Saturday, March 30, 2013

Don't Take Credit for God's Work be Thankful Instead.

As Easter rolls around again I am reminded of a call that nearly cost me my job. Years ago just days after Easter my crew was called to a difficulty breathing call. Yeah that was all the information we got as was the situation many times. Not that dispatch didn’t want us to have more information; sometimes a little info was all they could gather.

We arrived emergent at a nice suburban home and were greeted by a near hysterical mother and a somewhat calm dad. They quickly explained that their teenage son wasn’t breathing. As we entered the living room I saw the boy on the floor. He was tiny for his age and obviously had some sort of physical condition.

He had sever kyphosis a curvature of the spine, something like you see in the elderly where they have a huge hump below the base of their head. He was on the floor on his back and ghostly white.

The first question any paramedic asks themselves about a patient is simple; we ask is the person sick or not sick. Because of experience a good medic or EMT can tell in seconds if the person is sick and this kid was very sick.

As I approached him I could see that he had a pulse because of his slender neck his carotid artery was visible and pulsing. So I knew we didn’t have a cardiac arrest, yet. His body was very small and malformed he was less than fifty pounds but due to his outward appearance I could tell he was well past puberty.

His mother began telling us what had happened as I instructed my crew to begin protecting his airway. Mom said her son had a muscle disorder like MS or MD but didn’t really narrow it down. She explained she had picked her son up from school in his wheelchair and on the way home he had fallen asleep so she let him nap in the car.

Dad came home and when he went to check on his son he found him unconscious and not breathing so he had carried him in the house and called us. The first thing to do is check vitals and secure a patients airway. His vitals were all down and his oxygen levels as measured by a pulse oximetry was in the low 60’s, that isn’t good.

The first thing my guys tried was an oral airway device, this caused the boy to begin to gag, next option is a nasal tube, both are designed to help us push oxygen into the lungs with a bag valve mask, it too caused him to gag. So we were out of options at this point to use basic techniques to help him breath.

It is paramount that we gain control of a patient’s airway, in this condition if the boy were to vomit he would aspirate stomach contents into his lungs and even if that happens even to a fit person it can spell huge problems later.

As I considered my options I remember looking at the Easter decorations around the home and thinking of God. I was prone to praying for all my patients but really praying for the ones that I probably couldn’t help.

My next option was a procedure known as a cricothyrotomy, many people believe can we do a tracheotomy in the field but we can’t. A cric as we call it is like a tracheotomy only different, we have to use a scalpel to make a small hole in the neck right at the Adam’s Apple and then push a small plastic tube in to the airway.

I had done this on a conscious person before and it was horrible, the boy wasn’t conscious but because of his condition this wasn’t an option either, I couldn’t even tell where his Adam’s Apple was. About that time the ambulance crew arrived and much to my relief the paramedic on the ambulance was one of the few that had been on the streets longer than me.

I filled him in quickly as to what was happening and told him I felt the only thing we could do was what is known as an RSI, a rapid sequence intubation. An RSI is kind of scary on your average patient but on this kid it was not only going to be difficult, it was going to break the law.

You see an RSI requires that the paramedics completely paralyze the person with a series of drugs administered in a precise order. There are some rules or standing orders associated with an RSI; first you must have complete confidence that you will be able to get a tube in to the airway of the patient.

We knew we didn’t have that, mom had already said good luck with that as it normally takes numerous tries in the hospital to get him intubated. Second one of the drugs we needed to use was absolutely contraindicated for use in people with muscular disorders, this is known as a Black Box Warning by the FDA.

So what were to do? Let the kid die or break some rules? We chose to break some rules. About that time mom passed out in the kitchen and slammed her jaw on the back of a chair. I redirected my crew to care for her and myself and the other medic (I would use his name but I don’t have his permission, but he is one of the very best and still on the streets of my home town, thanks CS) rushed the boy to the ambulance.

We knew what we had to do and went to it. It went horribly wrong for us in many ways as we tried every known technique to intubate this kid without success. The good news was that once paralyzed it became very easy to bag oxygen into the boy’s lungs. His color went from gray to pink and his oxygen leaves increased to the mid 90%. We called ahead to the hospital and asked to have an anesthesiologist in the emergency room when we got there.
We finally used another device known as an LMA to secure his airway and it worked beautifully, thank God.

Myself and the other medic were subjected to an intense review for our actions and only avoided firing and criminal prosecution because of one thing.

