The “Gut Bucket”

By Hoss Feldhauser

This is a true accounting of some of the events that I experienced

while working on the Rescue Squad for 33 years. Some of it is raw and
may offend some readers. But in the times of emergency life can
sometimes be raw. I have avoided using descriptions that might
identify patients; but all stories are accurate to the best of my
recollection.

This is a draft version and you will note grammar errors and less than
perfect writing in some places, it is something I am working on. Your
comments would be appreciated.

Section A- The “Night From Hell”

Chapter I. The Overdose

I can’t start this story out penning the line … it was a dark and stormy night;
simply, because it wasn’t. In fact, the night was like most mid-February nights,
freezing cold and there were small piles of snow on the ground leftover from a
typical short-lived Northern Virginia winter storm that had passed through our
area the week before. The landscape appeared brighter than it really was due to
the half-moon shinning on this clear, cloudless night and the snow cover was
reflecting the glare of the moon.
I was on ambulance duty, nothing unusual about that as I had been active in
the local volunteer fire departments rescue squad for over 33 years. Spanning
those years the Friday night ambulance crew comprised of many different folks,
but the foundation of this rescue squad call team was anchored by my regular
partner, Hal Shaner, myself, and for many of those years we were fortunate to
have a steady driver, Junior Kisner. The rest of our crew members came and went,
most making an positive, helpful impact on the lives of those they came in
contact with; and a few that served with somewhat less distinction. I can proudly
say that many of the young “new bloods” that Hal and I introduced to the world of
emergency services grew on to do well in the “business” of saving lives. Some
went into the trade professionally and others faded away after enriching both
their own lives and the local society in general.
Hal, Junior, and I have shared many remarkable adventures while on the
squad; some were great fun, some were very rewarding experiences, and
regretfully there were a few events that we weren’t happy participants. On the
positive side of the equation was the fact that those “unfortunate” adventures are
limited in number. One of the most rewarding reflections I have is the knowledge
that there are people alive today as a direct result of our lifesaving efforts. We
didn’t do it alone, we performed as a part of the team of dedicated Cardiac
Technicians that served in our community.
One of the reasons our call team stood out was that we made an effort to pass on
the benefits of our experiences to the newer members of the Department. The
Friday night crew was a very popular team to be on because Hal, Junior and I
worked hard at providing “real life” training for our teammates.
One method of training that proved to be very effective was in the form of friendly
game I developed for the new guys. I would make a list of 10 items that could be
found on the “first due” ambulance and offered the challenge to identify every
item on my list. One condition of the contest was that anything on my list was to
be a piece of equipment that we did really use. The person had to be able to
locate it, identify it by the name we used to refer to that item, and know what was
it’s intended use. To make this game “sporting” I would place a wager with the
person; if they found all 10 things on the list that I would buy them a soda and if
they failed to find any of the 10 items they would buy me a soda. I would mention,
as a teaser, that I liked ginger ale or RC Cola or some other particular flavor as a
hint that I didn’t think they could do it. Almost all the time I would be awarded the
soda the first Friday night of the contest. I would “ham it up” a bit by doing a little
bragging on how refreshing the drink tasted. That flaunting would serve as
incentive to the contestant; they would work hard at learning where everything
was on the unit so that I would have to buy them a soft drink on the following
Friday. Often that’s just what would happen. I didn’t mind buying that soda at all
as I figured it was a good investment in advancing the value of our new team
member. When someone first started on our team they would initially serve as a
“gofer”, as in go for this – go for that, while they gained experience and learned
how to work with the patients.
There is one night of “on call” that sticks out over the others because I
believe that it demonstrates just about the full range of human drama and
emotions that we are often exposed to while working with the squad. Life saved,
life lost, humor, immense tragedy, sex, beauty, ugliness, and all classes of
passions were represented. As well, there were visible examples of the
cooperation and inter-working of the emergency medical environs. Most of all the
ability of the people involved to provide emergency care with compassion, all the
while maintaining their sense of humor, is portrayed within these circumstances.
The composition of the call team was a little unusual because Hal was not with us
on this fateful night, but Junior Kisner was on duty and he was a regular on the
Friday night team for over 15 years. Another member of our crew that nigh stands
out as he was the brother of one of our Department members, but not a member
of the Department. He had committed some minor foul with the law and had been
sentenced to “community service” by the judge. As events unfolded this young
man proved to be a hard worker “paying his debt” in earnest by cleaning up
around the station. After a couple of Friday nights observing the workings of the
Department he expressed some interest in going on a call with us to see first hand
what it was like “in the field”; so I signed him up. That is I had him register in our
ride-a-long book in order to certify that he would hold all confidences to which he
was exposed and not to sue us if he got himself killed while out on the “gut
bucket”. After we got the paperwork finished I conducted a brief safety in-service
on what was expected from him on a call as well as some of the limitations he
needed to heed as an observer. He was thrilled at the prospects of responding in
the ambulance on his first emergency call. As it happens sometimes, all evening
we didn’t have a call; not a wheel turned in response to an emergency.
You can tell the “young bucks” from the “old hats” around the firehouse
because the newer members want the emergency calls to come in and the older
members really are quite happy to have a slow, uneventful night. Sometimes,
jokingly, when it’s slow the newer guys have been known to grumble that if
something exciting doesn’t come in soon they are going to go out and “hurt
somebody” just to have some thing to do. They have never done that, of course,
but it’s an example of the humor used around the station to help ease the
tensions of being on stand-by with nothing happening.
