy.
***
Twice before I have been slowed down to a not breathing, told it would be a presumption, only to find the patient did not quite meet the standard. They were dead -- no doubt -- dead and not coming back, but not dead enough if you follow the protocol.
Picture the scene, officers offering the family condolences, the family calling relatives to tell them that granny has passed on. And the medics come in with their monitor only, then suddenly they go throw granny on the ground and start doing CPR and yelling for their gear.
And what does the family think after they've talked to the lawyer. The police did nothing. They slowed the ambulance down. Maybe granny would have lived.
And what would happen to the officers -- these guys who have my back, who save my butt when a psych wants to kick my ass, who help with lifts when my partners lack the neccessary strength, who put their backs on the line to save mine, guys I am friends with, guys who like me are trying to do the best they can for themselves and their loved ones. What happens to them if I start working the patient who we all know is dead?
The news is granny was dead.
Sometimes its a matter of interpretation.
I guess I have to fall on the side of doing the right thing for my own conscience.
Dead is Dead.
***
Later in the week I talk to police officer who runs a volunteer EMS service. I tell him about the call and ask for his perspective.
He is sympathetic to my decision making. The guy was dead, and had I worked him, I would have jammed up a lot of people, with no change in the result. We talk about how on one hand the state has protocols for EMS that suggest patients need to be worked regardless of fatal injury and on the other hand the average police department has no idea such protocols exist so they go on taping up obvious death scenes as crime scenes, and medics are slowed down on the way to presume bodies that may not quite meet the state standard. They wait outside the yellow tape while the photos are taken, then are given access to call the time. There was obviously no cross communication in the development of the EMS protocols.
***
(Another example is the state regulation that requires a police officer to ride in the back of the ambulance if the patient is handcuffed. The police departments all have policies that allow the officer to follow in their cruiser. Now the reason for the regulation is in case the person becomes suddenly ill, maybe stops breathing and needs to be unhandcuffed, what do you do if you don't have the handcuff keys readily available (i.e. in your immediate hands rather than in the car following)? Answer -- you are screwed. The patient is screwed.
Now sometimes the cop will ride in the back, but most of the time, they follow. You can be a hard head and insist that they ride in the back, but then that jams them up, they need to get another officer to the scene when they may already be holding police calls. Sometimes they'll just tell you no -- this is how its going to go down. I try not to argue with people wearing guns -- unless I think it is really important. They are just not aware of the regulation. I doubt they were consulted when the regulation was written.
What do you do? You may only be a few blocks from the hospital. Why be a stickler when the only reason you are going to the hospital is because the patient needs a few stitches? They are fully healthy and alert. Why be an obstructionist?
They will tell you one thing in a class, but then there is the reality of the street.
I try to use common sense on a case by case basis. Sometimes I ask the officer to ride in back if I think there might be a problem with the patient being cuffed. If I don't think there will be a problem, I go with the flow.
You need regulations, but you also need common sense.
I will note that I raised this issue at a regional MAC meeting many years ago -- just pointing out that it was a problem medics faced -- being asked to violate the regs in the due course of the daily job. A letter suppossedly went out to police departments for a third time, but nothing changed.)
***
Some would say the only way to do this job is to be black and white on everything. Others would say flexibility and common sense must rule. I am in the latter camp. Of course there is responsibility to be accepted whenever the issue is gray.
But I will accept that responsibility.
That's what being a paramedic is about.
In my opinion.
***
An interesting sidelight of our conversation is the officer mentions he has recently been on a call where he and other officers arrived to find a person in (nontraumatic)cardiac arrest -- not breathing, no pulse. They put on a defibrillator -- no shock advised -- they started CPR. A paramedic arrived. Put the patient on the monitor. The patient was asystole. The paramedic told them to stop CPR. She said she was calling the patient dead. The officer left, leaving another officer on scene. He later heard from the other officer that a second paramedic showed up, and after CPR had been interrupted for ten minutes, for some reason the second medic convinced the first medic that they needed to work the patient. So they ended up transporting the patient to the hospital, doing CPR -- all after a ten minute interruption(*see note below).
Now I wasn't there so maybe I have some of the facts wrong. It sounds like the first medic failed to follow the protocols that require you to do 20 minutes of ALS rescusitation on medical asystole patients before calling the patient dead. Did she not know the protocols? Was she lazy? Or were there other factors that I don't know about that led her to say stop? Maybe there was some rigor in the jaw? I have been on calls where the cops were doing CPR, but the patient had early riggor so I stopped. Dead is dead. But what happened when the second medic showed up? Why did they start working the patient again, and not just working for 20 minutes on scene and then presuming dead, but working and transporting? I guess you would have had to have been there.
What does it all mean? There are many decisions to be made. Everyone has their lines of demarcation. Some are inside mine. Some are outside.
I have argued against having medics have to call the physician to get permission to presume. I want to be able to decide for myself, but when I hear of people not working people who I would have worked, then I think maybe it is neccessary.
There are no doubt medics who might say I should have worked the guy in the car? Could they be right? I don't think so, but who am I then to judge someone else? Dead is dead. Or is it? There are people who are dead, who I will work only because there are too freshly dead for me to say they are dead even though I know they are dead. I don't like to walk a razor's edge.
Bottom line is the State Medical Committee is working on rewriting the state guidelines and not only do they need to be rewritten, but each medic needs to know what is in them and how much leeway they have in interpreting them. Good guidelines would allow common sense to prevail, and the best person to use common sense is the medic on scene who can take in all the information. But what if people don't have common sense? That is a whole other problem, and a very scary one.
