It's been awhile!

It's been awhile since my last post. Not much has happened since that last post, which is actually a good thing.

As you all know we just had the worst ice storm last week in years. I had to work that day and I didn't let it keep me from getting to work. Of course I had to leave an extra hour and a half earlier to get there safely. I arrived to work without problem and safe, and that's what matters.

During the ice storm, there were just over 530 motor vehicle collisions in Fort Worth. Also during the storm emergency responses, lights and sirens, were suspended. The decision to suspended emergency responses is done due to our vehicles not being able to go any faster than anyone else on the ice, and if you can believe it or not it keeps the roads safer as other drivers are not trying to rapidly move out of the way on the ice and crash into something or someone else.

During my shift the ice only gave us problems once as we got stuck on a slight incline at a red light. It was funny as we were sitting inside trying to rock the truck back and forth in an effort to get the tires more traction. It never worked of course. But eventually with the tires spinning it eventually melted the ice enough to get traction and go.

So far in the year 2009, I've responded to a over a 100 calls already. On 1/12/09 I responded to a shooting. We had just finished with another call down the street when this one came in. So we staged down the street and PD finally said we were clear in. So as were driving up, theres houses on the left (were the shooting happened) and apartments on the right and theres about 8-9 police officers with there AR-15's/M-4's (assault rifles) and shotguns out heading into the apartment complex all spread out. I am thinking to myself, there armed with their big guns and walking towards where the suspects were last seen and live and they said we were clear in, something doesn't make since here because if they ran into the suspects and shots were fired, were behind the police officers taking care of the victim and if the suspects fire and miss the officers its coming into were we are. The victim was about 18 years old if I can remember and he was shot at with a sawed off shotgun. He had two entrance wounds to his leg and an abrasion to his left chest from a round that grazed him. He was a very lucky guy.

That's really only the "good" trauma call this month and that's not a bad thing. I've had some serious medical calls that were "good." They had CHF or congestive heart failure and there lungs were filling up with fluid (pulmonary edema). I applied whats called CPAP (continuous positive airway pressure) that forces the fluid back out of the lungs into the circulatory system where it belongs. CPAP is a really good tool that lowers the chance of mortality in patients and lowers the chance of them being intubated and having a long ICU/hospital stay. It is something that I am glad MedStar has as a tool to benefit our patients.

Since I kind of stopped posting I am going to start blogging about safety tips and medical information.

Please stay safe out there, take care of yourself, and wear your seat belts while driving or riding in a vehicle.

Crazy Sundays

So I am now going to call Sundays..."Crazy Sundays." I figured I would call it that after the last two Sundays. This last Sunday was a crazy day for burns. First call of the day was for a burn patient that was burned by some type of camp fire was what the 911 caller said. The location of the call was at a business that was one of the auto vehicle salvage yard. Well we got there and found a pile of ruble that was on fire but that was pretty much all done burning and there looked like two cars were also burned, but didn't see anyone that was burned. As we were getting out of the truck I noticed someone laying on the outside of the burned area. Didn't look like he was moving and he wouldn't respond when one of the firefighters were trying to talk to him. He finally woke up and we put him on the stretcher and moved to the ambulance. He had a 1st degree burn on his back, and 2nd degree burns to both his lower arms and hands. Since his hands were burned to that degree he won a trip to Parkland in Dallas. This guy was very lucky to begin with that he wasn't burned more severely and that the workers who worked there came in to work on a Sunday. He didn't seem to be homeless and he gave us an address that wasn't any kind of shelter or anything. He's story also didn't make since as to why he was there to begin with.

Later on in the day we cleared from John Peter Smith and got a call for a burn patient from a house fire. It was just a few blocks away and got there quickly. This patient was very lucky as well as she only had some minor burns to her face and arms and singed hair. She wanted to go to one hospital but since she was burned that hospital wouldn't take her and she would have to go to a hospital that had the facilities to handle burn patients. Well when my partner told her that she couldn't go to the hospital she wanted to things went down hill fast. She became crazy and I mean crazy. She ended up being taken by the police to the hospital for treatment and psychiatric care and she was saying she wanted to die. Turns out that she was actually living under the house in the crawl space. The arson investigator told me that she had a nice little set up under there with bedding and all. It was her mom's house and the investigator was still trying to figure out if the fire was started on purpose or accidentally but was started with gasoline. The picture below shows me with the patient of the house fire taken by Glen Ellman. Her eyes have been blacked out to prevent her from being ID.