So, all was quiet and as our individual bed times approached we retired to the
bunkroom for what I hoped would be a good nights sleep. But alas, it was not to
be. About 2:30 in the morning we were alerted by a series of radio tones from the
911 dispatcher to an emergency call in the western part of the County.
Company #1 (Front Royal Volunteer Fire And Rescue) and Company #8
(Fortsmouth Volunteer Fire Department) were dispatched to respond to the 62-
year-old female who had taken an overdose. Due to patient confidences I must
omit any more detailed information on the location of the emergency or identity of
the patient. The scene of this crisis was in Co. 8’s first due area and we, at Co1,
responded because we were the only advanced life support unit in the County.
Junior Kisner was the driver and I rode “shotgun” on the right side of the unit as
the officer-in-charge and navigator.
Junior has an extensive knowledge of the roads in the County, and as usual
he knew where we were going and the best way to get there. Not having to first
look up the address in the map book or ask the dispatcher for a “cross street”
helped make our “response” very quick for that time of the night [that’s the
interval from dispatch to when the unit rolls out the door]. Also, because our full
crew routinely stayed overnight in the bunkroom at the firehouse we were able to
mark up on the radio as responding within minutes of the call coming in.
In the squad you quickly learn to be “fluid” in developing your plans for
addressing the emergency you are responding to; that is you often have to make
adjustments as more and more of the situation reviles itself. Especially at that
time of night I preferred the transports that were located out in the County,
because it gave some crewmembers time to wake up completely. On the other
hand I would frequently take the extra travel time as an opportunity to finish my
snooze. I oft times could cat-nap on the way to a scene, as long as the driver
knew where we were going and didn’t need me to navigate and also providing I
didn’t have to communicate with dispatch a whole bunch. There was nothing
exceptional about the ride to the scene of this emergency and we did not receive
any updates as to the nature of the problem we were about to encounter.
As we got close to the area of the call Junior made sure I was awake so that I
could perform a scene size-up as we approached. It’s a matter of safety to look
around the area of a call to identify possible hazards and to map out an alternate
emergency exit plan. If you find yourself in a predicament that requires a
emergency exit from the scene then this need generally develops rather rapidly
so it’s wise to layout something before the need arises. We also refer to this
urgent procedure by the designation PUHA. That’s pronounced just as it’s spelled
and is the abbreviation for “Pick Up, Haul Ass”
As we rode up to, and then just past, the dispatched address I noted the
presents of 3 maybe 4 inches of snow on the ground, that there was no car in
immediate sight of a double wide trailer, and there were no lights on the trailers
on both sides of out target. It’s our usual methodology to stop the ambulance at
the side farthest from our expected entry point. This gives the crewmembers a
chance to look around the immediate vicinity of the scene to identify possible
obstacles. A fenced in yard can mean there is dog to contend with or blood
splatter on the door can also mean we really need to look around a lot more
before going any farther.
Fortunately we didn’t see any of those difficulties and what we did see was
reassuring; the lights were on in the trailer and the snow had been removed from
the porch and steps. That the lights were on a 2 in the morning was a good sign
that we were in the right place and the fact that the snow had been removed is
always best so we don’t have to get our feet wet and helps reduce slips while
getting the patient out of the residence if we have to carry them.
I was pleased to notice that the crewmembers were following their training as
they prepared to step out of the unit. Regardless if they were riding in the front or
back of the ambulance they glanced up and down as well as side to side to search
for impediments or possible dangers. They also used this opportunity to take
notice what situation they were getting ready to step into. It’s a practice that I
have encouraged everyone to get in the habit of doing; some day it may save
them from serious injury. The significance of this maneuver was instilled on me
one afternoon several years prior when I forgot to look before jumping out of the
unit at a scene of a automobile accident and stepped waist deep in a snow drift
that was covering a ditch along side of the road. It is considered bad form to be in
the need of rescue before you can rescue the people in the original emergency.
Because we had a full crew I didn’t need to grab any equipment to carry in
to where we expected to find the patient. We normally leave the unit carrying
quite a bit of equipment. Including an oxygen bottle and the “jump bag” that has
a lot of the most common supplies you need to treat an emergency patient.
Whenever we anticipated that we were going to encounter a patient with cardiac
dysfunction we also carried in the EKG machine along with the drug box. At times
we felt that we were overloaded with equipment, but the goal was to be prepared
for what we thought we might encounter. I always encouraged my crewmembers
to carry a flashlight at night until you are certain you don’t need it. Even when
going into a building at night I always liked to have another source of light
because you never know if there is going to be sufficient light to see everything
you need to see.
As we approached the door I strained to hear if there were any noises we
should pick up on before we went in to the residence. Gun shots or screams
equate to taking extra precautions. In this case there were no alarming sounds
emitting from inside so I knocked once on the door while turning the door handle
and calling out “Rescue Squad” in a reasonably loud voice. Our objective is not to
scare someone by unexpectedly bursting into their home while at the same time it
is frequently difficult for someone to answer the door after calling for the rescue
squad. Announcing whom it was coming into the house also keeps the
crewmembers from getting shot at! There was no immediate response to my
calling out, so I stepped into the door way, after glancing in the door crack to see
behind the door and looking both ways before stepping inside.
