Shooting

So, yesterday I finally had my first real gun shot victim/patient.  I use the words "finally" and "real", because in the nearly two months now that I have been here, I have been dispatched to many "supposed" shootings, where no patients were found.  This is a good thing, but a little frustrating because every time people hear gun shots they automatically suspect someone has been shot.  The truth is most of the time here, the "gangsters" doing the shooting, don't really know how to use their weapons.  This turns out to be both good and bad, because we don't have as many people being shot, however many times, when someone is finally shot it turns out to be bystanders just as often as it is the intended target.  With our shooting yesterday it looks like that was sadly again the case. 
It was only 5 in the afternoon and we had just arrived at our post when the call came out as a adult male shot and involved in a MVA (motor vehicle accident).  As we headed code to the scene, we heard a second unit being called to another shooting victim, a 57 yr old female, just a couple blocks from where we were headed.  When we arrived on scene we found a middle aged man siting cuffed with his left side covered in blood.  A hundred feet away were two cars that had been crashed into a cement wall.  I quickly went to check out the damage to the two cars and see if any one else was hurt, then I went back to take care of our cuffed patient.  I cut off his shirt and found a small entrance wound in the left forearm and a subsequent more profound exit wound just superior to the elbow.   I checked the bones and joint and found he had full mobility, it was only a soft tissue wound, so we bandaged it and checked vital signs.  I was amazed at how calm the man was the whole time, till when in the ambulance after starting an IV I realized our patient had several scares from previous gun shot wounds.  We also ended up putting him on a backboard because the car accident, but he didn't seem to have anything other the the injury from the bullet.

So, the story is still being pieced together, but from what we were able to get from our patient and the other crew was that our patient was in his car when he came to a stop at a stop sign.  As he was stopped a woman stepped up to his car to beg or warn him or something when another man jumped out and started shooting at our patients car.  Our patient, who I already explained seems to have an interesting story, conveniently had his gun and started shooting back before taking off in his car.  After getting a little ways, he realized he was bleeding pretty bad from his arm and got distracted running another car off the street and ramming them both into a cement wall at the entrance to a park.  Whoever the other man was, he never got hit by any of the shots, or at least he hasn't gone to the hospital yet for his wounds.  The woman, however, who most likely didn't have anything to do with the whole thing, took at least 2 bullets and after coding in the other ambulance was declared dead within the hour at the nearest hospital. 


What a cruel thing is war:  to separate and destroy families and friends, and mar the purest joys and happiness God has granted us in this world; to fill our hearts with hatred instead of love for our neighbors, and to devastate the fair face of this beautiful world.  ~Robert E. Lee, letter to his wife, 1864

Oh, you go girl

Tonight (well. . . my tonight meaning from 4:45 when I started my shift yesterday to 5:30 am today when I got off) was an amazing night for crazy calls.  It was literally a parade of fools all night.  So hopefully, the next couple days should be full of posts from my experiences tonight, if I am able to make time.

To give you a quick taste, I'll tell about an assault call we received lasts night around 11 p.m.  When we arrived at the apartment complex with APD (atlanta police department) we found an 26 yr old male pacing back and forth in a dark courtyard between buildings.  People were all over, standing at their doors and looking through their windows, watching this guy screaming and crying about how some guy had come and hit him in the back of the head with a bat.  Approaching the man we could see blood gushing from a 2 inch laceration on his forehead.  Someone had brought him out a towel to stop the bleeding, but he wasn't using it very effectively and there was blood everywhere.  After working with a friend to calm him we we finally able dress the wound appropriately and slow the bleeding, but before we could convince him to goto the hospital he decided he wanted to go change into some pants.  After trying to fight for a bit we let him go.  As he walked toward his apartment he got light headed, fell, and we heard the very unique sound of a head smacking the cement.   we grabbed the bed tossed him on it and finally were able to really start checking our patient out.