Third cardiac arrest and first respiratory arrest

So last shift (Sunday) was actually pretty busy for a Sunday. Ended up working 17 hours instead of the usual shift of 16 hours because we got a call five minutes prior to our end of shift and of course that put us the 16 hours.

The entire morning there just wasn't anything good going on call wise. Which really isn't a bad thing because if its something good for me then it's something bad for someone else unfortunately. Then we got a string of 4 calls in a row that were good.

So around oh, if I can remember, about 4pm we got a call for an accident involving a car vs pedestrian. Call notes showed the person hit to be a 4 year old boy. So of course I am thinking this is going to be a pretty good call but since its a kid I start to get that depressed feeling of oh no something poor is happening to this kid who's probably not even in pre-school yet. So we arrive on scene and of course fire is already on and there is a little crowd surrounding the kid, his grandmother, and the fire crew. I had to push my way past this little crowd to get to the kid. Turn's out luckily the kid only sustained an abrasion to his right side and no other serious injuries.

Second call was for a woman in labor. That's one thing that I have been waiting for, because I think it would be cool to deliver a baby in the field. Well we get there, baby not coming yet, but the patients husband who speaks English (patient doesn't) said that her water has already broke. So we hurry up and get her loaded and get going to one of the local hospitals. On the way I heard the patient not really scream but just a really loud moan, then she said something that I couldn't hear (plus it was in Spanish) but I heard my partner say something like "sorry I don't have any water to give you." And in my head I am thinking: "She's not asking for water, she's saying her water just broke." Well we get to the hospital and move the patient over to the hospital bed and sure enough her water broke during the ambulance ride because it was all over the stretcher. Soon after the baby was delivered there at the hospital and I got to see it. It's not the first delivery I've seen but the first natural (other was a c-section). It's a pretty cool ordeal but definitely after watching that, it's not something I want to do in the back of an ambulance. Oh and it was a baby boy! Yay!

Third call was for what started out as a call for an choking turned into a cardiac arrest call when we turned onto the street. We got to the house and the patient was on the living room floor (we have to find a new term for "living" room b/c every cardiac arrest or dead on scene person has been in the living room so far). And the patient wasn't breathing but had a pulse (respiratory arrest). So my partner quickly intubated him there in the living room and we moved him to the ambulance and got going. When we got to the hospital he still had a pulse which was very good thing because respiratory arrest turns into cardiac arrest very quickly. As far as I know the patient is still alive but on a ventilator. I hope he gets to go home.

Fourth call and my third cardiac arrest. Get a call for a diabetic problem. Arrive on scene to were the patient's roommate stated that he tried to wake the patient up about 15 minutes ago and couldn't. Then tried again and still couldn't so he called 911. There was no light switch where the patient was (bedroom this time) and the only way to turn on the lights was to pull the string on the ceiling fan. Which was no minor task as the ceiling was 9 feet tall and the string was about two inches. So I managed to get the light turned on and look down to my left to find the patient on his bed and he looked dead. There's just this dead look that you see on patients and you know there dead. I could tell he wasn't breathing so I checked for a quick pulse and there was none. My partner was just about to pronounce him when he took a grasp of air (known as agonal respiration's). So we attached the monitor and it showed v-fib. Shocked once and it went into asystole (flat line). I attempted intubation and couldn't get it. My partner attempted with a view scope and couldn't get it so we placed a King airway (future post to come on the King Airway) and my partner also got an IV using the external jugular vein. I pushed a round of epi and atropine and then off to the hospital we went. Pt was pronounced on arrival at the hospital by the doc right at 2200 hours (10 pm).

So as you see Sunday was eventful and all 4 of those calls were back to back. So it was a fun and long day.

Working

So I am currently at work right now sitting in the back of the truck. I am in the back because my new partner is a driver training officer and she's currently training a guy on driving the ambulance.

