BORN AGAIN (Paramedic) - Re-Baptism By FIRE

I have actually found some much needed peace during my sabbatical over the last few months. Translation: By accepting a short lived job at Slacker EMS, running hand-me-down totes and nursing home sniffles, I shrugged off my shit-magnetism.... for a while.

I have done nothing but sing the praises about the new job with Grady Jr. EMS, the wonderful work conditions, nice trucks and equipment, friendly and caring staff and management, etcetera. I found my first few shifts after being released were being jammed into holes in the schedule until my permanent position officially opened on Jan 4. Nothing unusual for EMS really. I was slotted to work with the Fulton/Dekalb division based just outside of downtown Atlanta for my first few shifts. This division handles all the hospital contracts for Emory Healthcare (Emory University Hospital, Emory Crawford Long, and all the Emory Geriatric facilities around the university campus), Dekalb's main hospital, Dekalb's Hillindale campus, and Atlanta Medical Center (the OTHER trauma center in Atlanta). A good portion of their day is filled with discharges off the floors and from the ERs, going to the Emory Geriatric facilities, local nursing homes, or hospice centers. Then there are the "other" runs.

Of the numerous ambulances based here, there are two types of units. Double EMT units which do non-emergent stable patient discharges, and Paramedic led Advanced Life Support units which are available for Critical Care transfers and also handle NET transfers of vent patients. Stab ONE with the HOT BRANDING IRON. Guess which units I worked! Critical Care.

Mind you, I am not afraid of a good challenge. But over the years, Critical Care for me has been yanking up a 911 patient who is in some dire emergency and hauling ass to an ER with no transfer time longer than 15 minutes tops, throwing on appropriate oxygen delivery, starting IV's, dosing first-line medication boluses, and all in all having them in a considerably better shape than which they presented themselves to begin with.

Oh no, not that easy. Not too far into my first shift, we were called to transfer a vent patient from one ER that NEVER NEVER NEVER has Neurology services, over to Emory University. Subject one was a middle aged male who blew the big one and had a head bleed. He was unresponsive when 911 arrived, obviously stroked out (uh did a history of un-managed hypertension tell the dumb-shit medics anything?), and had to be intubated. Said ER had patient on a vent, slathered with Nitro Paste to "control" his hypertensive crisis blood pressure of 250+, IV's in place, and here we were taking him to the ER he should have went to in the beginning.

GAWD I HATE DUMBASS MEDICS WHO DON'T ADVOCATE FOR THEIR PATIENT BY INSISTING ON THE MOST APPROPRIATE DESTINATION FOR THE SITUATION!!!!! ARGHHH!

I've never operated a portable ventilator system, so the supervisor had to meet us at this ER and ride in with me. This poor patient was in a world of shit, and bless his heart, didn't know how bad he had it. Didn't really get much of an instruction or in-service on the vent, but I did learn just how involved these Critical Care calls really are, and boy did I quickly develop respect for CCEMTP's!!! Every day on that unit yielded a vent patient. So I am waiting anxiously for the next vent class. I am sure the supervisors are too. :-)

Then comes my first day on a 911 truck in Cobb county. Mind you this is not my regular schedule yet, but a taste of what is to come, and a chance to see my territory in daylight to learn my way around a bit. Our first run was not too bad. A 5 year old at the local ER with Appendicitis. Again... shoulda went to the Children's Hospital to begin with. But alas, if it weren't for dumb-shits (medics and regular citizens), we would not have job security. As we returned to the county, we settled into our posting area. It didn't take but maybe 30 minutes before the phones lit up and calls were going out everywhere. And then ours. CARDIAC ARREST. --Freaking Great! Did I mention that I was riding with Timid EMT today?

Allow me to explain why most medics I know detest Cardiac Arrests. Statistically speaking, say we respond to 100 arrest patients. Of those, maybe 10 are even good candidates for resuscitation efforts. Most are elderly, frail, multiple illness or end stage illness kinda patients. For the handful that remain, patients who might have been viable are denied a good chance of survival because of the lack of good bystander CPR.... or the FIRE DEPARTMENT GETS THEM FIRST. Do we do it anyway? Sure. Practice is never a bad thing. One day it WILL count!