All his vital signs checked out great and he really hadn't lost too much blood.  He probably fell because he had "maybe, had a little bit to drink".  His story didn't check out very well, though.  He obviously had not been hit in the back of the head, because there was no injury.  The wound was in the front.  And the wound was not likely from a blunt object like a bat.  It was a deep straight cut.  The police asked around and the real story came out.  Turns out that our man was in a fight with his girlfriend, when he got really angry and decided to throw a table at her.  She retaliated and smartly went for a more manageable object, which turned out to be a glass lamp.  I'm not sure if he was ashamed about getting it handed to him by a girl or if the blow had him a little confused, but it was a sad and kinda funny ending to another domestic.

Nature Calls

Tonight we had a very exciting call.  It was sent out as 45 year old male in respiratory distress, priority 1.  When we arrived on scene we found the home dark and completely locked up.  Fire pulled up and started walking around the house shining their lights in the windows looking for our patient.  As they did this, we asked dispatch to do a call back and find out where our patient was.  After a couple worrisome minutes waiting and watching the firemen prepare to break down the door, if needed, we finally got word that our patient was a quadriplegic in the back bedroom.  We were told to make as much noise as possible and see if we could wake the dog, which in turn would maybe wake the patients nurse or sister.  If that didn't work, we had been given permission to smash a window.  After a short time banging loudly on the window and door the dog began to bark and a very stunned and sleepy woman came to the door, gigantic dog in foot.  As the door swung open, the other medic I was with froze too scared as he came face to face with the full size St. Bernard.  I had to smile when I saw his tail waging away and I quickly explained to the woman about the call we had received.  The woman, who turned out to the in home nurse, turned and ran to the man's room, as another woman (the patient's sister) came in sleepily dawning a robe came into view.  I slid past the dog and began heading to the patients room, as the others stood hesitantly waiting for the sister to take care of the dog.

Upon entered the room, I found an agitated and apologetic man lying on a big king sized bed.  His nurse at the bed side hastily preparing a foley catheter (tube that goes up the urethra to the bladder).  Apparently, our patient just really needed to goto the bathroom.  He had been lying in bed for the last couple hours trying to get a hold of anyone, but had been unsuccessful.  His desperation finally grew enough that he decided to just call 911.  When you got to go, you got to go and unfortunently for this guy, his state doesn't allow him to go unless someone puts a foley in him.  Be happy that your organs work like they should.

Cardiac Arrest

I experienced my first cardiac arrest here in Atlanta the other day.  It was not really the best experience and I am not too eager to tell the story, but some have expressed an interest, so here it is.


The call was initially sent out as diabetic emergency, but as we arrived on scene we were informed that CPR was in progress.  Upon entering the residence, we found our patient a 52 year old male lying supine (on his back) with vomit all over.  Apparently, he had just finished eating dinner (chicken noodle soup) when his eyes rolled back in his head and he fell off of his chair unconscious.  Everyone was screaming and people kept running back and forth through the room as we tried to suction the vomit, get an airway in place (tube down his throat to breath for him), and get him on the monitor (put the pads on and see what his heart was doing).  As we were doing this, we had a panic stricken neighbor doing CPR till the fire department arrived.  After not being able to place a good airway because of continued vomiting and finding that our patient was in asystole (no electrical activity in the heart.  A rhythm that we can not shock) we used the fire department to get him out to the ambulance.  I had taken over on CPR after unsuccessfully being able to improving ineffective CPR being done by others (Important note: CPR has to be fast, hard (brake ribs), deep and you need to allow proper recoil of the chest.   Good CPR is the most important factor in lives being saved according to the American Heart Association).  A line for fluids and medications was then started via a IO (bone needle) into the tibia (I am not sure why that was done before any attempts were made on an IV, but we needed a line).  After giving the first round of drugs we were off and I switched back off CPR to see if I could improve the airway.  After just one second at the head, I could see that our tube (a king airway) was not getting any oxygen to the lungs.  I pulled it and found that the whole thing had become filled with partially digested chicken noodle soup.  After suctioning another 500 ml of junk out of our patient I just threw in a OPA (plastic tool used to keep the mouth open and to keep the tongue out of the way) and bagged him since we were arriving at the hospital.   For a little we had a rhythm on our monitor, indicating electrical activity in the heart, but we never felt a pulse so his heart never started beating again.