***
A number of years ago there was a call in the city where a veteran paramedic had called a suicide gunshot to the head dead when a new medic showed up and insisted on working the patient, which caused quite a bit of friction and led to the hospital issueing a policy that stated all medics on scene must agree with the desicion to cease or not start resucitation. I loosely used that instance as a basis for the first chapter of a novel I have been writing. (Note: In real life the patient did not live.)
The chapter is excerpted here:
Mortal Men: Chapter One
Thursday, July 28, 2005
Here's to You!
A week or so ago I wrote an entry called "A Remarkably Heroic Feat." It was about a police officer credited for saving a baby's life by performing mouth to mouth on what appeared to be a child who had suffered a fairly typical febrile seizure, which may briefly convince a layperson that the patient is not breathing. The officer's actions were widely heralded in the paper, on TV and on the radio. The quote is from a police spokesman.
Here is a story of a truly "remarkably heroic feat."
***
While I was at the hospital last week, a medic from one of the volunteer towns brought in an asthmatic patient he had found in respiratory arrest.
He told me that when he arrived at the scene ahead of any of the first responders he was met at the door by a young child who said, "I think my mommy's dead."
He went in and found a young woman on the floor not breathing, her face purple, an inhaler in her hand.
He intubated her and did his paramedic deal. By the time he got her to the hospital, she was breathing on her own and fighting against the tube. A week later he is town in the parking lot of the local CVS when the woman's husband gets out of a car with her twoi kids, comes over and intoduces them to the paramadeic, who he says is the man who saved mommy's life. He tells the medic that his wife is being discharged from the hospital with no deficts -- a full recovery.
Now the heroism in this story is not so much the medic doing his job, but the back story of how he came to be there to do his job. The town, a small one, which for years relied on volunteers to respond from their homes, hired him a year or so back to upgrade their service. He called the meetings, did the paperwork, put together the proposals, schmoozed the right people, stayed persistent and as a result, brought in paramedics, increased funding, updated equipment, and basicly built a new service that responds quicker and provides upgraded care -- a service that was able to provid exceptional paramedic care when seconds truly mattered and that is what saved the young mother's life.
I have not been using names in these reports, but I will break that policy here. Steve Johnson -- here's to you!
Here is a story of a truly "remarkably heroic feat."
***
While I was at the hospital last week, a medic from one of the volunteer towns brought in an asthmatic patient he had found in respiratory arrest.
He told me that when he arrived at the scene ahead of any of the first responders he was met at the door by a young child who said, "I think my mommy's dead."
He went in and found a young woman on the floor not breathing, her face purple, an inhaler in her hand.
He intubated her and did his paramedic deal. By the time he got her to the hospital, she was breathing on her own and fighting against the tube. A week later he is town in the parking lot of the local CVS when the woman's husband gets out of a car with her twoi kids, comes over and intoduces them to the paramadeic, who he says is the man who saved mommy's life. He tells the medic that his wife is being discharged from the hospital with no deficts -- a full recovery.
Now the heroism in this story is not so much the medic doing his job, but the back story of how he came to be there to do his job. The town, a small one, which for years relied on volunteers to respond from their homes, hired him a year or so back to upgrade their service. He called the meetings, did the paperwork, put together the proposals, schmoozed the right people, stayed persistent and as a result, brought in paramedics, increased funding, updated equipment, and basicly built a new service that responds quicker and provides upgraded care -- a service that was able to provid exceptional paramedic care when seconds truly mattered and that is what saved the young mother's life.
I have not been using names in these reports, but I will break that policy here. Steve Johnson -- here's to you!
Thursday, July 21, 2005
EMS Powers of Observation
The following was adopted from a post I read on a poker bulletin board.
Thanks to Edward Hutchinson of Mississippi for his post.
I have adopted it to relate to EMS powers of observation.
***
Try this psychology experiment.
Go to this site: http://viscog.beckman.uiuc.edu/grafs/demos/15.html
Run the tape excerpt and try to count the number of times the basketball is passed.
That's it.
Just count the number of times the ball is passed.
DO THIS BEFORE READING FURTHER
Then to learn more about your results, come back here and scroll way down.
DON'T LOOK BELOW until you have counted the number of passes.
keep scrolling down......
Have you counted the number of passes?
OK, fine. Did you notice anything unusual while counting the passes?
If you didn't, then go back and watch the tape again. This time don't worry about counting anything, just watch.
Did you see it this time?
Scroll down further for the answer as to what you should now be seeing
You will see a gorilla walk into the covey of players, stop and beat his chest, and then walk off the scene.
Go back and replay the tape if necessary. The gorilla is certainly not hidden in any way.
Now the real question: Why do most people not see the gorilla?
Ponder this question the next time you are confronted with eye witness testimony of what occured at an EMS scene.
Thanks to Edward Hutchinson of Mississippi for his post.
I have adopted it to relate to EMS powers of observation.
***
Try this psychology experiment.
Go to this site: http://viscog.beckman.uiuc.edu/grafs/demos/15.html
Run the tape excerpt and try to count the number of times the basketball is passed.
That's it.
Just count the number of times the ball is passed.
DO THIS BEFORE READING FURTHER
Then to learn more about your results, come back here and scroll way down.
DON'T LOOK BELOW until you have counted the number of passes.
keep scrolling down......
Have you counted the number of passes?
OK, fine. Did you notice anything unusual while counting the passes?
If you didn't, then go back and watch the tape again. This time don't worry about counting anything, just watch.
Did you see it this time?
Scroll down further for the answer as to what you should now be seeing
You will see a gorilla walk into the covey of players, stop and beat his chest, and then walk off the scene.
Go back and replay the tape if necessary. The gorilla is certainly not hidden in any way.
Now the real question: Why do most people not see the gorilla?
Ponder this question the next time you are confronted with eye witness testimony of what occured at an EMS scene.