The kid lived. So every Easter I think of that day and that boy and my friend (CS) and know that God is great.

Wednesday, March 27, 2013

What the Hell are you Looking at?

I saw these videos today Must see Videos and it got me thinking of the good old days on the streets. I remember people screaming at us when we blocked traffic on surface streets and even worse language when on the Interstate. We block lanes of traffic not so we can hide behind the fire truck and giggle about how much we love jacking up traffic. We block these lanes for our safety and for that of our patients and fellow emergency workers.

You may have noticed this phenomenon yourself as you slow down to rubber neck a traffic accident, without noticing it, you begin to guide your vehicle gently in the direction you are looking. Then suddenly you have to jerk your wheel in the other direction just before you nearly crash yourself. Feel kinda stupid and embarrassed when that happens I bet.

Well guess what, every year people react too slowly and slam into firefighters, cops, ambulance personnel, road workers and anyone else that has to do their job in traffic. I respect that drivers slow down for these accidents, what I don’t respect is their motive. See we know you aren’t slowing for us, we know you are ghouls, what is that people hope to see?

A dead body, a person tangled in the wreckage, the blood dripping from a car? I don’t know what is in the minds of the ghouls, but I know it isn’t honorable especially when their phone or video camera is trained on the events in front of them. It is truly sick to do this people. My God what if you accidently filmed someone you knew mangled in the twisted metal? What if was your family or friends killed or hurt? Would you still rush home to post it on Youtube or Facebook? Would you still Instagram it or tweet it to your friends and followers?

Who knows you might get some huge traffic on your Youtube channel, it might even go viral if you are lucky. Wow, how cool would that be if you captured some really gruesome images, maybe some guts or something? That would be something to show the kids wouldn’t it.

Seriously people slow down to help us and keep us safe, but put the cameras away please. Isn’t it bad enough that the footage from dash cameras in police cruisers and other emergency responder units end up on the internet? Do you need to contribute to the coarsening of society with another contribution? Government agencies have no choice in the release of their videos, it is a taxpayer funded endeavor and therefore a part of the public record it has to be released if that is requested.

Be a human being and show some respect for the tragedy that has unfortunately happened on your way to work, or church, or a meal. I understand the uncontrollable force that pushes your eyes in that direction, I do, but with training you can learn to drive by without looking, I do it all the time. I don’t look anymore, it is too familiar to me, and that is a part of my past, I had enough in my thirty years to last the rest of my life.

If you need to see gross, the internet is full of it I’m sure just Google it and enjoy. Bet you won’t last long. You know why? Because the human body comes apart very easily, we are fragile creatures trust me I know.

While I’m at it I have another pet peeve about the way drivers respond to any emergency vehicle on the road. If the cop car or tow truck, or fire truck is safely off the main road and not in traffic, stop slowing down and screwing up traffic, okay, drive on.

I just saw it today on the interstate, a semi truck had a flat tire and had pulled off on a scenic overlook. Two State Patrol cruisers with their lights on had stopped to help the trucker. This totally mundane event had brought all three lanes of traffic to a standstill. What the hell is that all about? They were all well out of the way, there was no wreck or hazard at all. Yet we all came to a screeching halt and had to gaze at the pretty lights.

I am sure everybody at the back of the traffic jam was cursing about the wait and complaining about how this was going to screw up their day right up until it was their turn to stare at the police cars, then they too had a gander. Why not after all you were already slowed down right?

I’m not sure the reason for these two phenomenon, maybe it is in our DNA, maybe it is a throw back to the days of gladiators and blood sports. All I know is it always bothers me and always will I guess.
I remember the day, 9-11, and I remember being glued to the TV as the events unfurled in front of my eyes that day, just like yours. I also remember the first image or two of people leaping from the buildings. I almost vomited. I looked away and wondered why the news would show those images.

They quickly self corrected and stopped showing those pictures. Maybe because it was live is why we had to see those horrors, maybe they didn’t realize quickly enough what exactly it was that was dropping from the buildings.

A film called the Falling Man Documentary was made about the most famous image of one of the poor people falling to their death. I watched this film not because I wanted to see it, but because it featured an in depth conversation about why we look. If you can stomach it I’d watch it, it just focuses on the one photo and the only newspaper in the entire country that ran it as a front page image and the blow back from doing that.

Alright I’ll put away my soapbox for now I’ve said enough.