As I looked around I observed an elderly appearing women sitting on a sofa in her
small living room. She was dressed in a green, full-length nightgown and had an
appearance of concern on her face.
“Did you call for the rescue squad?” Is my standard opening question, ask in
a calm but direct way. It establishes us as being with the squad and if there are
multiple people around can help us sort out whom is the patient. As well this first
salvo of interactions will start to give us an initial impression of the patient’s level
of consciousness and their clinical ability to communicate with us. It’s a “safe”
and non-threading question and it is the delivery of this question that can set the
tone of the rest of the call.
The next step, after observing the patient and by-standers for appropriate
responses, is to approach the patient and ask a focused question to establish why
we were called. I knew from my first question that this “little old lady” was our
patient and taking a clue from the nature of the call as dispatched I ask her
”ma'am, have you taken an overdose”? While asking this serious question and
observing the patient for their reaction, I like to make physical contact with the
patient at or about this point. When you invade a person’s “space” and especially
when you touch them, you have their undivided attention. The contact that I
usually initiated was to take the patient’s wrist to feel for the pulse. This is an act
that most people associate with something “medical” which helps to develop a
connection. This practice also goes far in helping establish the patient – caretaker
trust, a bond that can have only positive implications for the patient. I tried to
state my question in a tone and manor that expressed concern and non-
judgmental while establishing that we were going to discuss this topic in direct
terms and not beat around the bush.
The articulation of her response was expected and not all that unusual for
someone in this situation. With a crying/stuttering and anxious voice she replied
“yes, yes I have”. She turned her head away from me and she wrung her hands in
her lap; she presented with a distraught affect.
In the same concerned and direct voice I inquired “what have you taken, ma’am”?
In her feeble manor she blurted out “ he’s been doing drugs all day, I don’t know
what all he’s been taking”. Now this was an atypical answer! It was a strange
thing to say and my mind had been racing ahead trying to observe any
mannerisms about her that might help distinguish what type of drug she may
have taken or if the was she was acting could confirm whatever she told me. But
her answer was not computing in my mind; it didn’t fit what I expected her to say.
The time of day may have been a factor in my not grasping what I have been just
been told, but I really think it was that it simply was not what I expected to hear.
My next question was one to clarify what she had told me and to help me
comprehend what was going on. “I don’t understand, ‘what he’s been taking’”? So
she answered in the same direct and frank manner we had been communicating
so far, “ we were having sex and he made me swallow it !!!” she said this as she
burst out in a stream of tears and sobbing.
Again I must confess I was confused, and the words I heard did not make sense. It
simply was not something a little old lady would be expected to say; nor was it in
the realm of my mindset of what I anticipated her to say. I believe in court they
would call my next response a “excited utterance”, a comment made by a person
that was made without forethought in response to an unexpected event. I can’t
say that it reflects well on the professional mannerism I was trying to present, but
none the less I shot back at her “swallow what”? She then when on to describe in
candid and straightforward detail what sex act she and her boyfriend were
performing and exactly what he had made her swallow. Simply put, I was
dumbfounded. It took great restraint not to laugh at the patient or to make an
inappropriate comment. It was equally hard for me to comprehend what I just
heard from this “old lady”.
I did take notice of those around me; there were probably four or five other
rescue squad personnel in the room at the time. It does speak well for their level
of professionalism that there were no outbursts of laughter or comments for
anyone; I’m sure that they were as flabbergasted as I was. At this point she was
still weeping and I sat down beside her and once again touched her arm. This
slight show of compassion was to help her cope and was aimed at trying to settle
her down a little bit. Plus I was still quite astounded by the current turn of events.
I was assuming that the patient was serious and that her story was not complete
fabrication designed to shock us or to acquire attention for herself. I knew she was
going to need help. I was thinking more in the vein of psychoanalysis rather than
any physical form of support.
My next question to the patient was not founded on any medical need to
know or did it have a lot of bearing on how we were going to treat the patient, but
I ask her “so, where is your boyfriend now”? I didn’t so much really need to know
where he was but I did have interest in talking to him to help ascertain some
background information from a second source. Her reply was just about as
astounding as the first statement I had gotten; it helped solidify that there was a
need to pursue medical intervention. She said, in that sobbing, broken speech “I
wanted him to take me to the hospital, but he wouldn’t, he- he went back home to
his wife instead!”
We do cover the proper way to handle sexual related incidents in our
various levels EMS training. It is usually about a 10 minute, glossed over, lecture
and I can assure the reader that never, never in the 33 years that I was active in
the rescue squad was this particular problem covered in any course of training
that I participated in.
As far as the treatment for this lady was concerned we approached it just
like any other type of emergency call that we encounter. Take care of the basics:
airway – breathing – circulation while performing the primary survey to recognize
any life threading problems [and correct them as appropriate]. Then proceed to
the secondary patient survey to identify potential problems that reasonably may
develop and to establish a patient history that could reveal important underlining
conditions that might effect the patient’s outcome. We have been trained to be
observant and to recognize conditions at the scene that should be relayed to the
hospital personnel.