Wednesday, July 20, 2005
Ritual
I drove up to Boston, left my car at my friend's house, then took the train in to North Station, then took the T to Kenmore. Met my buddy at Boston Beerworks, and we drank several pitchers of beer while we got caught up.
We do this two or three times a year. We tell each other what's going on in our lives. Today after I've told him about my trip to the Dominican, and my job, and events in my personal life, he tells me a story about his father dying this past winter.
His father had Alzheimer's and he was his Dad's medical proxy. He gets a call saying his father is dying and he has to come right away. Its a snowy night and he tries to drive up the hill to get to the hospital, but his car keeps sliding down. He finally parks his car illegally, and walks up the hill through the blowing snow. He gets there and even though his Dad doesn't understand him, he tells his father all the things he's wanted to say, but has been unable to. He kisses him and tells him he loves him while he cries.
His Dad doesn't die. He hangs on. But my friend routinely gets calls, you have to come see your dad, he's really dying this time. He keeps hanging on. In the meantime, there is a nasty court case going on with his Dad's ex-wife, who basically stole millions from him while he had Alzheimer's, divorced him, and concocted a scheme to make it look like he had an affair so she could activate a bad boy clause in their prenup that would give her all his estate. A judge has ruled that she defrauded him, and is requiring her to pay back millions. She and her lawyer are stalling because if he dies before their appeal is heard, she gets to retain 1/6 of his estate. So his lawyer is telling my friend, he has to keep his Dad alive until the appeal is heard.
My friend gets a call from his father's doctor saying he needs an emergency trach -- right now --you have to decide. All these calls come at the worst times. He's in his car on his way to a criminal case -- he's a lawyer himself. He pulls over, talks to the doctor, then calls another doctor because he's required to get two opinions. One doctor is saying he needs it -- he's choking to death, the other is saying let him die. He decides to let him have it -- as a comfort measure. Then it turns out, he doesn't need it -- its just a nasal tumor that they remove and he is back breathing okay.
The calls continue to come. He is always pulling over to the side of the road to have to make these decisions. He calls his sisters and says, "I can't do this alone, you have to come see him, we have to decide together." His sister's come. His older sister walks in the room, sees their dad naked strapped down to the bed, with mitts on his hands because he is always scratching at himself, and makes the universal cut sign across the throat. "This ends now," she says. They put him in hospice. He looks very peaceful, and dies within the week.
My friend ends up having to pick up his ashes at the funeral home and they are in a paper bag. So here we are having beers before a Red Sox game like we do every year and have for the thirty or more years we have known each other, and he's telling me about how it feels to carry your father around in a paperbag. His father, just like mine, used to take him to Fenway Park ever year, as he now takes his own kids now.
Quite a story.
Around seven, we went over to the Park and took our seats. Right field box by the bullpen. The game started off well. Trot Nixon hit a three run homer into the bullpen right by us to give the Sox a 4-0 lead. But then things slowly unraveled. A bad throw by the third baseman, a poor scoop attempt by the first baseman. The slumping second baseman striking out again with runners in scoring position. A terrible reliever getting shallacked again. Then the final ending was brutal. Tied 6-6 in the ninth. The Red Sox brought in Curt Shilling, their injured ace, making his comeback as a reliever. Gary Sheffield, Yankee Villian #1, hits a double. Next A-Rod, Yankee Villian #2, parks it. 8-6. We got up and left.
There is a ritual to going to Fenway Park. I've been going for over forty years now. I find as I get older I enjoy the park less. It is overcrowded, the seats are uncomfortable. I resent paying $6 for a watered down beer. I don't like getting caught in the human traffic when the game ends.
Still rituals are important -- they tell us who we are, where we came from, where we are going. It was good to see my friend, even when the home teams gets beat so badly in the end. When the Red Sox win, I feel a little happier, when they lose I feel a little bluer. When they lose like they did, I feel beaten down. Still I tell myself, it's just a game. It doesn't mean anything really. It's just a game.
We do this two or three times a year. We tell each other what's going on in our lives. Today after I've told him about my trip to the Dominican, and my job, and events in my personal life, he tells me a story about his father dying this past winter.
His father had Alzheimer's and he was his Dad's medical proxy. He gets a call saying his father is dying and he has to come right away. Its a snowy night and he tries to drive up the hill to get to the hospital, but his car keeps sliding down. He finally parks his car illegally, and walks up the hill through the blowing snow. He gets there and even though his Dad doesn't understand him, he tells his father all the things he's wanted to say, but has been unable to. He kisses him and tells him he loves him while he cries.
His Dad doesn't die. He hangs on. But my friend routinely gets calls, you have to come see your dad, he's really dying this time. He keeps hanging on. In the meantime, there is a nasty court case going on with his Dad's ex-wife, who basically stole millions from him while he had Alzheimer's, divorced him, and concocted a scheme to make it look like he had an affair so she could activate a bad boy clause in their prenup that would give her all his estate. A judge has ruled that she defrauded him, and is requiring her to pay back millions. She and her lawyer are stalling because if he dies before their appeal is heard, she gets to retain 1/6 of his estate. So his lawyer is telling my friend, he has to keep his Dad alive until the appeal is heard.
My friend gets a call from his father's doctor saying he needs an emergency trach -- right now --you have to decide. All these calls come at the worst times. He's in his car on his way to a criminal case -- he's a lawyer himself. He pulls over, talks to the doctor, then calls another doctor because he's required to get two opinions. One doctor is saying he needs it -- he's choking to death, the other is saying let him die. He decides to let him have it -- as a comfort measure. Then it turns out, he doesn't need it -- its just a nasal tumor that they remove and he is back breathing okay.
