29 April 2004
"Just Under the Wire"
Have you ever been to a casino? In a hotel adjacent to the facilties, they normally hand out brochures of the games that are played explaining the basic concept of the game, how to properly wager a bet, and most importantly, your odds on winning. Depending on how well you know the game and do your homework, you can manipulate the house into tens of dollars or more, or you can end up with less money than you walked in with.
Today, we will play a similar game. The "Will they get a call game?" It is quite simple actually (getting your hopes up). I will detail a few clues as to the situation, and you guess the outcome. I will even provide odds for you. We can then gauge on how well you will do in Vegas.
DISCLAMIER ( the small print)
This is not an actual game and should only be intended for the sole purpose of the participant's enjoyment. Any or all winnings that can occur from enrollment into the game played, is not responsible for payment by said facility and participation is sole based on a volunteer stature. All participants should be of legal age and advised some working knowledge of EMS. Always wear your seatbelt. Some assembly may be required.
Okay, here is the senerio:
You are in a Three (3) truck rotation. Right now, you are averaging a call every 90 minutes. At 2230 (10:30PM for those who didn't study) you are required to do a trip that brings you back into your service area at 0000 (midnight..sheesh). Theoretically, you should be the next one out on a call. But as you return, yo ufind that neither of the other trucks have gone out yet. Keep in mind that it is now after midnight where call volume usually triples in the last eight hours of a shift.
Right now your odds are 1:3 that you will go out within the next 60 minutes.
As you tuck yourself away to sleep, you kind of tread lightly on falling all way down, knowing that you will go out soon.
An hour has passed, no more calls..your odds are 1:6. You fall asleep.
You awake to hear your partner stirring in the room gathering his things to put away. You look at the alarm clock and notice it is 0730. Did the other truck go out? did we miss it? Will I make it to the promised land.
Right now you are running 25:1 because you don't know the status of the other truck. You hit the snooze bar.
Time to get up. We are in the red zone now. The red zone is defined as the final half hour of your shift where tensions tighten a bit because you have absolutely no idea what is about to happen. The new crews will be in in roughly 15 minutes. They will usually take a call for you (usually...hmmp) and let you wind down your day with your daily chores and a cup of coffee.
Odds now are 10:1 (only because you have no status of the other truck, and you slept all night long.)
The other crews start to arrive. The time now is 0810. Almost home free.
Odds are a whopping 50:1.
The phone rings.
Is the call for you or is it for the other truck, will the new crew take it, or have they not arrived yet? You are staring at a 4:1 now...ewww.
Your pager goes off.
Paying out....50:1. Paying an additional 4:1 if you picked you are going.
Thank you all for playing. Please come back.
My partner makes sure I am awake as I am strapping my boots on. No relief in sight. Sigh.
EMS is like jello. There is always room for one more.
Coming out of the bedroom (which has no windows so it is dark as the bottom of my wallet), I made it into the all glass bay area. The doors face the east and the sun was just over the buildings at this point.
Trying to recover from my retinal blindness, I found what felt like a passenger door to the squad. I pulled it opened and felt the seat. (wanna play odds if someone is in it....if you do, you need counselling).
I climbed in and we took off faster than a launch off an aircraft carrier.
I looked at the screen on the MDT to see that it was for a general weakness call. Hmm..going awfully fast for that, are we. As we were off and acknolwedged by dispatch, we found that fire was not going to help us on this call. (Their crews changed at 0700...slackers)
Okay boss, John Wayne time.
We are on our own for this one.
Turning down the street, I noticed that a construction crew was blocking the road...right where we needed to go. Um..okay..what do we do now? We NEED to get to the other side. A side that is blocked and will take a few minutes to get to. I was just about to jump out, grab the bag and monitor, and walk over to the house while we found access when a foreman stopped construction (it was cement repair actually) and ordered his cement truck to back up allowing us access to the call.
Well, that is something you don't see everyday.
We clicked on scene, walked into the house and found our patient sitting there...this was not good.