I’m still quite surprised at the frankness of the patient and overall affect that
she was presenting. Even where I should go with the secondary survey was in
question, so I figured it would be best to call in to the emergency room of the
hospital to speak with the physician on duty. I knew for sure that I did not want to
repeat this story to one of the nurses in the ER; sure, they’ve heard it all before
and they would react with professionalism, but I would not be comfortable
discussing this with any female. I guess you can call me old fashioned; and I think
old fashioned is my position rather than any sort of male chauvinist component.
Then again I could not really figure out how to call this in, what wording I could
use and how I could repeat this story without bursting out laughing. I sure was not
going to use the radio, as there are many citizens that have receivers and would
overhear the details of this most unusual emergency rescue call. I found the
house phone mounted on the wall and decided to use it to call the hospital ER. It
had a long cord and I could step out on to the front porch to hold my conversation
with the physician.
One thing about using a phone from a patient’s house is that you learn real
quick to never pick it up without looking at the hand set first. Eight out of ten
people have a clean handset on their home phone, but it’s that other two out of
the ten that can be most disconcerting. Always look first, you never know how
much crud will be built up on the mouthpiece. This one was reasonably clean and
after a courtesy wipe off on my pants leg I used it to call the hospital for some
advice and direction. I had never called in to report of an overdose of this
particular product before now. I sure wasn’t going to call the poison control center,
as we sometimes do, because they don’t know me and this situation is so wiggled
out that they would, most likely, finger me for some kind of nut calling in as a
prank.
When the ER nurse answered the phone I identified myself and ask to speak
to the “doc direct”. It is not wholly unusual to want to speak to the physician
directly rather than relay the patient information through the nurse. Generally the
nurse could handle whatever our need was or answer any question we had, but
asking for the doc was not all that novel. When the physician came on the line I
again identified myself and in preamble I told him “doc, I’m not making this up
and this is no joke”. After my preamble the on-duty ER doc “OK, what you got?
I gave him the executive summary of the situation that we were involved in.
It took a minute for this information to settle, but as most ER docs he remained
calm and professional. He advised me to reassure the patient that she could not
ingest drugs in that fashion, but to bring her in as he felt it advisable to consult
with her. I’m not sure what the percentage was in his thinking that he needed to
speak to her for a medical reason or to check up on me to see if I was trifling with
him.
I returned to the patient side and, with much effort, was able to control
myself and not laugh in front of her; after all this is a person that is calling out for
help.
I shared with her that I had been talking to the physician on duty in the
Emergency Room and that he wanted me to console her whatever drugs her
boyfriend had been doing would not be transferred to her by the events she had
described to me.
I picked up some indicator, I really never figured out just what it was, but
something told me to dig a little deeper into this patient’s complaint. Since the
physician had been reassuring that a drug overdose was not a major concern, at
least not with the information as we had it to that point. I elected to do a little
more digging into the secondary survey to see if I could get more information that
would be useful to us in the field and to the physician at the hospital.
While I had been otherwise occupied in conversation with the physician the other
crewmembers had continued appraising the patient by obtaining a baseline of
objective data, including the blood pressure, respiratory rate, pulse rate, and
oxygen saturation of the blood. All seven of the patients assessed vital signs were
stable and within normal limits, the patient had no compliant of shortness of
breath or physical discomfort at all, so I choose to allow her to “self transport” to
the cot that was outside the door. Getting around in the confines of a trailer can
be a problem at times.
I also wanted some sort of action so that she would perceive that we were
going to “do something” to help her. Getting her to lie down on our cot relays the
impression that some positive action is taking place. Taking a positive step like
this may help to confirm in her mind that we are taking her stated problem
serious and were not going to abandon her like the boyfriend did. Once the
patient is settled on our cot, that is a good time to ask questions as the patient
does not have that nagging fear that we will not take them to the hospital.
So, I took this opportunity to ask the patient a few more questions, including
a repeat of some of the original secondary survey just to see if we get the same
answers. Upon questioning in greater detail, and after being somewhat reassured
that we were not going to ignore her cry for help and that we were not going to
“brush her off”. The patient was a little more forthcoming when I ask her for the
third of fourth time if she had taken any medicines that evening or afternoon.
That’s when it first came to light that she was on a prescription medication called
Lithium. This drug often used to treat mental dysfunction and patients with bipolar
illness in particular. She was vague and a bit evasive when I ask her how much
she had taken of that drug; she also was a very poor historian about what other
medicine she might be taking, either therapeutic or recreational. When we
encounter this type of situation I will commonly ask the patient where they keep
their medicines. At times you have to differentiate between the medicines they
have in the house from the ones that they are currently taking. I do not ask
specifically if I have their permission to look around but I do figure I have some
degree of implied consent since they told me where the drugs are kept. I’m not
sure that that would stand up in court; I’m probably lucky that never came up as a
problem.
So I took off in the direction of her bathroom medicine cabinet and found an
empty bottle of Lithium. A quick check of the label for the fill date and collation
with the prescribed dosage reveled that the bottle should have been better than
half full. It’s a liberal interpretation that she had been compliant up to this point
with the dosing instructions on the bottle as this is one classification of drugs that
patients often do not follow their physician’s orders. It’s not a proven certainty
that the patient has taken an overdose of this drug but there is a high degree of
suspicion; enough to follow up on with the patient as well as the physician at the
hospital.
