"For the Unconscious"

Calls run in random, almost crazy patterns that sometimes give you cluster days where you are bombarded with all similar calls. Some days its psychs, other days its carry-downs. (What really sucks is when a carry-down cluster intersects with a humongous patient cluster.) Other days it is asthmas or strokes or MVAs. I once had a cluster month of cardiac arrests where I did 10 in just 12 days of work.

Today was “unconscious” cluster day with a side helping of “cardiac arrest.”

Sign on in the morning and we are sent on a non-priority for a sick person in the north end. While enroute, we are switched to a priority one “for the unconscious” at the train station. Get there and can find no one so we clear no patient. Later we are sent “for the unconscious” also in the north end, possible drug overdose and no one is there. In the afternoon, we are sent “for the unconscious” in the height of rush hour. Arrive to find a man slumped over at a bus stop. He is just drunk.

Earlier we are sent for a “fall possible unconscious” at a chicken restaurant in another town. We find a man lying on the ground writing in pain. He says his knee hurts. He has fallen earlier in the day at a senior center – the man is 90 – he felt okay, then went about his way. While eating chicken, the pain became so unbearable he thought he was going to pass out. His knee looks a little deformed, but then so does his other knee. Only a little pain on palpation. His pressure is 93/60 – he says he usually has low pressure. He says he feels dizzy like he is going to pass out. We take him to the hospital – it is very odd – he looks terrible, but he says the pain in his knee isn’t as bad. The one problem with the call for me is he is hard of hearing and he has the most foul breath – it is so foul – it makes me think there is something wrong with his insides. I have to lean forward to shout at him, but then he answers before I can pull my head away and I get hit with a toxic plume of breath. Very unpleasant. We finally get him in the room at the hospital, and then he starts to puke. He fills up three emesis basins with thick food like emesis.

I am writing up my run form, when I hear on the radio of one of our fly car medics in a suburban town that there was a “cardiac arrest” there. Both fly medics are at the hospital writing their run forms up. I get a page then asking any available car to clear, so my partner and I clear and are sent to the cardiac arrest.

It turns out it isn’t a cardiac arrest, but still an interesting call. A forty year old woman, who has had a cardiac arrest a couple months ago and has an implanted defibrillator was mowing the lawn when the thing went off, knocking her on her back. It went off three more times. She is extremely anxious when we get there and worried she is about to die. It is the first time it has ever gone off. I do what I can to reassure her, as well as giving her some Versed to ease her anxiety and take away some of the pain should the defib go off again. Her kids who were with her when it went off are all bawling and we haveto try to calm them down as well.

Toward the end of the day we are sent “for the unconscious” man in a car. Enroute we get an update from one of the fly car medics that the man is in his car in the garage with the engine running. Then before we can get there we get cancelled. I am guessing the fire department got the man out of the garage and the medic called him dead.

Not two minutes go by before we are sent “for the unconscious” – a woman in a car outside a medical building. We arrive first and a woman directs us to a car where I can see someone sitting in the front seat. “I knocked on the glass,” the woman says, “but she wouldn’t move.” The door is open. The woman in the car is elderly, head slumped forward. She is cool and not breathing, but still limber. I shout to my partner that it is a code, and then I pull her out onto the board and do CPR as we wheel her to the stretcher. One of our supervisors has arrived and then the fly car medic. She is asystole. It is nice having two medics with me. All I have to do is hold out my hand and they hand me the ET tube or drawn up drugs. She has the tiniest chords. I am just barely able to get a 7.0 through them. We transport her to a local hospital, but we don’t get anything back. If she had died at home I would have worked her twenty minutes, then called her, but here the twenty minutes aren’t up until we are reaching the hospital. The doctor in room one calls her dead shortly after hearing our report.

***

One funny or not so funny from the day is when we arrive at the scene of the drunk at the bus stop. We pull in to the bus stop opposite traffic so only my partner can see the patient. I get out the passenger door, grab the blue bag from the side of the ambulance, then go around the back, thinking my partner has gone directly to the patient. As Iwalk around the rear, the back door swings hard right into me, catching me dead on. My partner is pulling out the stretcher and whether it’s him throwing the door open or a fierce gust of wind, the door catches me hard and quite by surprise. I give him a tough time about it. Fortunately at six eight, two-twenty-five, and the fact that I had my arm in front of me holding the strap of the blue bag slung over my shoulder, I avoided being knocked flat onto the pavement. I suppose then my partner would have had to have requested another ambulance “for the unconscious.”

1 Comment

  • Anonymous says:

    Two comments: Someone I was talking to in the last few weeks had a similar point of view. One day it was cardiac complaints. In that day, the crew went on 10 calls in a row, starting in the morning and going non-stop till 11 pm. I think there were two cardiac arrests, one witnessed. Another crew ran a “All Crazies” night. Crazy domestic violence guy, crazy coke snorter with blood nose, crazy abdomen stabbing guy, etc…I don’t really think there’s a true pattern, except that the human mind likes to find patterns.However, I would like to test the idea:Select 30 days out of the year at random. From one 12 hour shift, also at random, pull the PCRs and then code all the calls to see if any patterns emerge. Then see if it’s really true that some days are less random than others. I’d love to take a whole slew of PCRs and run them through some stats to see the trends.I’m sure for large corporations, there’s a lovely tome of data, but lots of smaller systems don’t spend much time really grinding through the data. It’d be a great way to do QI/QA:Which medic crews have the fastest average response time.Which medic crews have the best patient outcomes.Which medic crews favor a particular intervention.Which crews excel at handling a particular type of call, etc.

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