Our Patient, a female of actually relatively young age, looked gray. She was sweaty, cold, clammy to the touch. She was clutching her chest and leaning to one side in a fair amount of pain.
My partner and I kicked it up a bit and interviewed tha patient to find out specifics...we did not like the results.
First of all, the patient denied a medical history. This could be good OR bad.
Second, she stated the pain started 2 days ago. The fact that she was still alive was good, but the critical hour is now WAY gone.
Next,she stated she took some Pepcid AC because she thought it was heartburn, but it did not relieve it.
Then she decribed her pain as "when you eat ice cream and it freezes your body". Also, she said her pain was a "5" on a 1 to 10 scale. Okay, this is good. But then added, I have not expirienced pain before so I really don't know what to tell you about the number. Hmm..an honest answer.
I took her blood pressure and she was hypertensive (above normal ranges).
Bottom line, she was not looking good. My partner and I ran to get the cot. (Yes, we ran) and he looked and said "I think she is having an MI (myocardial infarction...a heart attack). I concurred going slightly down the stroke scale myself because she had leaning and some slurred speech.
We took the cot inside and helped her get onto it. Secured her and moved to the squad.
Inside, We gave her more oxygen than what we did in the house and began a quick check and followed our algorhythms to give appropriate care. I hooked up the cardiac monitor and turned it on..hoping for the best. She showed a regular sinus rhythm without any wierd ectopy (injury to heart). I wasn't satisfied. While my partner started an IV line, I changed the leads on th monitor.
Quick lesson, different leads show different angles of the heart and help to determine where the injury may be in the heart. We normally run through lead II (2...but there are 12 different angles to take a picture of the heart with). This normally shows the inferior wall. We have 3 lead capability, but leads II and III measure the same lateral angle. Lead I does an anterior angle.
There it was!!! a VERY profound elevated ST segment on the monitor. (Indicitive to a acute injury to the heart...in other words..she was having a very bad heart attack).
Time to shit and get. (sorry for the french there). leaving the back of the truck, I asked my partner if he wanted to go in hot (with the lights and sirens) and he said, "yeah, we better, the nito didn't relieve her pain). Whoa boy..this is bad.
Normally, we go to the hospital in the city with a patient "cold or with normal traffic without lights and sirens. We are so close that we really don't need to expidite if the patient is stable. It cuts down on the patient's anxiety, and it is safer for all because not everyone likes to obey the traffic rules and pull over anyways. I think in 15 percent of our total calls, we will go to the hospital "Hot" because time is money..or tissue in this case. This was one of those time.
With the weather as nice as it was, that acted as a factor in our favor. Traffic was light seeing everyone was at work already. Our trip to the hospital took just under 5 minutes. We unloaded the patient and gave report. Seeing I drove, my job was to put the truck back together. While I was doing this, the nurses started a 12 lead ECG (electrocardiogram) which shows all sides of the heart and injury that may have occurred.
Getting the cot back together, I hear the loud tones of the overhead intercom calling a "code purple" which means that someone is having a massive heart attack. I walked back in to see the doctor, three nurses, a pharmacist, a respiratory tech, and my partner in the room, working on the patient. She was still awake but now it was time for aggressive treatment. Cutting through the chaos, I heard one of the nurses telling my partner, "She is having an acute MI right now". Hmm..good call by my partner.
We drove back to the station, with a mild sense of gratification knowing that the call and the choice of care plans was correct.
I don't know the patient's outcome to this point but I will let you know when I find out info. My girlfriend is a nurse in the ER there so I will ask her to find out for me later.
I was off a half hour ago. I better go home now before someone calls off sick.
My fellow readers, in today's society, we tend to be more self sufficient as to our own medical needs. With advancements in medicine, we tend to think if we take a pill that we will be fine. This is not always the case in this matter. I have no doubt that if this patient would have waited and not called the ambulance, she would have died probably later in that day.
My message to you is, if you think your pain is something that is non-serious but is keeping you up at night or excruciating. Call 9-1-1. Let US be the judge of that. Otherwise, the next trip you might take, could be your last.
Be safe and wear your seat belt.
Rounding Third and heading home,