A day in the life...

[Kaisu]

Greetings from the wild, wild west.

I finished a 24 hour shift a couple of days ago. This is an easy day in the life of an AMR medic because it was not a 48. As you will read, sometimes it’s not about the length of the shift.

The shift began badly. I confronted an acting supervisor about an incident on the previous shift. I tore him a new one. The good thing is 20 minutes later, he followed me out to where I was doing my rig check to explain himself. I took it as a win for two reasons. First, he cared enough about my opinion of him to actually try to make it right, and secondly, I had made my point.

The first call of the day was a minor MVA. My patient was the restrained passenger of a car that had been rear-ended. He was complaining of neck pain – C1-C2. Routine. Stable patient, full immobilization and to the hospital.

Second was a “non-emergent” transfer from regional hospital to big city hospital. The transfer was ICU to ICU. I get to bedside and my patient has no eye-opening, responds to voice with moans, is on a 20 mcg/min NTG drip, contracture of the left upper extremity, spasms of left upper and lower extremities. BP is 146/90, HR of 101, respirations of 27 per minute. History of multiple sclerosis and hip fracture. Patient has three peripheral IVs including an EJ. This is a “stable” patient going by ground?

The nurse explains that the diagnosis is baclofen withdrawal secondary to possible pump malfunction and the patient is going to neurological ICU. She had started the patient on 40 mcg/min NTG to control BP and HR. Patient had gone down too much, rate had been adjusted to 20 mcg/min and symptoms were being controlled with Ativan.

The last time I had questioned the stability of a patient for non-emergent transfer, I had been told by the Dr. that if he didn’t think the patient was stable enough, he would have called for air. My supervisor had told me to shut up, document my concerns, and transport the patient.

I told the RN that I did not carry Ativan, and the only benzo options I have are Valium and Versed. She said that would work. I don’t have an infusion pump and told her I would have to take hers. She was upset about that. I told her that I would not take the patient without the pump (thank you St. V’s clinicals for making sure I am comfortable with the operation of the Alaris). She goes to confer with the higher ups and comes back with some ad-hoc paperwork pulled out of someone’s butt and it’s all good. I still have a hinky feeling about the whole thing, but it isn’t till well after the transport when I do some research that I find that if the Dx was on the money, the patient would be HYPO- not HYPER- tensive. Be that as it may, I load the patient and we head 100 miles across the desert.

To make a long story short, the details of which include delays across the dam, bleeding air out of the pump lines several times (it’s bumpy and at one point, the NTG bottle flew off the stand), emptying my drug box of benzos, considering upping the nitro, being misdirected by staff at the destination hospital not once but 3 times, assisting the RN at the destination hospital switch out incompatible tubing and no food for 6 hours, we finally arrive back at the station (after returning the pump to 2nd floor ICU and replenishing my drug box) at 8:00pm to find the crews had had their butts kicked, running about 20 calls in the time we were away and that we were up for the call. This is two crews mind you, with a couple of the calls being handled by a move-up crew from the sub-station.

Usually, when a transfer crew comes back, they drop to the bottom of the rotation. My EMT partner objects to us being up, but I silence her, telling her that rough as our transfer was, we had still had an easier time of it then the crews in the city.

I get to sleep about 10:30pm to get toned out at midnight for a difficulty breathing out of town, part of our coverage area, about 20 minutes out running code. Female patient, 73 years, history of CHF, COPD, oxygen dependent. Patient has cellulites bilateral lower extremities extending to the knees. I feel the heat radiate off her legs, treated 2 ½ weeks ago for an unspecified infection.

Pneumonia or pulmonary edema? Quiet in both lowers, sounds like snot in the right upper. I’m thinking diminished because of the COPD and snot because of pneumonia?

Fire first responders had started A & A via SVN – I hate that. It’s routine around here – they think any difficulty breathing needs A and A. Until we get her in the ambulance, it’s their patient. We load up the patient and as we are lifting her (she’s a hefty one – blue bloater) and there is a gurney “incident”.

My partner is about 5 feet tall, weights 100 lbs soaking wet and she was the leading contender in the station “who goes out with a career ending injury” pool. She had been back at work for about 4 months after 6 months light duty from her last back injury.

All I know at the time is that we are lifting and suddenly the gurney drops. I am at the dumb end (cause I’m a moose) and she is operating the legs. I control the descent of the gurney; patient barely realizes there was a problem. The patient was sitting straight up and blocking my view of my partner. I don’t know what happened. I peer around the patient, make eye contact with my partner, she nods and we lift again. This time she goes up without incident. Gurney is not as high as I like it but my partner does not want to try again. I lift the dumb end into the rig, go around to lift the other end (cause I’m a moose) and the fire medic is already lifting. Totally against company policy, but I raise the legs and off we go.