Today started out "great" with the first call being dispatched as an "unknown problem." Arrived on scene at the apartment complex where management met us. Management advised that she talked to this guys family and said the family hasn't seen or heard from this guy in days and that they tried to open the apartment door but the deadbolt was locked. As Fort Worth Fire is arriving the manager stated something to the effect of: "Oh and the neighboors are complaining of a fowl smell." At that point fire kicked in the door, yes kicked it in even though they had their tools with them, but hey, its their foot and knee. As soon as the door flew open this god awful smell came flying out. It's a smell that immediately smelling you know what it is. Poor guy was laying on the floor. I was only in the apartment long enough for us to call time of death and then I was out. I didn't really see the guy good enough (lighting was poor) but I thought he was a black guy, but management told us that he was a white guy. So that means that he's been down for awhile. So no idea what the cause of death would be, so I'll just wait on the TCME report to come out.

Also ran a stroke victim to far today. Not many of the calls we get for strokes actually turn out to be a stroke as they usually turn out to be a diabetic problem. Poor guy was truely having a stroke. Upon arrival at the ER we took him straight for a CT scan and he had a bleed in his brain. Hope everything turns out ok for him.

Well thats it for now as were just getting a call at a nursing home. Those are always fun.

Cardiac Arrest #2

Ok so last night was a great night for action at work. Around 8pm got a call for an unconscious person. Arrived on scene with an elderly lady meeting us at the front door holding what looked like a German Shepard or mix at least (very pretty dog) back and she had this worried look on her face. She said her daughter was just sitting there in the chair and then slumped over. So we make it to the living room and well yes, we find her slumped over in the chair. We repositioned her back in the chair and I see that her face is grayish in color and her lips are blue, she's not breathing and we can't feel a pulse. We get her on the floor and CPR is started. One of the Fort Worth Fire guys went back out to the ambulance to get the monitor and I went back out to get a back board. So we come back in CPR still going, we attach the monitor and she's in V-Fib (see prior cardiac arrest post for ?? on V-Fib). We defibrillated once and CPR resumed for about two minutes when we checked for a pulse and there was one and it was going good. So we load her on the stretcher/back board and move out to the truck where I established an IV and gave some Lidocaine to keep her from going back into V-Fib. If you ever saw the opening credits for the old show Emergency! where Johnny pops the tops on the syringes, yes I did that and its fun to do! So we took her to the closest hospital and she was still alive when we got there. Staff there did a 12-lead ECG and she was having the "big one." She was having a massive heart attack. Since that hospital doesn't have a cath lab to fix the problem they were going to have her Careflited from that hospital to a hospital in downtown Fort Worth. (So many people think Careflite is so much faster) We were still in the ER room and we said we could get her there faster so the ER stabilized her more and we transported her to the other hospital where she went straight to the cath lab (after a brief stop in the ER) and hopefully she is doing good. I am going to try and see if I can track her down in the hospital tomorrow since I work and see what the final outcome is. It's unfortunate that a lot of "out-of-hospital" cardiac arrest don't make it to the hospital alive and it's even more unfortunate that of the majority that make it to the hospital alive don't leave the hospital alive or in the same condition they were in prior to the cardiac arrest. I pray that she makes it out alive and in the same condition that she was in prior to last night.

Just another day

As an update to my previous post. I found out that the patient had died of an aortic dissection. If you don't know what an aortic dissection is I will explain briefly. Your blood vessels and arteries have several different layers. Overtime blood starts to get in between those layers, and eventually breaks/busts the artery and you start bleeding internally. So as a result there was nothing that me or the crew I was with could have done. The man needed surgery and by that time we got there it was too late. Knowing what he died of and knowing that there was definitely nothing that I could have done to save him it makes me feel better, however. The call still bothers me and makes me upset because it's my job to save people and/or make a difference in their life and on this call I couldn't. Yes it's part of the job and it's a hard part of it.

Also on a different note. Public safety education is great and there are people out there who do a great job, a really great job actually, of teaching people safety (ex. Lewisville LAFS clowns). It has come to me that while people are being taught safety and to call 911 in an emergency, that they are not really being taught what an emergency is. Ex. "I called you because I haven't been able to go to the bathroom in a few days." While yes that is a problem that needs to be taken care of, and I don't mind running you up to the hospital as that's what I am here for, what it doesn't need is the EMS and fire departments to be running lights and sirens and putting them at risk of a serious accident. I just would love to see education on what deserves a call to 911. And now I am stepping of my soap box.