At the hospital they were able to get an NG tube in (tube to the stomach) and sucked out all the rest the chicken noodle soup and the air that had filled his stomach.  This made it possible for them the get an airway in place, but they never had anything but asystole on their monitor and the doctor ended up calling it (declaring the patient dead).  


I think I should mention that we also pushed several more rounds of drugs and checked his blood sugar on top of other things that I didn't mention above, however this was unfortunately not one we were able to save.  In every call like this you find yourself wondering if there is more you could have done or if you should have done something differently, especially when they are younger, like this guy who was only 52.  But what saves me from worrying too much, is my knowledge that there is a master physician watching over every patient that I take care of.  Our loving Heavenly Father is the master of all and he decides who will stay and who will go.  Sometimes he allows me to be an instrument in his hands to save lives, but other times he calls them back to him.  As I have worked in this field I have seen and heard about miracles were people get away from certain death without a scratch, but then other times it is just the persons time and I am coming to accept that reality.  His will be done.

Partying it up at "The Jungle"

So, I just got back from a call at "The Jungle".  Um. . . yeah, when I heard that was where we were going I thought it could be one of two places: a strip club or a gay club.  Turns out, it was the second.


This weekend is Atlanta's gay pride celebration and the streets have been full of rainbows and transvestites.  According to Andrew Collin's article on about.com, "No city in the southern United States throws a more potent gay pride celebration than Atlanta" (http://gaytravel.about.com/od/gaypridefestivals/qt/Atlanta_Pride.htm).  With regards to the patient that we picked up, this explanation couldn't have been phrased better.


Our patient, a 28 year old male, was most likely drugged with HGB (the date rape drug).  Upon arrival we found him unresponsive to any stimuli and super diaphoretic (sweaty), however he was doing a great job maintaining his own airway.  We immediately tossed him on the stretcher and went to the back of the ambulance, where we started a line (iv fluids), put him on oxygen, and checked all his vitals.  While we were doing that, the patients friend called his cell phone to find out where he had gone.  We explained what was going on and let him know that we needed him and any info he could give us on his friend.  Next thing we know, there is this big group of nasty sweaty dudes in their underwear standing outside the ambulance.  After getting the one friend to put on some pants and tell us what he knew about the patient, we were on our way.


Everything went fine all the way to the hospital, all his vital signs looked great.  I did put in a NPA when he started snoring and we tried a drug called narcan (an antidote for narcotics overdoses) to see if it would wake him up, but it had no effect.   Supposedly, when patient wake up from HGB they become very violent, so we were happy when we got to the hospital before he really started to wake up.  In all it was a fun and funny call.


(dedicated to my friend Ben Ralph who I know likes to hear about men in underpants)

The memories they just can't seem to escape

This morning I fount myself, yet again, in the back of the ambulance with a sad psych patient, but for some reason it really hit me hard this time.  Lots of times we get these CRAZY wild psych patients that are just not all there and it is really just kind of funny.  Especially when they start to sing Elvis in the back of the ambulance or when they dance a little jig for you as you walk them into the hospital.  Other times, though, we are called to pick up these sad PEOPLE who have just had life hit them with something that was too hard for them to handle and it's disturbing because you can see these terrible memories taring at their minds and souls.

The man we picked up tonight suffers from post traumatic stress after being beat half to death in prison and was called in by his mother because he has been non compliant with his medications.  We ended up restraining him to our cot, because he has a full body tick that appears very intimidating (He swings at the air and yells out as if he is going to fight), but in the end it was probably not necessary.  On scene, however, there were 3 different APD (Atlanta police department) units, since it seemed very likely that we were going to have to take down this big muscular dude when he decided to fight.