There are several standard steps we take on the squad when we believe
that someone has taken an overdose and the aggressiveness of those
interdictions are driven by the physical and mental status of the patient. A few
years ago the standard of care was to administer syurp of Ipecac to induce
vomiting; thank goodness that protocol has undergone several revisions since the
60’s. Our approach is now a little less invasive as long as the patient is asymptotic
and has stable vital signs. The urgency to have the substance expelled from the
body is balanced with the overall edict of “do no harm”. As our patient’s
respiratory and cardiac functions were within normal limits I decided that our best
action would be to contact the poison control center. I was asking for guidance in
the proper care of a patient that has consumed what I conceived was an overdose
of Lithium and there was no mention to them of the other product that the patient
alleges she had swallowed. Taking this step is the same thing the personnel in
emergency room will often do, as the poison control center is the most up-to-date
definitive authority in possible toxin related issues. I was not inclined to call the
poison control center for the possible overdose of protein but was not
embarrassed to ask about the medicine Lithium. We were not 100% convinced
that the patient had taken this drug to excess but we wanted to see if there were
signs or symptoms we should be aware of and if there were any possible
complications that we should be prepared to address.
We were advised by the poison control center that an overdose of this substance
have few potentially life endangering consequences, even if taken in large
amounts. The potential complications to the patients health need to be addressed
by the physician because of conceivable problems that may present themselves
over the course of time, particularly fluid imbalance and liver function impairment.
I was alerted to one side effect that we should expect and that was the rapid
onset of uncontrollable diarrhea.
Explosive and chronic diarrhea does have some medical implications for the
patient but the onset of those health problems are in terms of hours or even days
and not something we need to address in an emergency setting. I was trying to
balance the possible need to start a Intra Venous line on the patient for fluid
replacement balanced against the desirably of the physician to obtain a baseline
of the patients electrolyte values before I induced a hypertonic or hypotonic
solution into her circulatory system. Having established that our patient was not
in immediate danger I elected to hold off on the IV. That our patient was alert and
oriented to place – time- and name [the three standards in determining mental
status], and having established that she could ambulate without assistance was a
great relief.
I must commend the ambulance crew for the compassion they exhibited
towards this patient and for their not laughing out loud at the circumstances of
her original chief complaint. Every time I ran the events through my mind or
started to develop a “sight picture” in my head I had to struggle to maintain
control.
The patient was uncomfortable on the ambulance cot. Not from physical
discomfort, but from what I interpreted as her mind set that she was in serious
medical trouble if she had to lie down on the “bed”. Of course this wasn’t the
case, in reality the ambulance cot is the best place for the patient to be situated if
we need to provide any assistance during transport to the hospital. They are
centrally located to all the medical equipment and are accessible to the
attendants. But it is not an absolute necessity that they be on the lying down on
the cot. Most of the time when this is an issue simply sitting the back of the cot up
into an upright position is enough to calm the patient’s fears. This patient was still
disturbed by being on the cot and ask to sit on the bench seat. Since there were
no medical issues contrary to her request I let her get off the cot and sit on the
bench seat beside one of the basic life support providers. As long as she would
tolerate wearing a seat belt I did not see this as counter indicated by any medical
concerns; and in fact she rode to the hospital on the bench seat without problems
and it did have an apparent calming effect on her.
Our ride to the hospital was without notable event. I did engage the patient in
some “small talk” while in route to the hospital emergency room. This was done to
help the patient remain calm and to take her mind off whatever was bothering
her. It also serves as a means for us to continue to evaluate for any possible
changes in the way the patient is presenting to us. It also makes the ride seem
shorter.
After so many years and hours spent in the back of an ambulance I am quite
comfortable and it is easy to overlook the intimidating appearance of all the
emergency medical equipment around us. It’s mundane to me and to the other
providers in the squad but it can be a source of concern to the patient; probably
related to the unknown. Not knowing what the equipment is used for and maybe
not knowing what’s going to happen to them next, all this wrapped up can be a
cause of concern for the patient. We do try to take steps to ease this fear by
talking to the patient, by telling them what we are doing and what we are going to
do next. The most important methodology here is to speak in a calm, even tone.
This is true even in the face of true emergency’s, where the patients life is in
danger, where you are very concerned, and even maybe a little bewildered about
the care you are providing. No matter what, you must always present with the
appearance that you are in control and that you have everything under control.
The providers demeanor can help or hurt the patient’s outcome and can result in
an incident being managed in a safe manor or handled dangerously. In this case
the reassuring calm actions of the ambulance crew had a desired effect on the
patient. She had quit crying, had obviously calmed down and was less concerned
about her current circumstance. We like to be “light and airy” but we try not to
forget that the patient feels that they have problem and never dismiss patient’s
fears.
When we arrived at the hospital emergency room I ask the patient to remain
sitting in the back of the unit until we could get a wheelchair for her. One of the
attendants stepped out to get a chair from inside the door of the ER. The patient
stood up and was helped out of the side door of the ambulance. She had to take a
few steps over the curb and to where the attendant was holding the wheelchair
for her. Unfortunately, the poison control center had been right on the money with
their forecast of uncontrollable diarrhea.
The patient had a brown streak down the back of her nightgown and left behind
small brown puddles on the pavement wherever she stepped. This sort of thing
happens and we are trained not to embarrass the patient because they have lost
bowel control, they would stop it if they could, and we try to treat them with
respect. An experienced medic also has learned how to avoid stepping in it as
well.