The calls continue to come. He is always pulling over to the side of the road to have to make these decisions. He calls his sisters and says, "I can't do this alone, you have to come see him, we have to decide together." His sister's come. His older sister walks in the room, sees their dad naked strapped down to the bed, with mitts on his hands because he is always scratching at himself, and makes the universal cut sign across the throat. "This ends now," she says. They put him in hospice. He looks very peaceful, and dies within the week.
My friend ends up having to pick up his ashes at the funeral home and they are in a paper bag. So here we are having beers before a Red Sox game like we do every year and have for the thirty or more years we have known each other, and he's telling me about how it feels to carry your father around in a paperbag. His father, just like mine, used to take him to Fenway Park ever year, as he now takes his own kids now.
Quite a story.
Around seven, we went over to the Park and took our seats. Right field box by the bullpen. The game started off well. Trot Nixon hit a three run homer into the bullpen right by us to give the Sox a 4-0 lead. But then things slowly unraveled. A bad throw by the third baseman, a poor scoop attempt by the first baseman. The slumping second baseman striking out again with runners in scoring position. A terrible reliever getting shallacked again. Then the final ending was brutal. Tied 6-6 in the ninth. The Red Sox brought in Curt Shilling, their injured ace, making his comeback as a reliever. Gary Sheffield, Yankee Villian #1, hits a double. Next A-Rod, Yankee Villian #2, parks it. 8-6. We got up and left.
There is a ritual to going to Fenway Park. I've been going for over forty years now. I find as I get older I enjoy the park less. It is overcrowded, the seats are uncomfortable. I resent paying $6 for a watered down beer. I don't like getting caught in the human traffic when the game ends.
Still rituals are important -- they tell us who we are, where we came from, where we are going. It was good to see my friend, even when the home teams gets beat so badly in the end. When the Red Sox win, I feel a little happier, when they lose I feel a little bluer. When they lose like they did, I feel beaten down. Still I tell myself, it's just a game. It doesn't mean anything really. It's just a game.
Saturday, July 16, 2005
Remarkly Heroic Feat
It was on TV, on the radio and the following article in the paper:
Officer Praised In Saving Baby
City police officials are praising one of their North End beat officers, saying his quick actions saved a baby's life over the weekend.
Officer X, a year veteran of the Police Department, was on foot patrol about 9:30 p.m. Saturday in the 2600 block of Main Street when the child's grandmother approached X with the unconscious boy in her arms, police said.
X, who was training probationary Officer Y, performed CPR on the baby, who regained consciousness after about three minutes. The boy, reported Sunday to be 1 year old, was taken by ambulance to Medical Center, where he was treated and then released, police said.
"It was just a remarkably heroic feat by Officer X," Assistant Police Chief Z said Monday.
X was in a police-sponsored training course Monday and was not available for comment.
Information was not available about the medical condition that caused the child to lose consciousness, but police said he had a high fever, was not breathing and was turning blue at the time the grandmother found X.
***
Okay this happens about once a year. A police officer "saves" a baby not breathing. Gets a lot of PR, picture on the news, etc. In a couple days, they'll have a TV crew filming as the baby and officer reuinite in the thankful parent's home. Etc. Etc.
Of course anyone whith any medical training can see what really happened. The baby had a typical febrile seizure. Their eyes roll back, they can turn slightly blue and it can appear briefly that they are not breathing. Don't worry, if they don't seem like they are breathing, they will be breathing soon.
No baby who ever truly suffers respiratory or cardiac arrest is treated and released shortly after.
But its good PR. Happens all the time. There is never an article about EMS saving people. We get paid to do it. And of course we don't have publicists like police and fire do. A couple years ago the police had a similiar call. The ambulance wasn't there so they threw the not breathing kid in the back seat and drove like crazy to the hospital. Of course the kid was breathing by the time they got there. Maybe a little battered from being tossed all over the back. He too was released a few hours later. The department basked in their glory and ambulance bashed for a few days after that.
***
"Remarkably Heroic Feat" = Doing mouth to mouth on an inner city baby, then washing your mouth out with Vionex at the hospital worried that the baby gave you some kind of disease, which purportedly is what the hero was spotted doing at the hospital.
Give him credit for putting a baby's life over his fear of cooties.
Officer Praised In Saving Baby
City police officials are praising one of their North End beat officers, saying his quick actions saved a baby's life over the weekend.
Officer X, a year veteran of the Police Department, was on foot patrol about 9:30 p.m. Saturday in the 2600 block of Main Street when the child's grandmother approached X with the unconscious boy in her arms, police said.
X, who was training probationary Officer Y, performed CPR on the baby, who regained consciousness after about three minutes. The boy, reported Sunday to be 1 year old, was taken by ambulance to Medical Center, where he was treated and then released, police said.
"It was just a remarkably heroic feat by Officer X," Assistant Police Chief Z said Monday.
X was in a police-sponsored training course Monday and was not available for comment.
Information was not available about the medical condition that caused the child to lose consciousness, but police said he had a high fever, was not breathing and was turning blue at the time the grandmother found X.
***
Okay this happens about once a year. A police officer "saves" a baby not breathing. Gets a lot of PR, picture on the news, etc. In a couple days, they'll have a TV crew filming as the baby and officer reuinite in the thankful parent's home. Etc. Etc.
Of course anyone whith any medical training can see what really happened. The baby had a typical febrile seizure. Their eyes roll back, they can turn slightly blue and it can appear briefly that they are not breathing. Don't worry, if they don't seem like they are breathing, they will be breathing soon.
No baby who ever truly suffers respiratory or cardiac arrest is treated and released shortly after.
But its good PR. Happens all the time. There is never an article about EMS saving people. We get paid to do it. And of course we don't have publicists like police and fire do. A couple years ago the police had a similiar call. The ambulance wasn't there so they threw the not breathing kid in the back seat and drove like crazy to the hospital. Of course the kid was breathing by the time they got there. Maybe a little battered from being tossed all over the back. He too was released a few hours later. The department basked in their glory and ambulance bashed for a few days after that.