We are busy in the rig. I am treating pneumonia, the fire medic is treating CHF. She got about 250 mL, I checked lung sounds, shut off the fluids and we continued the CHF route. Fire medic was right, I was wrong. (This is only my 4th or 5th CHF patient in a year. It’s not the problem here in AZ like it is in WI. I guess that’s why we don’t have CPAP on the rigs.) PS.. sure makes that A & A treatment look good huh?

We get to the hospital and my supervisor opens the ambulance doors. WTF? Fire medic has disappeared. Supervisor and I transfer care, I take care of the paperwork and return to the rig. It’s at this point that I become aware that my partner was taken to ED room 7 in a wheelchair. She had called the supervisor while driving and told him she was hurt.

I am trying to make this really long story short. Bottom line – she is in CT scan, pumped full of dilaudid and muscle relaxers and telling the supervisor I dropped the gurney. I wind up waiting at the hospital until 3:30 in the morning while he does paperwork because we can’t get an EMT to man the rig and he is now my partner. When he is ready, we return to the station. I write out incident reports and try and figure out what happened. Opinion at the station is about 80% that the girl is looking for the injury and throwing me under a bus. I’m not so sure. I am filling out the paperwork to request evaluation and remediation if required of my lifting technique. I am more upset about this incident than anything

else that has happened – or will happen – this shift. (yes there is more – I am so grateful to those of you still with me on this.)

I don’t make it to sleep when we get toned out to a MVA on the highway. It is about 5:00 am. No idea what type of MVA or injuries if any. I ask my supervisor, who’s driving and is the senior medic if he wants patient care. He says no. I do the standard calculations of enroute times vs. launch times on a rotor and decide against a rotor. (20 minutes there – 20 minutes back vs. 35 minute ETA plus 15 to ED for rotor unless they are lying, which has happened.)

On scene, I see the rear axle of a vehicle in the northbound lane. The rest of the SUV in on its roof about 100 yards south in the ditch. First responders are log rolling a patient. The fire medic is palpating the back. The fire medic is relatively new, excellent with medical, tends to freeze up on trauma. He’s the guy that was puking his guts out on the scene a few months back when we ran on the guy tortured with the box cutter.

No O2 on the patient. EMTs directed to put a hi-flow NRB on the teenage female. She is messed up. In and out of consciousness, 4% partial thickness burn on right thigh, major lacs, abrasions, etc. etc. Scene time 9 minutes then running code to the hospital. Initial BP 128/70, HR 80. 8 minutes later BP is 103/58 and HR is 113. I got a BP cuff compressing the bag running NS into the I/O and a second line in the right AC.

Bottom line – 2 16 year old members of the swim team going to practice. Both moms in the car following. SUV hits left guard rail, over-corrects and rolls. Both occupants ejected. Driver lying partially under the SUV, dead on the scene. My patient has basilar skull fracture and other injuries, flown out to trauma. I get back to the station at 7:30am. (no sleep except for 2 ½ hours and up since midnight.)

Last but not least – I was supposed to be off at 8:00 am. One of my co-workers is doing FTO testing this am and was informed it would be from 8:00 am till 10:00 am and had asked me to hold over for him. He is a great guy and I am a big fan of improved education in the field. If you remember how I was thrown to the wolves when I started this job you will understand why.

I surrender my rig to the on-coming medic and take over the rig my friend was in. In the minds of some of the pea brains that work here, this puts me up for the next call. I refused. It didn’t do me any good tho… the FTO testing started at 9:00 am and my friend was not done until 1:00pm. I ran calls.

Thank you so much for reading this. It is an important part of my debriefing and I appreciate any comments you may have on any of this.

Call me crazy, but I still love my job.

[Kaisu]

PS..

right after I got home, I found out that Alyssa had died.

[Eydawn]

You need a hug. *HUGS*

And you also need a statement from the fire folks that were with you on the call with their statement of what happened on that lift. That was retarded of your partner to not TELL you that she'd been hurt on that lift. You didn't drop the stretcher, she did, because she shouldn't be lifting.

I'm sorry it was such a rough shift!!! And I'm sorry that your monkeys who run the "who's on first" system don't think things through.

Get some good sleep!!!!

--Wendy

[Dustdevil]

Wow, what an epic arsewhipping.

These are the shifts that remind us why we do it, though. Patients that truly needed you, and needed you now. Other "professionals" that would be lost without you. No time to sit around and wonder, 'am I really doing any good here?' I hope you got a nice 48 hours to wind down from that though.

I would love to see the producers of "Trauma" do a show based solely upon this post! THAT would be a winner!

[HERBIE1]

Sounds like a bad day. I've worked with a few people who I know are frauds- out to scam the system, and nothing irks me more. Most of the time these duckers end up hurting their partners because they are lazy/incompetent/and too busy looking for a free ride.

I recommend a frosty and festive beverage of your choice to get ready for the next work day.

[DwayneEMTP]

Yeah, I'm with Dust. That's why you like it!

Every few months we get a post telling how you got your ass kicked, yet it's all good.

If it was slow we'd hear from you every day about how bad it sucks! :-)

Sounds like you did real good Lady...Get some rest.

Dwayne