The MacMedic

A busy night, very busy considering the sleepy college town that I live in and the supposedly dry campus. Seven calls for the night was great even though only three of them resulted in transports and all of those were BLS. the four that weren’t transports were all alcohol related calls on campus, go figure.

It was really nice to be busy. Who needs sleep when you’re busy?

The students came back to the university this week which has meant an increase in the local call volume. I’m happy to say that even though I thought it would be difficult for this college to match some of the incredible feats of stupidity that I had experienced in Medic 1’s area that has proven to be no trouble for the local college population.

With a 48 hour a month requirement for shifts at the volunteer ambulance I figured I would be a “wise ass” and since the primary crew was fully staffed for the night shift I would sign up for the backup crew, get my 12 hours credit and sleep at home in my own bed all night. You would think that someone with my experience would realize that any shift is a crap shoot and you stand a good chance of being disappointed if you count on anything.

Shakespeare had once said “In the darkness of mens souls it is always 3am” and I should not have been surprised when the tones went off for a fight a little after 0300. Still, I was on the backup crew so I did the “rollover” maneauver by reseting the pager and going back to sleep. For some reason, that eludes me right now, I was very surprised when the tones dropped for the backup crew and I actually had to get up, dress, and head out the door to back up the primary crew.

When we pulled up it was quite an interesting scene. University police, local police, and state police all were on scene, it’s never a good sign when you find police from other jurisdictions on your scene. The radio traffic was making this sound like a major melee with multiple victims. Almost before the ambulance was in park the fire department was walking one of the victims up to the back doors and opening them up. The victim climbed in and sat down on the stretcher. All that anyone could find wrong with him was a 1cm lac on his scalp.

Since there was still a lot of police activity on scene and no other patients to be found I figured it would make more sense to get out of the area rather than try to sort out why two patients with head lacs needed two ambulances. Three minutes after we arrived we were enroute to the ED. The transport was uneventful and we arrived moments after the first due ambulance.

Clearly I am still adjusting to a new system, and I managed to tick off one of the nurses early on. Our patient insisted on ambulating into the ED under his own power and we were met by the triage tech who directed us to a room, took my report, and left to chat with the nurse. Seconds later she was back and the patient was directed out to the waiting room to sign in. Figuring that my job was done I went back to the EMS room to muddle my way through the electronic PCR. Halfway through my partner tapped me on the shoulder and let me know that the nurse was upset that I hadn’t given report to her.

OK, true enough, I had not spoken directly to the nurse but I had given report to the triage tech who had relayed enough information to the nurse to make the decision to send the patient to the waiting room. There was not much that I was going to be able to add other than that the patient had no idea when his past tetanus shot was. I finished my report and printed out the hospital copy.

When I brought it to the nurse she had somewhat calmed down and the brief exchange that followed led me to believe that this was simply an issue of me knowing “whose was bigger”. Whatever, I really have not played those games for the past 24 years and I certainly am not going to start now. I gave the report she asked for and we headed back to the station and after that back home.

We still never figured out why that call took two ambulances and probably never will. In reality it doesn’t much matter, I learned my lesson (again) that there is no such thing as a sure thing. As one of the other people on call last night said “Don’t do the time if you can’t stand the crime”. Yes, at 0430 in the morning the best we could do was a twisted paraphrasing of Beretta.

I started out being on the schedule from 2200 to 0600 for coverage at the station. Nobody picked up the 1900-2200 piece of the evening so I decided I would do that as well but I would cover those hours from home. The service likes to have a crew in the station but if that doesn’t work out personnel coming from home is the next best thing as long as they are can be at the station in eight minutes from the time that the tone drops.

For last night it didn’t matter much as there was no calls and I managed to get a good six hours of sleep.

OK, with credentials from the hospital and completed orientation from the corps I have jumped out of the frying pan and into the fire. A little after 0700 the pager went off requesting a full crew respond with the second due ambulance (the scheduled crew was already out) for a patient with back spasm who was unable to stand up. While my last call had four providers on the crew (something I am not used to) this crew would end up being just me and an EMT-B/driver. I was it and the request from the fire department on scene was specific for an ALS ambulance.

Living so close to the station I was there in just a few minutes and signed on awaiting the arrival of the rest of the crew. As it was snowing and pretty icy road conditions I vacated the drivers seat and figured the more senior guy should do the driving. He arrived and we were on the way. Fortunately the officer in charge had the sense to cut our response down from “hot” to “cold”. Better to get there a few minutes later than not to get there at all.

We backed into the driveway and the first EMT to approach me made a point to have me bring in not only the routine gear we would take into the house but also to grab my narcotics as well. I had already had that feeling and was fishing for my keys as he said it.

I felt a little anxious as I walked into the house carrying ALS gear that I had never used before, with different protocols than I had used way back in the dark ages of last year. I was guided into a second floor bathroom that was so narrow that my I couldn’t understand how someone seated on the toilet could sit straight without banging their knees on the other wall. This patient had somehow managed it and was clearly in severe pain and cried out anytime he moved, successfully or not. No way he was getting out of the room in the condition he was in.

I took a deep breath, swallowed hard, and went to work trying to recall my new protocols. Since I had never used Fentanyl before I was a bit more conservative than some of the paramedics I had been with so far but after 25mcg and then another 25mcg in his IV his pain was lessened. A milligram of Ativan right before we started taking him down the stairs and he, while still in 6/10 pain, was much less irritable and much more cooperative.

A nice slow, easy ride to the hospital and 20 minutes later he was getting more medication from the ED staff. While it had been a fairly routine call for everybody else I was quite chuffed with myself for having made it through the call with no major or minor screw ups and even chose to use what seems to be the preferred treatment modality (Fentanyl/Ativan) rather than the one that I was familiar and comfortable with (Morphine/Valium).

Of course all my feelings of accomplishment were blown out of the water when I had to tackle the Electronic Medical Record (EMR). What would have been a ten minute job when writing out by hand took me almost 45 minutes before I was sure that I had checked every box I was supposed to and clicked every applicable button.

Only one more call for the day, a “man down/unknown” outside a campus building but by the time I got to the station and pulled the ambulance out we were being cancelled. No matter, dorms were opening for the spring semester today and the students were coming back. From what I have been told it is time for the call volume to make a steep increase before leveling off. I am looking forward to it.

I got to crew my first official call in this state and even though there was another paramedic on the ambulance it was a simple BLS call for shoulder pain post motor vehicle crash. Board, collar, and an easy ride to the hospital. Nothing difficult and I probably could have begged a ride back to the station and gone home but I was out and the hope was there for something else to come in.

Nothing did, but I could always hope.