***
"Remarkably Heroic Feat" = Doing mouth to mouth on an inner city baby, then washing your mouth out with Vionex at the hospital worried that the baby gave you some kind of disease, which purportedly is what the hero was spotted doing at the hospital.
Give him credit for putting a baby's life over his fear of cooties.
Friday, July 15, 2005
Funeral Procession
15 month old not breathing. You rush out to the ambulance, buckle yourself in, and as you flip through your field guide to read the recommended ET tube size for the age and the epi dose, you wait for them to update you. Child is breathing. Child choked on some milk, but is alert and crying. Child had a seizure, but is now breathing. Nearly every time they call you back and tell you this. Like clockwork. After you hit the lights and sirens -- forty-five seconds, maybe sixty seconds later, you get the update -- It's okay. Take it easy. False alarm.
This morning, they update you with these words: "Starting rescue breathing. Continue code three."
A woman is screaming and two police officers are on all fours like giants over a doll. I have already told my partner to set up in the back of the ambulance, my plan is to snatch the kid, and do walking CPR out to the ambulance where we can work it.
I pick the baby up. It is cold, its skin white mottled in places with livitity, its limbs stiff. It feels just like a mannequin, except it is much smaller. The baby isn't fifteen months, it's fifteen days.
I ask the woman, when she last saw the baby moving, while I raise it's mouth to my lips, and press my fingers against it's chest. All I can hear from the woman is noise. I don't know what she is saying, but there is no answer for my question. I turn and begin the hurried CPR walk out to the rig, out of that too small house.
"The baby is dead," I tell the officers and my partner on our way out. I give it another breath. "We're going to the hospital, but the baby is gone."
In the back of the ambulance, I lay the baby on the half board and we put in an oral airway and bag the child while we do CPR. An officer drives. We go lights and sirens. I tell him to drive slower. Drive like you are in a funeral procession, I say.
I radio ahead. I say "15 month old found not breathing. I mean fifteen week old, no -- day old. It's got some rigor and livitity. Aystole. We're doing BLS CPR."
When I get to the hospital, I am expecting a quiet room with doctor and clock on the wall that he can look at and call the time, but they have heard baby not breathing and they have paged soome sort of code Blue. I have never seen so many faces standing around expectantly.
"The baby's dead," I say. I hold the baby up and show them the stiff legs and arms, the lividity.
The doctor understands now. He examines the baby briefly, then asks for the time. The word is passed to all the people crowding around trying to get into the small room. The baby is not workable. There are still questions asked. When was the baby last seen? What happened? What is the history?
I don't know. All I know is the baby was dead, and we had to get it out of the house. I couldn't just say. "Time of Presumption: 8:02. Here's my name, license number, date of birth, car number. You can call the ME now."
I suppose I could have called medical control on the way in and said the baby's dead, may I presume it here, call the time, shut down the sirens, pull a sheet over its head.
I don't mind calling the time on someone whose time has come, but for a baby, you sort of have to go through the steps. How can you ask a doctor to presume a 15 day old he hasn't seen? Isn't it better to say. We did what we could. I don't know. I may be callus, but I have a hard time calling the time on a fifteen day old. Let the family know we did what we could -- CPR, transportation to the hospital -- while at the same time not violating the corpse with IV and bone needles. But everyone has their own limits on what they feel they should do.
This is the third stiff baby I have brought to a hospital. The first one was ten years ago. When we got there the fire department was there. I remember them swearing at me with tears in their eyes, big grown men crying. "Where the fuck have you been? What took you so fucking long? The baby's fucking not breathing!" That child was ice cold. The other was a baby expected to die. The mother crying to the child, "No, no, not yet, I'm not ready yet. Don't go. Don't go!" We transported him, with the mother in the back, wailing in grief the whole way to the hospital. She wouldn't let go of the baby's cold hand.
Today I don't remember what the mother or grandmother or anyone else in the house looked like. I could see them in the supermarket later and not recognize them. The same with the other parents, I could sit next to them on a bus and talk for hours and have no idea who they were. I remember each of the babies though, exactly how they looked -- like cold lifeless dolls.
On my way out of the hospital, I hear the howls coming from the family room down the hall.
This morning, they update you with these words: "Starting rescue breathing. Continue code three."
A woman is screaming and two police officers are on all fours like giants over a doll. I have already told my partner to set up in the back of the ambulance, my plan is to snatch the kid, and do walking CPR out to the ambulance where we can work it.
I pick the baby up. It is cold, its skin white mottled in places with livitity, its limbs stiff. It feels just like a mannequin, except it is much smaller. The baby isn't fifteen months, it's fifteen days.
I ask the woman, when she last saw the baby moving, while I raise it's mouth to my lips, and press my fingers against it's chest. All I can hear from the woman is noise. I don't know what she is saying, but there is no answer for my question. I turn and begin the hurried CPR walk out to the rig, out of that too small house.
"The baby is dead," I tell the officers and my partner on our way out. I give it another breath. "We're going to the hospital, but the baby is gone."
In the back of the ambulance, I lay the baby on the half board and we put in an oral airway and bag the child while we do CPR. An officer drives. We go lights and sirens. I tell him to drive slower. Drive like you are in a funeral procession, I say.
I radio ahead. I say "15 month old found not breathing. I mean fifteen week old, no -- day old. It's got some rigor and livitity. Aystole. We're doing BLS CPR."
When I get to the hospital, I am expecting a quiet room with doctor and clock on the wall that he can look at and call the time, but they have heard baby not breathing and they have paged soome sort of code Blue. I have never seen so many faces standing around expectantly.
"The baby's dead," I say. I hold the baby up and show them the stiff legs and arms, the lividity.