Viability aside, cardiac arrests are MESSY. MESSY AS HELL. Intubation usually yields vomitus and/or suctioning. You start IV's and push drugs. Wrappers and boxes are strewn from one end of the bus to the other. In the chaos you drop needles and sharps and have to rummage through said garbage to find those - BEFORE you clean or touch anything. Once the truck is clean again, here comes the restocking: ET tubes, stylettes, blades, handle, combi-tube, BVM, tube holder, suction canister, suction tubing, Yaunkeurs tip or soft cath suction, backboard and straps, c-collars. Drugs, drugs, drugs. Signatures for this and that, and inventory before you can seal the box and send it off to be restocked and get a new one.

So I was already cringing at the thought of my first bonafide 911 call at the new job being a cardiac arrest. We arrive just behind the rescue and engine. Please call a DOA, please call a DOA. I headed for the door of this beautiful half million dollar home, just to be waved off by the fireman. Wait. Was this backwards? Hey, I'm usually the one waving off the fireman. Just to be sure the squirrels have all their nuts in a stack, I go on in and discovered a bloody mess. Literally. The deceased was an elderly patient, terminal metastatic throat cancer, who had ruptured some major vasculature, and whilst seeking out someone for help in their final moments, had blown a fountain of blood through their trach / stoma across the entire lower floor of this gorgeous home before collapsing in a pool of blood in the den. Wow. Impressive.

In trying to calm the deceased's frantic panicked daughter, in trots Timid EMT telling me that we have another call to go to, that the fire department is handling this one. Off we go to an insurance seminar on the freeway. We arrive to find the fire department appropriately obtaining signatures for refusals. Sweet! Back to post we go. I settle down with my lunch box and savor my turkey sandwich, chips, pudding cup, and mandarin oranges in their entirety. I actually managed to consume a full meal? Just the quiet before the storm. Always.

The next call out... CARDIAC ARREST! You gotta be shittin me! Sure enough. Smack in the middle of an industrial area, a warehouse that has been converted into a large equipment and diesel repair garage. We slide across 20 yards of parking area, six inches deep in mud, to find rescue pumping away on this poor mechanic who is as blue as a smurf's nutsack. I turn to the buddies who called and asked how long ago he'd collapsed. Their reply: "Been about 45 minutes or more. We thought he was jokin at first, but when we couldn't get him back up we realized he needed CPR"

God bless their hearts. They'd been doing bystander CPR for nearly an hour. I looked at the firemen and told them to continue BLS / CPR until I could get med control on the phone to terminate the code. Nope. They refused. While on hold for the doc, they started a line and pushed EPI. HE'S BLUE FOR GOD'S SAKE!!! WILL YOU STOP THAT SILLY SHIT!!! Damn Rescue Randy's!!! "Atropine's down" WHAT? Oh nevermind. We worked the code.

An onscene time of 15+ minutes to get this guy boarded and carried over engine blocks and grease buckets, and across the U of A football field to the truck. By the Grace of Gawd the bystander CPR prevented his blood from coagulating and the bastards actually had a patent flowing line of saline. So I felt there was no need to make the pumperheads look bad by intubating with an ET tube... they already missed two. I dropped a combi-tube and bagged em all the way to the ER. Fire continued the asystole protocol (go figure on that rhythm) dropped drugs, defibrillated whatever electricity those drugs stirred up, and pumped their till their hearts were content. Exactly 1.3 minutes after arrival, the ER attending called the code, and ole boy was DRT. Dead Right Thare - Just like he was before the Fire Department tried to yank him back from the light.

While wrestling with this nightmare of documentation on these new fangled ToughBook Laptop PC's METRO uses, an OD went out a couple of miles down the road. The responding unit was going to pass the ER to get there, so I told Timid EMT to take the call. Off we went to snatch another poor soul from the grip of death.

