15 October 2006

Medical Terms - M-Rod Style

15 October 2006

"Medical Terms - M-Rod Style"

Again, other than the occassional psych patient (really, you don't want to hear about that) or the drunk passed out person, I really have nothing to offer you.  So I thought that I would jot down some medical jargon that I use....that may not be in the books yet.

1. FDGB - "Fall down, go boom".  Pretty self explainitory and holds value to a high percentage of calls that we go on.   A good portion of the time, you get to their house and "reset" them. This meaning, you pick them up, sign them off (they never wnat to go to the hospital) and wait for them to fall again so you can do it all over again. It is a vicious cycle, but it is also the circle of life.

2. Gourmet Chucker - I classify these people who have the tendency to projectile vomit all over the rig and it is usually right after a hefty meal of hot dogs, chicken noodle soup, or mac and cheese.  Now, if you think it all smelled bad BEFORE they ate it, Imagine rotting food with mucus mixed in hovering in a confined space for a 15 minute ride.   Usually, I am the one sucking oxygen.

3. O2 (Oxygen) therapy -  Here is one of the many differences between police and EMS. They have guns...we don't.  And when you are locked in the back with a patient who just ripped his restraints off and is homocidal to the point where he has targeted you for termination, you grab the one thing that is heavy enough to make a statement, yet light enough to raise...the O2 tank. One good contact with that to their head and they will be sleeping off their knife wielding ways sooner than you can say "damn, that really worked". (Note: I do not suggest clocking anyone that looks at you wrong. This is a LAST resort issue so use judgement...I figured someone was going to complain about this so I typed in this disclaimer).

4. DFO - "Done fell out"  In other words...they are on final approach to heaven international airport.

5. JACOBS - or "just a couple of beers syndrome". Ask anyone how many they had to drink...and it is always "two beers".  What were the two beers? Kegs?  You in the field know what I am talking about.

6. Chipncokeia - This is the disease that one gets from smoking too much dope.  It is the expressed desire to consume some Cool Ranch Doritos and a Pepsi. Cures almost everything there.

7. Acute Lateralphobia - These are the people who have the fear of pulling over when the squad is coming down the road behind them.

8. Chronic Noctournal Influenza - Disaese that people have who call the squad for thier common head cold that they have had for 10 days and desire to go to the hospital at 3 AM. 

9. Paramedical Euphoric Antigen - My name for Tylenol PM...I think it is the wonder drug that should be put in the water.

10. Ambulatic Retread - Anyone in the field that has left and came back for some unknown reason.

Well, that should be an appetizer for you all....

Talk to you all soon....

Oh yeah, if you have Myspace, let me know and I will add you to my friend's list.

Rounding Third and Heading Home,

M-

04 October 2006

The Nocturnal Countdown - Part II

04 October 2006

"The Nocturnal Countdown - Part II"

For some unknown reason in my life, I have favored my left side. 

Maybe it was my competitive nature to always root for the underdog. That coming from a male who is right-handed by nature, I have picked my left side for several aspects of my life.

One, I can bat left-handed in baseball. I don't have as much power from that side, but I am fluent at it and can really screw up a defense that has me set up as a right handed pull hitter.

Then, there is video gaming.  Holding a controller, your left hand is the one that usually actuates coordination such as movement and aim.  Sure, you can operate it from the right also, but it is more comfortable from the left for me.

Plus, there is spelling....Left is shorter than right. Yes, I know it is only one letter, but I am pretty lazy at times.

So I picked to go left.  I knew that by going left, it would take me deeper into the woods whereas if I had gone right, I would eventally have met the road and logic has it that if his friend had come from that way and had come along the road, he would have A) been picked up be a motorist going by, B) Not had made it back to the house because it would have made him double back and disorient him more than he already was, and C)...well, there is no "C", but I incorporated it with the writing style so "A" & "B" could thrive on its own merits.

The path only grew darker as this pushed me even further away from the squad and the reference point it stood as.  The treeline to my right depicted a darkness that would scare the hardest of people as knowing what was beyond it was equal to stepping into an area of indefinate condemption.  You could feel eyes just staring at you from deep within and the fact that you could not see back held its own surrender and terror.

Calling out to see if a response would come from the patient, my words felt heavy like the deep humidity of a mid-summer's night deep in the country.  That kind where the cliche "you can cut it with a knife" emminated from.   Even if you called for help, no one would ever be able to hear you....ever.

There were only two sounds that were audible at this point.  One was the steps of my feet recoiling off the soft, damp ground. And the other was my heart, my pulse slowly growing as the increased adrenaline began to flow rampid in my blood.