I couldn't escape the sadness of the situation as we drove to the hospital, though.  This man was probably a normal happy child at one time with dreams and aspiration, but now he was this mental wreck tied in the back of our ambulance.  Another man we pick up on a regular basis was at one time a high school history teacher, then he shot an intruder that snuck into his house late one night.  The intruder turned out to be a young neighbor boy and this man was never able to get over it.  He now wanders the streets and drinks till he cant walk.  

I just finished reading Ishmael Beah's book "A long way gone, memoirs of a boy soldier".  I was so inspired by the ability of this boy to overcome his terrible memories after all he had passed through.  What makes him so special?  Why can't these people I pick up, free themselves from the memories that are destroying them?  How would I fair if I were in their situations? 

"A sick thought can devour the body's flesh more than fever or consumption."
- Guy de Maupassant (Le Horla)

Band aid, not 911!!!

This post is intended to inform. Even though I know that the people reading this blog are not the ones who need to hear it.  I just need to say it.  The ambulance is not a taxi service or a good replacement for a family doctor.  It is ridiculous how many of the calls we go on each day are (pardon the word choose) Bull Shit!
I understand many times people panic when they see blood and think things are a lot worse than they really are, but then other times it is just because people are too lazy to take the bus to the hospital or because they can't stand to let a fever plague them for more than an hour.


One such call was dispatched to us as a traumatic injury, both us and fire were sent, priority one (lights and sirens).  When we arrived we found a middle aged woman with a slightly bloodied hand towel wrapped around her finger.  She had cut her finger while preparing dinner.  We uncovered the wound and found a tiny superficial laceration that had completely stopped bleeding after she had applied a little pressure.  We calmed the woman, placed a regular band aid on the tip of her finger and were on our way, after trying to explain how future "emergencies" should be handled.

Scissors

One of my favorite calls so far was a stabbing that we were sent to.  Both because it was an interesting call and because it was the moment my preceptors really began to trust my skills.


When we pulled up to the scene a big muscular 30 year old male walked up to the truck.  I jumped out thinking he was going to take us to the victim, when I notices several little half inch cuts that were lightly bleeding on the man's chest and arms.  "Is there anyone else injured?" I asked, slightly disappointed that this was our supposed stabbing victim.  There wasn't and I started going through my assessment.  Turns out our patient had entered in a dispute with his little brothers friend over some football game or something, when the friend grabbed a pair of scissors from the counter and stabbed our patient several times in the chest and arms before running away.

After cleaning and examining the wounds only one slightly disturbed me.  It was a puncture on the left side just superior to the man's nipple.  The wound was not really bleeding and it didn't seem too deep, but it was hard to see.  Just to be safe we checked his lung sounds, Oxygen saturations, and started heading to the hospital.  Quickly, our patient started complaining of difficulty breathing and became very diaphoretic (sweaty).  I explained to the man the fact that it was possible that blood was seeping into his lung, however when I looked up I met the disbelieving gaze of my preceptor.  He, kind of, gave me that; "you don't know what your talking about look" and explained that there was no way the scissors went deep enough, since our patient was such a muscular man and since there was no air bubbling out.   However, I still was unswayed and placed the patient on oxygen, started a line, and kept trying to listen to the man's lungs.  As we approached the hospital the man vomited and I noted a drop in sats if the man laid flat (indicative of fluid on the lungs), all good indications that he was developing a hemothorax.


Rolled the patient into the trauma bay I could tell my preceptor was starting to agree more with my diagnosis, but his pride wouldn't allow him be bested by his brand new student.  That made it all the more difficult for me not to smile when the trauma surgeon immediately ordered a chest tube be placed, because it looked like a hemothorax had begun to develop.  Even after that my preceptor was reluctant  to admit to me that I was right, but ever since I have noticed a bit of a shift as he is eager to have my opinion and have me decide in what direction we should go with medical calls.