The patient looked up at Junior Kisner and, with a small and self-conscious voice
said to him “I think I messed myself” to which Junior replied with tenderness and
kindness in his heart “Yes ma'am, shit happens”! The patient took no offence with
the choice of wording because he had said it with a smile on his face and in a
manor that was not intended to be demeaning.
When we entered into the Emergency Room at the hospital the staff could
not have been better towards the patient. The Physician had told them the story,
but as expected, they were nothing but professional in the manner they deal with
the patient. They did seem to smile a lot, but you could only pick up on that if you
had worked with them in the past. The nursing staff and the others on my crew
transferred the patient to one of the available exam rooms while I looked for the
physician on duty to finish giving full report on the patient’s condition and to
report what steps we had taken in the field.
We both concurred that this was a very unusual call. The physician shared
with me that what he expected he would uncover during his examination of the
patient was that the "overdose” was really a call for help and her choosing that
particular substance to report as having taken was an attempt to get everyone to
take her serious. I started my paperwork while the physician went to perform his
assessment of the patient.
The physician had finished interviewing the patient and forming his options; the
nurse’s staff had also expertly preformed their duties in gathering another set of
the vital signs. The physician had decided on a treatment plan for the patient; he
gave orders to the nursing staff that a gastric suction was needed.
Another description for this particular procedure is to “pump the stomach”.
Having seen this procedure many times before I knew that I didn’t want to be
around if I didn’t have to be. The procedure is neither barbaric or that difficult, but
I don’t care for some of the noises the patients make when it’s done. Nor do I like
to see what comes out of someone’s stomach. The patient put it there and the
patient can keep it in their stomach without any complaint from me.
We decided that this was a prime time for us to return to the firehouse to
complete the paperwork and make sure the unit was in a ready condition for the
next call. [The last part sounds good, but the truth is that I didn’t want to hear the
patient gag and gurgle as the tube was being passed down her throat.]
As we were leaving we had to walk past her examination room to get to the
ambulance. When we past her doorway she was standing up at the door looking
out and ask me if they were going to “bring me something to make me throw up”;
meaning that powerful drink called syrup of Ipecac, the drug of choice to induce
vomiting. I try, as a rule, to not out-and-out lie to a patient nor unnecessarily
mislead them and I didn’t do it this time either. I also know that there are many
things that are best explained to the patient by the physician or nurses because
they know how best to educate someone as to what’s going to happen to them.
So as we passed the room and the patient ask me what was going to happen I
was torn, not wanting to lie, and not wanting to speak out of place I elected to
sort of side step the issue. I responded “ no, I thing they have something else in
mind”. To which she responded in a feeble and pitiable voice “oh no”. I took that
as a strong indication that this was not her first time and that she had an
understanding of what was forthcoming. But we did not stop and talk, we
continued on toward where the ambulance was parked just outside the doors of
the emergency room.
We were about 10 foot away from the exit when both doors to the ER burst
open and two young men came into the hospital dragging a third companion
between them.
Chapter II. Hypothermia
N

Now, you might think that this is an extraordinary event but it happens from time
to time in the emergency room. Having someone dragged into the emergency
room can present a dilemma as the patient needs to be on a bed and one is not
always right where you need it to be. But the hospital staff is used to this sort of
drama and handle whatever situation presents itself. Since we were right there
the young men dragging the victim called out to us to help them. They didn’t
know that we were not the right folks to ask for directions in the ER, that we did
not know which empty examination rooms had been cleaned after their last
patient or which rooms had a patient assigned to them. Fortunately one of the ER
nurses were handy and directed the pair to put the young man on the bed in room
number 9. This examination room was designated as the main trauma room and
was the one nearest to the front door. So it was convenient for the two to drag
him in there and lift him on the bed. The patient was obviously unconscious and
unable to walk on his own power. The two that were dragging him looked to have
plenty of adrenaline flowing and could have hauled him a mile or so if they had
been ask to do so. It’s amazing what you can do when you’re excited.
Someone ask this pair of good Samaritans what happen and they immediately
began to distance themselves from association with the guy laying on the
stretcher. “I don’t know who he is” was the immediate reply. The next logical
question from the nurse was “Where did you find him?” and that inquiry was also
met with vagueness. “We were all at a party and we thought he had left, but when
we were leaving we noticed him passed out in a snow bank”.
Now we had a better picture of what happened and could form some initial
concepts about the patient’s possible problems. These early opinions can be
inaccurate and everyone in the emergency medical field knows that you weight
your initial assessment as only one component of the quotation in deciding what’s
wrong and what needs to be done.
Even before examining the patient several facts were evident; the patient was
unresponsive, had AOTB [alcohol on the breath], was wet, and very cold to the
touch. We continued to seek information from the boys about the circumstances
of this case while we also began working on the patient. It’s not our “job” to assist
with patient care in the emergency room but we often gave the nurses a helping
hand whenever we could. The hospital has their own contingency plans to handle
staffing shortages when the work load becomes overwhelming for the ER nurses,
but it’s mutually beneficial for us to be that extra set of hands for the emergency
room staff. Especially late at night the staffing at the hospital ER is stretched; plus
it was a good method to add to our background medical knowledge. We didn’t
know then, but the hospital was going to execute their emergency staffing plans
latter on in the night.
The depth of this patients loss on consciousness, estimated [guessed at] skin
temperature, history of events as we knew them, skin color, lack of proper winter
clothing for the freezing temperatures, all combined to announce to us that we
had a severe case of hypothermia on our hands.