Cardiac Arrest

So last night I ran my first cardiac arrest call. Arrived on scene after Fort Worth Fire Dept. (FWFD) to find the man in his RV in the back yard. I placed a back board on the steps of the RV and the man was placed on it by FWFD. So we got the man on the ground on the back board as a hard surface is needed for good CPR. I confirmed there was no pulse and began chest compressions as one of the FW firefighters began using a bag valve mask (BVM) for ventilations. The other Paramedic I was with attached the heart monitor/defibrillator and we confirmed the patient (Pt) was in coarse ventricular fibrillation (V-fib), which is where the heart is just quivering and not pumping. Seeing that heart rhythm, we immediately shocked the heart with 150 joules and began CPR again. After about a little less then two minutes we stoped CPR and had a heart rhythm that looked like it could of been a sinus rhythm with ST-Elevation or just peaked T-waves. The rate at first was about 40, checked for a pulse and found that a very weak pulse was present. The other paramedic had already established an IV and has already given one "round" of epi at this point so we gave some Atropine and that got the heart rate on the monitor to around 60-70. Since the Pt did have some what of a pulse but still wasn't breathing we went ahead and placed the pt on the stretcher and moved to the ambulance, where the other paramedic intubated the pt. As we were leaving the scene we lost the pulse even though there was still a sinus rhythm on the monitor (known as pulseless electrical activity or PEA). CPR was started again by one of the FW firefighters that went with us while I ventilated the Pt. A end-tidal CO2 device was attached to the monitor and we had a ETCO2 reading between 10-20 which is very good in a full CPR event. We also were able at one point to obtain an SpO2 reading of 6 (SpO2 is the amount of oxygen in your blood). We were able to obtain the SpO2 level because the the good CPR that was being done by the FW firefighter and at this time I would like to thank him (and his crew) for there help. Even with all the things that we were doing and all the good readings on the monitor that we could get, it wasn't enough to save this man. It's unfornuate and I wish we could of saved him but it was his time. I can't even begin to explain the feelings I had when the doctor "called the code" at exactly 2100 hours (9 pm). Its a mix of sadness, I've done everything I could of done thoughts, he's too young to die, and it's his time, all racing through my head at the same time.

Update

Ok so finally finished with the new hire academy and now I am doing a month long of driving training with a driving training officer (DOT) where I am actually driving to calls. Started doing that on October 4th. I am currently working 16 hour shifts which seem long but it's nice to only have to work three days a week right now.

So yesterday was my fourth shift with my DTO and earlier in the day we were talking about how he (my DTO) has never had anyone that he's trained that had been involved in a preventable accident with one of the ambulances. Well guess what... he jinks it. I was sitting at a red light, first in line, at a complete stop, and I got rear-ended. Lovely!!! Wasn't anything serious, in fact barely felt the collision and no one was hurt.

I haven't had any really "good" calls per say, but have had some interesting ones. Yesterday was probably the best as far as calls go. Had two different motor vehicle accidents with each having a vehicle that had rolled over. One of the calls had a total of six patients but none critical. I also went to an assault call where the victim was on the side of the road and while taking care of the patient the police were driving by really fast with lights and sirens and there was a police helicopter flying around with its spot light on looking for these punk kids who attacked this poor guy because he didn't give them any money. My guess, they already planned to assault him anyways.

We'll see what tomorrow's shift brings....

End of week two

So the end of week two has come. Feeling a little bit better about being able to work as a paramedic. Well still waiting on my certification from the state but I have my national registry certification. So its just waiting for it to be processed. But still, the nerves are calming down as training continues. Today was the end of a certification class called EPC which is short by Emergency Pediatric Care. Passed it with a test score of 96. Well actually a 98 but the instructor said he couldn't change my score because the people who are in charge of the class have it wrong on the key, but that's ok.

Nerves

So week two has begun (well on Monday). Monday and Tuesday was a certification course in trauma. And as I sit in class and listen to the "war stories" of the things that happen in Fort Worth I begin to wonder, am I as good as I think I am to do this job. I have the knowledge and the will power, but learning it in class with a few practice scenarios is different from the real thing when real peoples lives are in your hands. So we will see how it goes as training continues. Speaking of training, today we had mapping and navigation training. Not living in Fort Worth and only being in the city about four times before in my life when I was young does not help in having to know the streets and how to get somewhere. Thank God for just four weeks straight of just driving and learning the streets.