Most of the reading I do is of an educational nature, to increase my knowledge in the medical or sea kayaking fields, or the teaching of same.  Rarely do I read for the pure joy of reading, time just doesn’t permit me to do that.  Having disclosed that, I had been looking for something in my den the other evening, something I still haven’t found but if you saw my den you’d immediately know why (but I digress).  As I worked my way to the bottom of a pile of files and “important” papers, I found a book that I’d gotten a couple of years ago from my wife (not sure if it was for birthday, Christmas, or just because).  Hmmmm . . . I was about finished with the current edition of Ocean Paddler, and was tired of reading The Merck Manual of Patient Symptoms, and re-reading The Outward Bound Wilderness First-Aid Handbook.  Standing there for a moment I opened the freshly uncovered book, which the spine looked like I had never opened it before, and I just randomly opened it and read a quick story, and I laughed out loud.  I realized that what I had just read was what I’ve been living for the past few years as an urban emergency medical technician (EMT).  Perhaps even more ironic, the previous evening I’d had a conversation at the station between calls talking to others about EMS in the urban jungle and how it wasn’t much different in any large urban city.

Amazon dot com has the book, as well as the newer one (More Blood, More Sweat, and Another Cup of Tea).   Either, or both, would be a good gift for anyone working in EMS.  What I like is that there’s no plot to follow.  You have two minutes—pick it up and read a short post.  Got an hour, pick it up and read several posts. Start in the middle, at the end, at the beginning, it doesn’t matter!  One reviewer called it “a great toilet book”.  Well that pretty much sums it up, it is indeed a great toilet book!

One passage:  “There is something deeply disturbing about walking on a sticky carpet—especially when the flat (apartment) is in a compete mess and the punter (patient) has called an ambulance four times in the last 2 days for a pain in the chest that has lasted 2 years. . . note that the pain hasn’t changed in any way, it’s not worse, or moved around the body, he has no other symptoms . . . It also doesn’t help when the patient smells so bad that I want to leap out the side window.”  Now I ask my colleagues in EMS, who amongst us can’t relate to this?  If you can’t then you’ve only been working the streets for a few hours, just wait until the next run.

You can keep current with the author of these books by reading his blog at http://randomreality.blogware.com/

Posted: December 10th, 2010 under Emergency Medicine, Reviews (books, Uncategorized.
Comments: none

Flat line, a bad thing!

It had been one of the busiest shifts that we had worked in awhile, maybe ever, for my partner and me. First emergency call came to us within about 2 minutes of our shift starting, didn’t even have time to give the squad our usual thorough check over. . . just the basics: green bag, blue bag, OB kit, AED, oxygen, check, roll!

Four hours later we finally get a chance to get fuel. Just as we are thinking about the shift coming to an end, at least the end is only two hours away, which means maybe one more call, our squad phone rings and dispatch asks if we are clear of fueling yet. “Just clear”, I respond. “Ok, got a 10-17 with fire coming to your screen.” The screen starts squawking with “emergency pending, emergency pending” being announced. As I hit the enroute button which silences the announcement and sends a signal to dispatch that we are rolling, I read the address out lout to my partner. She hits the lights and the siren and begins to maneuver the squad through the city streets, we’re 4 to 5 minutes away. The nature of call is “unresponsive”. As we approach the intersection from the north where we need to turn to the address given, we see the responding engine coming from the south. As in kayaking, the gross tonnage rule applies and we yield to them. As we turn the corner we see a group of people mid-block on the left, one of them is doing CPR on someone lying in the easement between the street and the sidewalk.

As we roll to a stop, the firefighters are jumping out, and we are doing likewise. There are now six trained professionals on-scene and the by-stander steps back. Without saying more than one or two words between the six of us, one firefighter readies the AED, which will also analyze the cardiac rhythm and deliver shocks as appropriate. My partner kneels at the head and carefully straightens out the neck to get a patent airway. I check for a pulse as another firefighter is checking for responsiveness. Non-responsive, no pulse and not breathing. We know what needs to be done and as if we had worked together as a team for ever, we set about the task of trying to save a life. As one firefighter readies the airway materials; I cut-off the person’s shirts so the AED can be attached. There are no visible signs of trauma. Chest compressions begin. AED is attached. Not a shockable rhythm, continue chest compressions. A paramedic rig arrives, along with several police cars. We lift the lifeless body onto the cot and place it in the back of the med rig. An IV line is started to get medications on board, they could make a difference. The patient is intubated and connected to a bag-valve mask that will force oxygen into the lungs, it’s all about getting oxygenated blood to the brain.

More police arrive and are canvassing the area. What happened to this guy? The medications work and bring the heart into what is analyzed to be a shockable rhythm, shock delivered. No change. Continue chest compressions. The firefighters take turns doing compressions, the effectiveness of compressions decrease as fatigue sets in, and doing chest compressions is hard work! At this point there’s not much for my partner and I to do. If we weren’t blocked in by all the other responders we could leave. I’m glad we can’t. Not only am I an EMT, but I also teach CPR, a real life experience to use in my teachings!

We answer a couple of questions the police have for us. I tidy up the equipment still on the ground where we started. As the patient (aka “code”) is worked, several police officers, along with my partner and I, stand at the back of the ambulance looking in at the lifeless body on the cot. Another shock is delivered by the AED, still nothing.

After about 50 minutes, and following their protocol, the paramedics determine that further efforts would not convert him. Compressions are stopped, the breathing via the BVM is stopped, the monitor turned off, and the body covered with a couple of sheets. A police officer with a mobile ID gadget takes a couple of finger prints and within a couple of minutes has a positive ID from the marvels of cyberspace.

In this case we know what the outcome is, which we often don’t. We still wonder why? What happened? What took the life of this 25 year old? We have a theory, but we will most likely never know for sure.

I’ve been called to the scene where someone was discovered a few days after dying, and I’ve had patients who were pretty close to death, this was the first “fresh” PNB (pulseless not breathing) for me. And, it was a good team effort between all the EMS on scene! Unfortunately this teachable moment doesn’t have a positive outcome, never-the-less it is a valuable experience.

Oh what a night!

Posted: April 24th, 2009 under Emergency Medicine, Uncategorized.
Comments: 3