The two that brought the patient to the hospital probably knew more than what
they were sharing but that was not something we could, or should, resolve at this
point. One issue that was not in any doubt was that they had saved this
teenager’s life by bringing him to the hospital. Although at the immediate time we
weren’t too sure that the patient would survive.
We didn’t know of the full extent of other injuries the patient might have, other
than what we had observed. Nor did we know to what degree the hypothermia
had compromised the patient’s vital functions. As we all turned to focus on patient
care the pair of lifesavers left the building. Did they run away? Leave so as not to
be in the way? Or most likely they left to avoid any additional involvement and to
avoid interaction with the authorities.
We were all busy and didn’t notice at first that they had slipped away. There were
some other questions we would liked to have answered to help the physician
formulate his treatment plan but these questions would have to wait while we
addressed the urgent problems that the patient was presenting at the time. Could
we have interviewed the pair to narrow down the time of exposure? If they had an
idea of the volume and type of alcohol he was drinking? Any possible medical
history? Like seizures or diabetes? Was there any known drug usage, legal or
recreational? Seldom is that last question answered with much candor. The basic
lifesaving care could do without this background information it’s just that it would
have been advantageous to have the chance to get some secondary information.
We had our hands full as it was. The physician came right away to the call from
the nurse and while they were assessing the patient the ambulance crew and
myself could best help by removing the wet clothing and getting the patient
covered with blankets from the blanket warmer in the hallway.
Warm intravenous fluids, warming blankets, warm fluid edemas, warm fluid
gastric lavage (something I would personably avoid being around when they did
it) and other, more invasive measures were all being considered by the physician
and staff. The goal is to warn the body without doing any additional harm; the ER
staff had a lot to think about.
We began removing the clothing, layer by layer, cutting as necessary, trying not
to rock the patient as we might interfere with the work of the nurses and knowing
that in cases of severe hypothermia the cardiac functions can become irritable
and any rough treatment may cause more harm. Being dragged by the arms into
the ER was plenty of “movement” but our goal was to remove the wet clothing as
fast as possible while disturbing those around us as little as possible. The patient
had on a pair of lace up boots and we were removing those first.
It was quite obvious to us that the patient had lost control of his bladder and
bowels; the odor was really strong. We hold nothing against the patient because
of this, it happens. Loss of body function control can be the result of many things,
from his apparent intake of alcoholic beverage, his diminished level of alertness,
drug use, and/or the hypothermia. The patient’s incontinence was not something
that needed to be addressed, it is doubtful it was much of a factor in the
physicians overall assessment of the patient.
I think this individual had been eating fish heads and goat cheese the way it
smelled! When a person defecates on themselves and then rolls around in it
always has a very strong and pungent odor; but this case was worse than most.
In the vernacular of medically oriented people, in their typical conservative way of
stating a fact, this was a very sick person. It’s very important to repeat that the
occurrence of the patient defecating is not the focus of the story, nor the focus of
those treating the emergency needs of the patient. It does set the groundwork for
what happens next.
As I have pointed out the air was pungent and the ride-a-long crewmember [that
was with us as an observer only] had not ever experienced anything like this. He
had already witness something bizarre on our previous call and now he was
seeing a very sick person, in real danger of loosing his life in spite of our efforts to
save him. The raw drama, influenced greatly by the odor in the room, was a little
much for him to endure. He asks Junior if he could step out side and “grab a
smoke”. I was glad that Junior took pity on him and told him that it was OK. Junior
had also noticed the waxen paleness of his face and was pleased that he was
going out to catch a breath before he passed out or threw up in the emergency
room. It doesn’t look good, nor build positively on our reputation, when a member
of the ambulance crew does either in the ER.
We continued to work at our assigned task, helping the staff in the emergency
room and being very careful not to get any “foreign” material on our clothing as
we didn’t want to be a carrier of the odor back to the firehouse or to our homes.
About 45 seconds after our ride-a-long stepped out we heard the doors to the
Emergency Room bang open as someone came running through the entrance. It
was our ride-a-long crewmember; his eyes were wide open and if possible his face
was even a shade paler than it was before he went outside.
Excitedly he ran into the room while pointing outside and said, “there’s a dead
man laying on the ground out in the parking lot!”
Chapter III. The Dead Man

To the general public seeing someone dragged into the hospital would be
disconcerting. To the ER staff and to us on the ambulance crew it certainly was of
interest, we did not dismiss it as folly, but we didn’t get overly excited. Just like
the fellow that we were working on, being dropped off at the door by “friends”
who don’t want to get involved or interact with authorities happens from time to
time. It’s something we’ve experienced several times before. Ninety-nine times
out of a hundred cases like this involves alcohol and /or a victim that has been in
an altercation of some kind. The typical circumstances involve host of folks at a
party with a little too much alcohol to drink and may have gotten on the loosing
side of a confrontation and so the “friends” drop them off at the door of the
emergency room to be treated for what ails them. When this happens the patient
is treated according to the depth of the insult to their body and the fact that the
problem may be self-induced is not a determinant in their care. Alcohol poisoning
is something that can be deadly and is taken seriously within emergency services;
it’s not something we brush off as unimportant.