The doctor understands now. He examines the baby briefly, then asks for the time. The word is passed to all the people crowding around trying to get into the small room. The baby is not workable. There are still questions asked. When was the baby last seen? What happened? What is the history?
I don't know. All I know is the baby was dead, and we had to get it out of the house. I couldn't just say. "Time of Presumption: 8:02. Here's my name, license number, date of birth, car number. You can call the ME now."
I suppose I could have called medical control on the way in and said the baby's dead, may I presume it here, call the time, shut down the sirens, pull a sheet over its head.
I don't mind calling the time on someone whose time has come, but for a baby, you sort of have to go through the steps. How can you ask a doctor to presume a 15 day old he hasn't seen? Isn't it better to say. We did what we could. I don't know. I may be callus, but I have a hard time calling the time on a fifteen day old. Let the family know we did what we could -- CPR, transportation to the hospital -- while at the same time not violating the corpse with IV and bone needles. But everyone has their own limits on what they feel they should do.
This is the third stiff baby I have brought to a hospital. The first one was ten years ago. When we got there the fire department was there. I remember them swearing at me with tears in their eyes, big grown men crying. "Where the fuck have you been? What took you so fucking long? The baby's fucking not breathing!" That child was ice cold. The other was a baby expected to die. The mother crying to the child, "No, no, not yet, I'm not ready yet. Don't go. Don't go!" We transported him, with the mother in the back, wailing in grief the whole way to the hospital. She wouldn't let go of the baby's cold hand.
Today I don't remember what the mother or grandmother or anyone else in the house looked like. I could see them in the supermarket later and not recognize them. The same with the other parents, I could sit next to them on a bus and talk for hours and have no idea who they were. I remember each of the babies though, exactly how they looked -- like cold lifeless dolls.
On my way out of the hospital, I hear the howls coming from the family room down the hall.
Saturday, July 09, 2005
Open Sesame
Most ER's require you to punch in a code to get in the ambulance entrance. The near universal code is 911*. Sometimes it's a little bit of a pain if you have a serious patient, and have to stop and fiddle with the keypad or if it is raining and the hospital doesn't have an overhang. At one of the hospitals they have recently set up a security station just inside the door where the guard has a button that enables him to automatically open the doors when he sees someone trying to come in.
I often stand outside the door and declare "Open Sesame!" when people approach. I have it timed so that as soon as I say it they are coming into view of the security guard inside who magically opens the door. Sometimes I clap my hands and say "Clap on, clap open, the clapper!" Others I simply say, "allow me to open the door for you," and I extend my arm to allow them to pass as the door opens.
My timing is perfect.
I kill myself sometimes with the simplest amusements. I am easily entertained.
Today I see this volunteer ambulance pull up and park across the street because they can't fit their big box rig in the already packed ER driveway. I'm guessing that the driver is new because he could have pulled up on the sidewalk instead of parking on the other side of the street. He and his partner take their very large patient out of the rig, and try to come up the steep end of the driveway. They can't push the patient up the hill, and for a moment I am worried they are going to flip the stretcher over. Someone closer than me comes to their aid, and helps them go around to the more level end. Next I see them coming around the ambulances in the drive.
"Can you get the door for me?" the guy lugging the front says. His shirt is drenched with sweat, and he looks quite frazzeled.
I am not standing in my usual spot. I gauge where he is, then say, "Just say 'Open Sesame!'"
"Hey I have a patient here!" he says angrily.
"Open Sesame!" I say again.
And the door opens just like that.
Two nurses on smoke break laugh at my funny, but the guy doesn't think its funny. In fact, he is so busy straining to pull the patient along that the joke is lost him. Maybe he thinks someone else opened the door and I was just being an unhelpful wise guy.
I feel really bad like I should go find him and apologize and explain the schtick. "I wasn't trying to be a smart ass," I imagine saying to him. "You see I say open sesame, the guard inside sees you, he opens the door, but it looks like I was the one who opened it by saying the magic words. You following me?"
Another crew comes along with their patient. "Aren't you going to clap open the door for us?" the paramedic says, stopping just short of the door.
"Oh, yes, but of course," I say, "Allow me."
I clapp my hands twice rapidly.
The door opens.
"You're the best," the medic says.
I often stand outside the door and declare "Open Sesame!" when people approach. I have it timed so that as soon as I say it they are coming into view of the security guard inside who magically opens the door. Sometimes I clap my hands and say "Clap on, clap open, the clapper!" Others I simply say, "allow me to open the door for you," and I extend my arm to allow them to pass as the door opens.
My timing is perfect.
I kill myself sometimes with the simplest amusements. I am easily entertained.
Today I see this volunteer ambulance pull up and park across the street because they can't fit their big box rig in the already packed ER driveway. I'm guessing that the driver is new because he could have pulled up on the sidewalk instead of parking on the other side of the street. He and his partner take their very large patient out of the rig, and try to come up the steep end of the driveway. They can't push the patient up the hill, and for a moment I am worried they are going to flip the stretcher over. Someone closer than me comes to their aid, and helps them go around to the more level end. Next I see them coming around the ambulances in the drive.
"Can you get the door for me?" the guy lugging the front says. His shirt is drenched with sweat, and he looks quite frazzeled.
I am not standing in my usual spot. I gauge where he is, then say, "Just say 'Open Sesame!'"
"Hey I have a patient here!" he says angrily.
"Open Sesame!" I say again.
And the door opens just like that.
Two nurses on smoke break laugh at my funny, but the guy doesn't think its funny. In fact, he is so busy straining to pull the patient along that the joke is lost him. Maybe he thinks someone else opened the door and I was just being an unhelpful wise guy.