Sweeping the light back and forth, I made a pass from the left and brought it across my body to the right where the light stopped...and so did I.

A reflection glowed from the brush just ahead and to my right about six feet into the woods.  The beating of my heart sounded rhythmically similar to a set of tribal drums used during a war dance.  My eyes widened as I stood there trying to slow the thought process that has taken on warp speed deep im my subdural.  I took a gasp of air...then I stepped forward.

Using the flashlight as a brush guide, I moved the surrounding vegetation and prepared myself for the worse.  "God I hope this isn't what I think it is. Please let it be something else." I began to cry with my inside voice taking my hand and removing the final piece of brush.

For those of you you who says God never listens.......

You will be saddly disappointed.

God heard me....

...it wasn't him.

Instead, I found what appeared to be an old street sign that had laid dorment in the woods with years of corrosion and rust supporting it deep inside the ground which became its new resting place.

Recaptuing my breath, a sigh or relief was quickly filled by a gasp of despair knowing I would have to go farther back...where it only got darker.

By now, I am a good mile and a half down the yellow brick road except that I have not even found the scarecrow yet, there are no rubies on my shoes, and if a lion did come out of the woods, I would guarantee you that I would set a new land speed record in sprints that would make Guiness go "What the hell was that?"

Wondering if I should turn back and wait for the rest of the search team to gather and execute the search with more than just a flashlight, a radio that has lost signal, and a open-ended prayer, my attention was caught again by something that seemed to break the cloak of night...and this was moving.

Half mile up, there was a right turn that split the already dark woods into a path that was as I dubbed, "the road less traveled".  Coming down this road was a light, a rather bright one at that too. Within a second, the one light became two and both moved in tandem rhythm along the dreary horizion.  They were headlights. Someone else was back here.

At this point, I didn't know if I should hide or wave who, or in this case, what, down to see if they had the same purpose as I did. God, I hope they did. Otherwise, I was an accident waiting to happen.

The truck pulled closer and I moved out of the way but stayed in site as to get the driver's attention. The truck speed towards me increasing speed.  Even standing to the side, I was in the direct path of the truck and I had no where to go even if I had wanted to. 

It was ironic, cinematic, and not a damn thing I could do about it.

I held my mag light up to show that there was someone standing on the path with the hope that whoever was driving would see me and stop.  I sure hope they stopped. Otherwise, it was yet another body that they were going to need to find.

My heart stopped, my eyes widened again, and I felt the need to scream at the top of my lungs. (well not really, but it segwayed nicely into this story at this point.)

Here it comes...moment of truth time.  Would I become a resucer or a hood ornament? I closed my eyes...I couldn't look. Then my brain processed a thought I wasn't prepared for.

"Shouldn't I have gotten hit by now?" I felt my subconscious tell me in that "huh?" sort of tone.

I opened one of my eyes only to see the truck had swerved and stopped beside me.  Recaptuing my thoughts and collecting myself, another voice overcame me suddenly, this one had a different tone to it. This one was petrified.

"Help my, he's in the back here. Get in, he needs your help."

The voice came from the passenger of the ATV who sat vigilant by his friend in the bed of the truck.  The truck which belonged to the father of the very injured son. He had left down the trail to find his son hell bent on bringing him back so that I could save him.

I jumped in the bed of the truck and we shot off like an aircraft off a carrier back to where the squad was.  The internal clock that I had started when we left the station had begun to tick even louder.  The two minute warning was over, it was time to play no huddle offense.

Getting closer to the squad, the reception from my radio improved and so did signs of life on the other side.

I screamed in the mic at Darnell to get the immobilization equipment ready and set me up my trauma roll-outs.

Racing in the back of the pick-up, I felt as if I were a field medic somewhere in the hot zone with 2 injured Marines racing away in a hum-vee trying to get out of the range of the artillery.  I had limited to no equipment with me, the sky still remained dark and illuminous, and judging by the response, or lack of, from my patient, I could tell that being "under the gun" was no where near the pressure that I faced with the uphill battle that I will begin.

Roughly 5 minutes after being picked up, we were back at the starting point. More lights, more equipment, and most of all, more people. I was glad to be back to a familiar sight, my squad..where I do my best, where I can pull off miracles.

Getting my first look at the patient, I could see he was in sadder shape than I had anticipated and I knew that if he had ANY chance of survival, I needed to be on my "A" game here. There was no room for error, for bad judgement, or for second guessing myself.  This was what I do. THIS was who I was.  Then, with that thought fleeting my mind, a switch was thrown, my adrenalin kicked in once again, and my field quarterback instinct kicked in. 