Just When You Thought You Were Safe (make sure you read it with a dramatic movie voice)

So, I have to tell you about one of the calls we had last night.  It was very memorable and a lot of fun.  Initially I didn't think of it as anything special, because it was dispatched to us as a "traumatic fall".  When we get calls dispatched as falls it is usually for drunks or geriatrics (old people) falling and it's usually not that exciting.  This call, however, was a little different.

As soon as we realized that the complex was a sort of retirement community I started thinking through the possible causes of a fall in an older person (cardiac problems, stroke, Alcohol, etc), none of which were even close.  Fire had arrived before us and as we approached the apartment we heard a woman yelling for help and some very loud banging, which turned out to be the fire department breaking down the woman's door.  Several security guards were also present and I started wondering if we had some type of domestic abuse going on.  When we walked into the room, however, we found only one person; a heavier set woman in her night gown, but she was not simply laying on the floor.  She was trapped under her power chair, with her night gown wrapped up on of the wheel.  

Apparently, she had been driving around as usual in her chair getting ready for bed when her new long gown caught up in the wheel.  Before she realized what was happening she had been pulled off the front of the chair and right into its path of the monster.  It rolled over her left leg, pinning her just, luckily, just inches from here purse.  After retrieving her phone from her purse she decided to call her son (in florida) so he could get her an ambulance, since she had forgotten the number for 911.

After rescuing her from her attacker, we checked her out and everything turned out to be totally fine.  No real injuries, however, we did take her and her chair to the hospital just to be safe.  She was a really funny lady and we laughed about the whole thing all the way to the hospital, but she was a lucky one.  Let it be a lesson to all to watch your backs, you never know when technology will turn on you. 

Me and the culprit 

Grady Living

Here is a little treat for ya!  My living quarters at Grady.  I thought I'd show it to you since I made an attempt at cleaning the place up a little.  Sad I know, but worth the $150 a month we are paying. Well, for the proximity at least.

Grady EMS

Image, that I love, found on the NW wall of Grady Hospital

Alright, lets get this really started!  Sorry, for some reason I have been procrastinating this.  Maybe, it is because I am totally addicted to playing with my new I-phone.


So, before I tell any exciting gory stories I want to explain a little bit about how things work here in Atlanta.  Grady EMS is responsible for the whole city of Atlanta.  It is a very high-volume hospital based service that serves a population of nearly 500,000 people (according to wikipedia) in an area over 132 square miles.  Here they responded to over 120,000 calls in 2009 and I believe I heard that they are projecting that number will be much larger for 2010.


I work with two different preceptors here;  Monday and Tuesday I work 16:45 to 6:30 with a very intelligent paramedic originally from Long Island, NY, but who has been working here for almost 10 years and his partner, who is an EMT-Intermediate from here in GA somewhere.  Then Wednesday through Saturday 18:15 to 4:30 I work with two wild goofy paramedics who have been here for about a year.  The woman, my preceptor, is a short high strung, but funny lady for Alabama and the man, is a country bumpkin from some small GA town.


How our shifts work is; we show up at our scheduled time, find out what truck we have for the night, pick up our equipment (keys, drug box, radios, monitor, etc), then we have 15 minutes to check the truck out (making sure we have everything and that it all works fine) and get "in service".  Once "in service" we are dispatched to specific post via a message sent to a computer screen on the dash.  Throughout the city there are different "posts" (gas stations, school parking lots, etc) where we are strategically placed to wait for calls.  When a call is received it appears on the the computer screen as an address, complaint, and priority.  A priority (1 through 3) is assigned to all calls as to help us know how emergent the problem is.  For example, we do not want to drive lights and sirens to a headache, putting ourselves and other drives in danger.  So, a headache would be assigned a priority 3, not meaning that we will not hurry, but only that we will do so safely.  After we are on our way to the call, we are also able to receive additional information about the age and complaint of the individual via radio.  On an average night we will run anywhere for 3 to 15 calls and drive hundreds of miles zig-zagging back and forth through the city.  Some calls are gruesome, some are sad, and others are just ridiculous, however, it makes for a very interesting and fulfilling job and I am absolutely loving it.

Being pinned as paramedic

Training