I feel really bad like I should go find him and apologize and explain the schtick. "I wasn't trying to be a smart ass," I imagine saying to him. "You see I say open sesame, the guard inside sees you, he opens the door, but it looks like I was the one who opened it by saying the magic words. You following me?"
Another crew comes along with their patient. "Aren't you going to clap open the door for us?" the paramedic says, stopping just short of the door.
"Oh, yes, but of course," I say, "Allow me."
I clapp my hands twice rapidly.
The door opens.
"You're the best," the medic says.
Sunday, July 03, 2005
Hurt
Lady had a syncopal episode on the toilet, hit her head and sustained a lac above her eye. She crawled to the phone and called her neighbor, who came over and helped her call her doctor, who said she should go to the hospital.
She checks out okay. Vitals are good, skin warm and dry, no deformities, just the lac above her eyebrow. Is she in pain? Yes. Anywhere you touch her body. Her response is disporportionate to the light touch. She whines and moans. "I don't feel well. I don't feel well." "I hurt all over. I hurt all over." "My face hurts." "My feet hurt." "My legs hurt." Her words are interrupted only by fits of crying.
"Mary come with me! Mary come with me!" she cries to her neighbor, who shakes her head at me as she leaves and closes her own apartment door.
All the way to the hospital, we hear it. She hurts. She hurts. The blood pressure cuff hurts. The torniquet hurts, the Iv hurts. "Ow! The bumps! The bumps! Why don't they fix the road! I don't feel well. I hurt!"
She is eighty-eight years old.
"I don't feel well. I don't feel well."
I try to imagine her as a child, as a teenager, as a young woman. As a mother, a grandmother.
I can't.
I try to imagine how her life left her like this -- living alone in a small apartment with her walker, and a neighbor, who helps her because that's what neighbors do, but who wants no more part of her than that.
I am unable to do so.
"I don't feel well," she says again and again.
Tell me how you really feel, I want to say.
I hurt, she says. I hurt.
She checks out okay. Vitals are good, skin warm and dry, no deformities, just the lac above her eyebrow. Is she in pain? Yes. Anywhere you touch her body. Her response is disporportionate to the light touch. She whines and moans. "I don't feel well. I don't feel well." "I hurt all over. I hurt all over." "My face hurts." "My feet hurt." "My legs hurt." Her words are interrupted only by fits of crying.
"Mary come with me! Mary come with me!" she cries to her neighbor, who shakes her head at me as she leaves and closes her own apartment door.
All the way to the hospital, we hear it. She hurts. She hurts. The blood pressure cuff hurts. The torniquet hurts, the Iv hurts. "Ow! The bumps! The bumps! Why don't they fix the road! I don't feel well. I hurt!"
She is eighty-eight years old.
"I don't feel well. I don't feel well."
I try to imagine her as a child, as a teenager, as a young woman. As a mother, a grandmother.
I can't.
I try to imagine how her life left her like this -- living alone in a small apartment with her walker, and a neighbor, who helps her because that's what neighbors do, but who wants no more part of her than that.
I am unable to do so.
"I don't feel well," she says again and again.
Tell me how you really feel, I want to say.
I hurt, she says. I hurt.
Saturday, July 02, 2005
Paramedic As Sly Hero
Looking over my last two posts, it occured to me that they share a similar bent. They are both in the paramedic as sly hero genre, where the villians are an uppity flight medic and a nasty triage nurse.
Now for a disclaimer I think flight medics are great and I respect their training and education and experience whether it is more or less than mine. The same with the triage nurses, most of whom I think are great.
I bring this all up because I was reminded of a great book I read called Talking Trauma: Paramedics and Their Stories by a guy named Timothy R. Tangherlini, who is a sociologist. His book is a collection of tales told by paramedics, and an anaylsis of what the tales mean from an anthropological social perspective. I thought it was fascinating reading.
The paramedic as sly hero is a very common form of paramedic tale. I will have to find my copy of the book to review what he writes about it. I think the bottom line is that paramedics use these tales as sort of a rebellion against the medical caste system where they are often considered to be lesser people than the caste of the villian. The tales serve to validate the paramedic's self worth.
Interesting.
Now for a disclaimer I think flight medics are great and I respect their training and education and experience whether it is more or less than mine. The same with the triage nurses, most of whom I think are great.
I bring this all up because I was reminded of a great book I read called Talking Trauma: Paramedics and Their Stories by a guy named Timothy R. Tangherlini, who is a sociologist. His book is a collection of tales told by paramedics, and an anaylsis of what the tales mean from an anthropological social perspective. I thought it was fascinating reading.
The paramedic as sly hero is a very common form of paramedic tale. I will have to find my copy of the book to review what he writes about it. I think the bottom line is that paramedics use these tales as sort of a rebellion against the medical caste system where they are often considered to be lesser people than the caste of the villian. The tales serve to validate the paramedic's self worth.
Interesting.
Left Lateral Femoral Condoyle
We are sent on a priority one for severe pain at a nursing home. The home is in the southern end of one of our satellite towns -- not a facility where we routinely respond. It is pouring rain and we race up the driveway and park under the awning. As we are pulling our stretcher a woman comes out and says, "The ambulance entrance is around back."
"I'm sorry," I say. "We don't come up here much. Was there a sign?"
"Yes," she points down the hill. It's raining too hard to see anything.
"Didn't see it. Sorry."
We reload our stretcher and drive down the hill, and then up the back way. We find the ambulance entrance, but there is no awning. Fortunately, it isn't raining quite as hard as it was just moments before, so we quickly pull the stretcher and race in.
A nurse looks at us as we come through the door. "Who are you here for?"
"We don't know. Someone with severe pain. We were sent lights and sirens."