I began to bark orders at anyone who was in an ear shot of me.  "Get me a Backboard", "Hold his neck so it doesn't move,"  Cut his coat here."  The words flew rhythmically, I was in the zone.

Loading him into the squad, my challenge of saving this young man grew even greater for several reasons.

First, there was the fact that some of the signs he displayed showed that he had been down for quite some time.  The black and blue around his eyes (we, in the field, call these "raccoon's eyes") signifies that he has a significant head injury which could lead to and/or include a brain bleed.  Here is the catch-22.  There are certain meds that you can give to the patient that will greatly reduce the bleeding in the brain once given. BUT, you have to give them in the first 3 hours after the initial signs and symptoms have been identified.  He had been down for almost 2 hours. It took us 40 minutes to find him and get him back to the truck. It will take 10 minutes to get to the hospital, and even then if he DID have those, let's say, 10 minutes left, he would have to meet a criteria in order to get those drugs. One of those being if they suffered a serious head trauma in the last 2 weeks....Well, duh...he expirienced one within the last 2 hours. You see...catch-22.

Next was the factor that I was the ONLY paramedic there. Darnell is an EMT and even though she is a great asset, she can only do so much.

Finally, I had TWO critical patients.  Remember, I work in the country so getting one squad takes a while, getting a second could double that time considerably. I didn't have time to wait for the other truck so I elected to load them both in and get the heck out of Dodge.

Add into the mix that I had a firefighter drive us into the hospital.  This is kinda like having Scotty (from Star Trek) sitting right next to you saying Click Here to Hear Voice .

Load and Go. This is the only option that I have.  Sirens blaring, moans coming from the patients, Darnell kicking out vitals to me, I begin to manuveur from body to body, hooking up the ECG, startingIV's, seeing where bleeding is coming from, trying to make sense as to what is going on. 

Game face still on, I call the hospital and advise them of what I have and what they will be in store for and at the same time praying that the worse doesn't come to worst.

Feeling the speed of the squad picking up even greater, the concern now is taken over by anxiety...and not from the patients. 

"Okay, everyone here, slow down.  First of all, let's not try to get there before the squad itself...slow it down a little up there. As for everyone back here. let's all breathe while we are doing what we do." I reeled in my crew before they let the emotions get the best of them, and with that, I didn't want judgement getting clouded. 

Two things progressed forward from this point forward.  The distance to the hospital fell shorter...and so did the level of consciousness of my critical patient.  I could feel the "pucker factor" beginning to settle in my stomach knowing this kid was going down hill and I didn't have a way to stop him.

With that, as if the hand of God touched me yet again, I felt the familiar left turn that signified the squad pulling up to the emergency room.  Keeping the crew on their toes, I began to give the directions as to who to unload and where and that the game wasn't over just yet. 

Wheeling the first of the patients into the trauma room, it was pretty much a no-brainer (no pun intended here) that this young man was going to take a flight somewhere.  And before we finished unloading him, a call for the God Squad (what I call Life Flight) went out.

A few moments later, the second patient was unloaded and into his exam room also being attended with vigilant and utmost concern.  His fate, despite his slightly better health status, mirrored his buddy's as he, too, was going for a hop ina big yellow taxi.

(see......Yellow).

Pulling the cot out of the last room, I felt a mental collaspe suddenly overwhem my body.  Running on sheer adrenelin, my body just physically gave out as thefatigue, the exhaustion, and the pain began to arise all over my body.

Making it out to the truck to get the clipboard, I peeked in the back of the squad which had looked like someone had flipped it over and all the contents found their way to the floor of the rig.  Poor Darnell, she had a lot to clean. (As a rule, before you all get like "why didn't you help her?" whoever is in the back does the report and the other cleans and restocks the truck. I know we were both back there but I am the medic of record so I have to do the reports and the fact that Life Flight was inbound, I had to get them done before they got there.)

There I am. Sitting in a break room, staring at the comment section of the run report.  It wasn't that I didn't know what to write, it is that the mental records of the events began to slowly catch up with me and the remininscing began to take place.  Did I do this right? Could I have done this different? What if I missed that?   Second guessing is a nature of the beast when it comes to EMS. (Hence my last entry).

I think I was doing fine, getting my head straight, focusing on the job at hand that I needed to finish...until the father walked in and requested my presence.

Here he was, a man who looked like he carried the weight of the world on his back and was just too tired to walk anymore. His eyes swelled with tears, his face just riddled of exhaustion. He was spent and was running on shear will power right now. 

Making a barely audible tone, he reached out to shake my hand. The tears began to flow. His voice crackled with sorrow and fear. He, was completely spent.

"I just want to thank you for saving my son. He is a good boy that just  got into a bad situation.  He means the world to us and I just can't thank you enough for all you do."