As I confirmed the address in my handy lil GPS (named Emily), we arrived at a cemetery. You gotta be kiddin me! Nope! Graveside services in progress, pops stopped breathing. We found our patient to be a rather large man in a wheelchair, HUGELY swollen legs full of edema and probably a nifty case of incurable cellulitis. The very handsome son, in his Marine Corps Class A's, tells me that his dad has OD'd a few times now, taking his pain meds for those really painful legs, and being in an altered state from the narcs forgets his prior dose of meds and takes more, until... BAM. RESPIRATORY ARREST. Imagine that!

Sure enough. Pops wasn't breathing. The firemen started ventilating the patient with a BVM, and somehow (dunno how) his gag reflex was still intact and he nearly choked up the oral airway. No intubation for you buddy. I grabbed IV supplies and immediately popped a line in him and looked up at Timid EMT and said. Get me some Narcan. Timid EMT shat himself. NARCAN PLEASE!!! Off he strolls to the drug box, and returns with 2mg of prefilled Narcan. Nice slow IV push. Don't want an ass beatin today. Wait. Wait. Wait. Wait. No response. Next thought is massive stroke. Just as I tell the firemen to gather pops up and we lay hands on him to hurl him from wheelchair to stretcher, he suddenly draws in the deep raspy breath and looks me square in the eye and said, "what in the hell are you doin to me?" Oh, goodie. I was dreading lifting your 300 lb swollen ass outta that wheelchair.

"Sir, can you please help us get you on the stretcher?"
"Why?"
"Cuz you took too many of your pain pills and you need to see the doctor"
"No I didn't"
"I think you did"
"No, the hell I didn't"

This exchange could have gone on forever, but Handsome Marine (potential BabyDaddy?) intervened and for a couple of minutes there was a Jerry Springer-esque exchange of cursing and threats. Finally pops gave in and agreed to go. We loaded him into the truck and started back to the ER we had left only minutes ago. He suddenly became less responsive, and within seconds... bad news... respiratory arrest again. As I go for the second round of Narcan, I am being a good girl and call in on the radio with report, asking nicely for the second dose (which he was gonna get anyway). Somewhere in the broken and static filled message I heard *intubate* and *support respirations* What part of intact gag reflex did you not hear? Oh well. Second round of Narcan in.

Pops awoke and started breathing again as we rolled through the sliding doors of the ER and into the trauma/critical care/oil change bay. "Won't give orders for nothing" Attending MD spouts off with "guess he didn't need more narcan or intubating after all." Um yeah... whatever. Sign here please.

Needless to say the rest of my shift was filled with restocking and cleaning, chain smoking, and grunting at the Toughbook and documentation software.

Thus far, I have had a middle aged guy with sudden onset dizziness and visual disturbance. Plood Pressure? 260/140. HE went to a neuro capable ER, just in case the radiator hose blew.

Then there was the overturned mazda truck that was being operated by a less than capable intoxicated driver at 1am. He struck the concrete abutment of a bridge at about 50 mpg, flipped along the two lane bridge several times, rupturing a 4 inch water main, and coming to rest on a gas main. He was unconscious per residents who heard the crash and ran out to see the spectacle, but regained consciousness before rescue got there. He self extricated and sat down next to that gas main the truck was resting on. Rescue was staring at him we arrived. No collar, no board. Sitting on gas main. BRILLIANT! We rapidly placed him in a collar and on a board. When I cut his clothes off in the truck I found a tattooed and distended upper belly, rigid over the liver. EVEN BETTER. Emergency to Atlanta Medical Center Please!!!

Last night's emergency was a 40 year old junky with very symptomatic chest pain, hypertensive at 190/100, history of CABG, AICD, CHF, and NO IV ACCESS. O2, 324mg of aspirin, nitro sprays, 12-lead, and DIESEL!

BAPTISM BY FIRE. Thanks Hunny. My SHIT-MAGNETISM is in full swing again.

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