"Oh, yes, this way." She leads us down the hall, giving me the report as we go. The nurse is Indian, and speaks in a rapid syncopated accent. "This patient fell this morning being assisted to the bathroom. We did an x-ray that shows a fractured left lateral femoral condoyle."
I admit it takes me a moment to figure out what she is talking about. It is partially the accent, but it is partially that I am used to people giving the plain English version, saying she broke her leg. The left lateral femoral condoyle, of course, is much more accurate and professional. In plain English the break is to the left femur where it fits with the patella -- the knee. The woman, as expected, has swelling and pain just above the knee. She is in a fair amount of pain. They have given her tylenol only. I would like to give her some morphine, but she is allergic to it. We put a pillow under the the leg for comfort, and then put a sheet up around her head like a pullover hood to protect her from the rain. She now looks somewhat like Mother Teresa.
So we go to the hospital -- again not one we routinely transport too. When we arrive, the triage nurse is being very sarcastic to a patient who is using her telephone. "You need to get off the phone, get off right now. Off, off off. I need to use the phone. You're supposed to be dizzy, you need to lay back down." She looks at me and says, "and what do you have?"
Before I can even answer, she is talking to another nurse, and making a comment about someone being a bitch.
I wait for her to look back at me. "And..." She looks at me expectantly. "You have?"
I try to keep my answer short and sweet to start because it seems she just wants to know the down and dirty while she digs among a stack of papers for a triage report form. "A fractured leg," I say.
"And how do we know that?" She says it rather rudely, in such away like who am I to say she has a fractured leg because I am just an ambulance person. I can suspect a fracture, but I can't say a fracture.
"An x-ray."
"How do you have an x-ray?"
"They took one already, read it, and determined she had a fracture."
"And what time did this all happen?"
"This morning. She was being walked to the bathroom and she tripped and fell."
"And it's four o'clock now." I am not certain whether her sarcasm is directed at me, at the patient or life in general, but the sarcasm is so thick, I can't resist toying with her.
"Is there something unusual here?"
"Well, yeah. She fell this morning. Let's say she fell at 11:59. Okay? Its now four o'clock."
"And that's unusual?"
"Yes. Why didn't she come when she fell?"
"She's from a nursing home."
"So?"
I am tempted to say, "Is this your first day as a triage nurse?"
Normally, the fall occurs several days before and they don't get an xray for a day or two and don't get it read for another day, and don't transport till the day after that when the patient's leg is massively swollen and bruised, and the patient is crying in pain. "They move slowly sometimes," I say.
"And where is the fracture?" she asks.
I take delight in the answer. "Left lateral femoral condoyle."
She looks at me blankly.
I point to the spot just above her knee. "Right there," I say.
"I'm sorry," I say. "We don't come up here much. Was there a sign?"
"Yes," she points down the hill. It's raining too hard to see anything.
"Didn't see it. Sorry."
We reload our stretcher and drive down the hill, and then up the back way. We find the ambulance entrance, but there is no awning. Fortunately, it isn't raining quite as hard as it was just moments before, so we quickly pull the stretcher and race in.
A nurse looks at us as we come through the door. "Who are you here for?"
"We don't know. Someone with severe pain. We were sent lights and sirens."
"Oh, yes, this way." She leads us down the hall, giving me the report as we go. The nurse is Indian, and speaks in a rapid syncopated accent. "This patient fell this morning being assisted to the bathroom. We did an x-ray that shows a fractured left lateral femoral condoyle."
I admit it takes me a moment to figure out what she is talking about. It is partially the accent, but it is partially that I am used to people giving the plain English version, saying she broke her leg. The left lateral femoral condoyle, of course, is much more accurate and professional. In plain English the break is to the left femur where it fits with the patella -- the knee. The woman, as expected, has swelling and pain just above the knee. She is in a fair amount of pain. They have given her tylenol only. I would like to give her some morphine, but she is allergic to it. We put a pillow under the the leg for comfort, and then put a sheet up around her head like a pullover hood to protect her from the rain. She now looks somewhat like Mother Teresa.
So we go to the hospital -- again not one we routinely transport too. When we arrive, the triage nurse is being very sarcastic to a patient who is using her telephone. "You need to get off the phone, get off right now. Off, off off. I need to use the phone. You're supposed to be dizzy, you need to lay back down." She looks at me and says, "and what do you have?"
Before I can even answer, she is talking to another nurse, and making a comment about someone being a bitch.
I wait for her to look back at me. "And..." She looks at me expectantly. "You have?"
I try to keep my answer short and sweet to start because it seems she just wants to know the down and dirty while she digs among a stack of papers for a triage report form. "A fractured leg," I say.
"And how do we know that?" She says it rather rudely, in such away like who am I to say she has a fractured leg because I am just an ambulance person. I can suspect a fracture, but I can't say a fracture.
"An x-ray."
"How do you have an x-ray?"
"They took one already, read it, and determined she had a fracture."
"And what time did this all happen?"
"This morning. She was being walked to the bathroom and she tripped and fell."
"And it's four o'clock now." I am not certain whether her sarcasm is directed at me, at the patient or life in general, but the sarcasm is so thick, I can't resist toying with her.
"Is there something unusual here?"
"Well, yeah. She fell this morning. Let's say she fell at 11:59. Okay? Its now four o'clock."
"And that's unusual?"
"Yes. Why didn't she come when she fell?"
"She's from a nursing home."
"So?"
I am tempted to say, "Is this your first day as a triage nurse?"
Normally, the fall occurs several days before and they don't get an xray for a day or two and don't get it read for another day, and don't transport till the day after that when the patient's leg is massively swollen and bruised, and the patient is crying in pain. "They move slowly sometimes," I say.
"And where is the fracture?" she asks.
I take delight in the answer. "Left lateral femoral condoyle."
She looks at me blankly.
I point to the spot just above her knee. "Right there," I say.
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