I didn't know what to say.  I don't know what I said. I am sure it was the standard issued "He is going it be fine" and "best of luck to you and your family".  It seemed like the right thing to say, I knew deep down it was all pre-programmed crap.

Watching him walk away, I couldn't help but feeling what he was feeling. Going through the anguish and earth changing fears running through his head. I couldn't help but see his world through his eyes while trying to be strong for the rest of his family. I couldn't help but taking the place of a parent, and expiriencing the hurt of your child, and being able to do little to nothing about it.  For a moment, I was that parent.

An hour later, we were as good as new, used and well beyond the capacity of function. Pulling out and around the hospital, I had Darnell stop the squad to watch the helicopter take off.  The dust began to lift as the strength of the rotors lifted the patient starward into the heavens.  He was in great hands now. All I could do is watch.

The whole trip home, I don't think I said much. If I did, it was utter small talk and beared no meaning what-so-ever to the case.   I couldn't help but feel as if the chain of events for the evening had somehow been etched into me subconscience for the rest of my life here on this Earth.  I don't know if I will ever forget how and why this happened....and in a way, I am not too sure that I want to.

Rounding Third and Heading Home,

M-

02 October 2006

The Nocturnal Countdown

01 October 2006

"The Nocturnal Countdown"

Time is money.

So I am told.

In the general population, the faster you work, the more productive you become causing a faster turn over and greater profit. On the other edge of the sword, the more time you give a project, the more intricate with detail and skill you provide give the authenticity of your work even more value.  Time can be a two headed monster with a negated path no matter which one you take.  Unfortunately, this is life, and it is one of those few things that we have control of.

In EMS, Time is more than money. Time is a luxury, a luxury that is often against our greater purpose and, along with it, usually has a lot of friends that makes relief and rescue just that much harder...and that much more tolling to the rescuer.

 

Song of this entry is "Superman" by Five for Fighting

0258 Hours

I could tell Darnell wasn't feeling too well with her constant shifting in her bed and the just above audible snoring that she had going on....Enough to wake me and migrate myself to the couch, not that it is her fault, I could never really sleep well while I was at work.  Maclimating my body into a position of comfort, I pulled my fleece blanket up to my chin and began to resume my duties of unconsciousness...

...Until the phone rang.

Now, unlike when I worked at my other job, when a 9-1-1 call comes in, you can hear the caller on the other line.  Now, this serves as a one of those necessary evils that you really don't want want to partake in but you need to in order to get pertinent information about.

Getting up and dressed, I began to hear the caller on the loudspeaker.  Her voice cracking, shrieked with terror, and it was if you could even hear the tears coming down her face.  The pitch in her voice reaching out as if it were a swimmer drowning looking for that one hand to pull her out of the water and bring her back to solid ground. 

Her son had left with a friend to go to a birthday party on their ATV to celebrate a friend's birthday with a bon fire and some adult beverages.  The weather warranted the closeness of friends and adding the celebration of birth only iced the cake a little more.

A few hours later, there was a knock on her door...from her son's friend who ventured with him through the woods to the party....and he was covered in blood.

On their way back through the darkened trails, the mixture of nocturnal cover and intoxication brought on speed, recklessness, and sharp left turn which negated further travel by hitting a tree squarely.  Both ejected from the ATV. Both without a helmet. Both of them going unconscious. 

With the grace of God, the passenger made it to his feet irregardless of the pain in his shoulder which had separated, not thinking about all the blood he had lost, and barely able to recognize where he was, returned to his friend's home to render help.

At this point, I can actually feel the anxiety, the tension, and the fear that this mother had for her son who lies helpless somewhere in the vast woods that  border their property.

Grabbing my Mag-Lite from the other truck, I made my way to the squad, opened the garage door, fired up the sleeping giant, hit the red, glowing switch marked "Emergency Lights" and began our journey into the brisk, cold, starry night.

Now, I have been on dozens upon dozens of DUI related crashes but unlike this one, they all had a common ground that made them a little easier to deal with.  These crashes were on the road or in the immediate vicinity so access to the patient was fairly feasible and, barring any extrication, accessible.

Tonight, the stakes were going to be raised.

One of my biggest concerns was the temperature. For the first day of October, and especially at 3:00 AM, the weather outside was in the mid forties.  Despite the countless and otherwise, celestial cover that drapes overhead, the absence of cloud cover creates a cooler environment that, with a trauma patient, can cause hypothermia if we don't find them quickly.

Next was the fact that we really didn't know where in the woods this person was.  He could be five yards back, he could be five miles back.  I just don't know, and that worried me even more.

And finally, the shear darkness of night.  I felt this was comparable to a blind man in a dark room looking for a black cat that isn't there.   You just have to put your hands together and pray.

Turning off the highway onto a two lane surface road, I tried to run multiple game plans in my head with priority on the actual search.  Because of where the house was located, the time of night, the rural area as a whole, and the amount of support staff that I can conjure up, it was pretty apparent that we were going to be the first ones to arrive on scene, and it was up to me to formulate a plan....and fast. 

Continuing down the desolate stretch or road, the only illumination that was granted, was the soft red and intermittent white strobes that were reflecting from the rescue squad.  Looking at the addresses, I saw that I was in the 4700 block of the road I needed to be on. My physical destination laid in the 5200 portion of roadway. 

Coasting over hills, I felt as if a stopwatch began to tick in my head and the race had officially begun.

4900 block. Getting closer.

I quickly began to feel my stomach sink as I realized one other factor that may cause a problem.  This being the vegetation that was rather abundant in the area.  Corn stalks grew in access of seven feet towering over even the tallest of men hiding with it unwanted shadows and disrupting potential orientation for the search parties.  Now I was starting to sweat.

5000 block.

I began to slow not really knowing if the numbers were going to make a crazy jump and I didn't want to pass up the address knowing that a frantic mother awaited and time being of the utmost essence at this point.  My heart began to pound to the point where I felt it against my chest wall.  "Okay Mike, calm down, time to get your game face on and just keep your emotions in check. " I began to tell myself as the 5200 block came into focus.  Pulling some extra light from the spotlight equipped in the truck, I found our destination. It was time to do what we do...and do it fast.

Turning right and ascending up the driveway, I saw a small figure emerge from the shadows waving frantically in the air signaling us to stop where we were.

Getting out of the rig, I knew right away that this was the caller whom so desperately seek our help and guidance to find her lost child.  Her face is plastered with concern, worry, and most of all, fear.  Tears streamed down her face and the shear exhaustion from the moment was beginning to catch up with her.

A brief, but thorough course of events were given to us and as I feared on the way over, we were the first ones to arrive.  It was time to go looking.

Turning on my flashlight, I found a basic set of tire tracks that led deep into the soft terrain and extended onward into the decidious landscape.  There was no way that I was going to get the squad back there without getting it stuck in the marshy grass, so I opted to go back on foot.  It was up to me now, and I wasn't leaving until I found who I was looking for.  About a quarter mile into our journey, I could see that this was going to be a bigger problem that I had anticipated and would soon need greater resources than I was capable to handle on my own.  Not to mention, I really didn't know what was back here and the fear of the unknown settled like a rock in the bottom of my stomach.

I made the decision to send Darnell back to the truck seeing I would be out of the range of the radio's repeater soon. I told her to grab the cell phone and to notify dispatch to alert the fire department and have them respond with their 4x4 vehicle.  It was the only way we were going to get this young man out...once I find him.  Also, I didn't need Darnell getting hurt or twisting an ankle.  I am trying to limit how many patients I actually have here.

Turning around to show her the trail back, the only illumination that was visible at any point was the headlights from the ambulance that looked like the sun shining through a pinhole.  The distance was great but the grass was soft and level so I knew she could make it back okay.

Continuing on, I would occassionally call out for the victim only to hear myself encased in the eerie calm that blanketed the vast area at this time of night. I was well close to a mile back into the woods now and the ground began to get even softer.  At the base of my feet, I could see that the landscape turned from ordinary lawn to soy plants.

The soy plants were about 18 inches in heights and covered acres of land on both sides of me.  Despite their meager size, it was enough to camoflauge a body had there been one even two feet away.

Hearing the portible radio crackle, I knew that I was just about out of range from the squad and soon, my search would be difficult at best without the communication aspect to help me.

Continuing on, it wasn't long before I ran into not one, but two separate problems that seemed to add on to an already complicated situation.  The first being that the tracks had stopped to the point where I couldn't see them anymore.  The second was the path stopped too.

Here I am, standing in the middle of a field, blind, cold, sensory heightened having to make the critical decision as to what to do next.  A few steps further, I notice what seemed to be a dirt service road of sorts.  The road ran from north to south and looks like it has been traveled a lot by other all terrain vehicles.  Now, my search lied in the hand of a coin toss.  Do I head right and stay in the small, yet still noticeable line of sight of the squad, or do I turn left and follow the woodline deeper into the muck.

Closing my eyes, I take a deep breath concentrate as to what I need to do, and open my eyes. My decision will have consequences if I am wrong.

It is time to go.....

To Be Continued....

Rounding Third and Heading Home.

M-