When someone is dropped off (dumped) at the hospital it’s managed and we find
that most time it’s of immediate concern but not emergent. The victim can be in
need of emergency care but not necessarily be immediately life threatening as
was the patient that we were at present caring for. What we expected to find out
in the parking lot was a very intoxicated and/or injured victim. We were to be
proven wrong.
Junior and I walked out of the Emergency Room to see what the situation was
while the ER staff continued to provide crucial medical assistance to the life-
threatening patient they already had in their care. We went outside to look right
away, but we didn’t take off running or anything like that. This confused our ride-
a-long observer, as he didn’t understand why we were not running out to the
victim like he was. He was outside the doors of the emergency room gesturing
wildly towards the person on the ground. Sure enough when we looked across the
parking lot we saw what appeared to be a body lying on the pavement some 100
feet from the emergency room doors.
Our actions may have been confusing to our ride-a-long friend but anyone trained
in emergency services can appreciate the benefit in walking, not running, towards
any scene of an emergency. The extra few seconds you take in the approach
allows you time to size up the environment, and to plot an escape route away
from the scene should things turn ugly. I was searching for anything that might be
a hazard, or an aid, to us in determining the extent of this predicament.
When we approached the patient I took notice that there were no outward signs of
breathing. Surprisingly, sometime this is difficult to determine; shallow
respiration, periods of apnea, and multiple layers of clothing can disguise what is
the actual situation. On closer examination I determined that this patient was for
sure not breathing and had no palpable pulse.
The “down time” or how long ago did this person quit breathing and their heart
stopped pumping blood was a big unknown factor so our protocol is to start basic
cardiopulmonary resuscitation efforts at once. We had no one to give us a history,
to say how long he had been lying there or how he got there.
As we started basic CPR we advised our other team members that the patient was
“ART” and we needed to “PUHA”. They immediately ran back to the unit to get the
cot so we could get the victim off the pavement of the parking lot and inside the
emergency room. The terms we used communicated a lot of information that the
team members understood. This terminology is not found in the textbooks nor are
they approved medical terms, but our crew understood not only what the letters
represented but I also conveyed my assessment of the situation; as well as what
we wanted them to do. ART means that the patient is not alive and thus is
“Assuming Room Temperature”. You may remember the meaning of the term
PUHA; the crew recognized that it was time to “Pick Up, Haul Ass”.
The ER staff was still occupied with the touch-and-go hypothermia patient in room
#9. When we rolled in the emergency room doors with this “code blue” [patient
being administered CPR] we took him to one of the other empty treatment rooms
and continued with basic interventions and started to provide ALS services
[advanced life support] until the ER staff could shake free.
The “charge nurse” [the nurse supervisor for that shift] had initiated the hospitals
contingency plan to get more nursing staff in the ER during this climacteric
period. The physician also broke free for a brief inspection of the situation. Our
protocols [which are written, standing instructions, from the hospitals medical
staff detailing what actions we are to take when we encounter certain medical
problems in the field] apply to what care this patient required. These protocols are
a match to the same standard of care that the staff of the hospital would perform
had they been in the room. The physician noted that we were following the proper
protocol and instructed us to continue, as he needed to return to the first critical
patient. The actions of the physician were appropriate and well justified in the
truest interpretation of the principals of triage, the sorting of medical priories.
As soon as some of the RN’s from other parts of the hospital arrived we
relinquished the “lead” in providing emergency care, but we did stay to continue
to provide whatever assistance they might ask us for. One problematic area is that
the staff from other parts of the hospital was not familiar with where equipment
was stored in the emergency room; and the exam room we were in was not set-up
with all the equipment that we needed in the resuscitation efforts. Of course the
equipment and drugs were available within the emergency room area, but neither
the nurses nor I necessarily knew where they were located and in the middle of an
emergency is not a good time to have to look around for what you need. So that is
why we mostly used the drug box off the ambulance and the equipment out of our
resuscitation bag that contains the same type of instruments that the ER uses in
the first stages of providing the appropriate care to patients needing
resuscitation.
Our ride-a-long observer was pressed into service and given a quick, on-the-job,
lesson in providing the chest compressions to get the blood moving in the
circulatory system while I provided trachea intubation [placed a tube into the
trachea to provide a patent airway.] After just a few minutes the ER physician was
able to clear himself from the first patient and do a more compressive
examination of the patient we were working on.
We had even less information about this patient than we did about the one in
Room #9. We had no idea what happened to this guy, past medical history, drug
intake [medical or otherwise], length of time he was without heart beat or
breathing, even the name was not available as he didn’t seem to have a wallet on
him. Was this another case of someone “dumping and running”? Did he drive
himself to the hospital and collapse in the parking lot? We had lots of questions
that were intriguing but were not a major factor in the way we treated the patient
as he presented to us.
I got freed up as more hospital staff arrived and I had the opportunity to look
through the clothing we had removed from the patient. I was looking for anything
that might help answer some of the questions that were outstanding. That’s when
I found a “baggie” of what appeared to be marijuana in his front pants pocket.
This find might have been interesting to the police but it had very little value to us
in trying to unravel what may be the underlining cause for this person to be on
the emergency room table. The abuse of “weed” does not ordinarily generate life
threatening side effects.
Our first patient, the overdose, was in one room quietly and patiently waiting her
turn for treatment. Her medical situation was important but not critical. As I
walked past her exam room so I took the opportunity to check in on her to
reassure her that she was not forgotten, that she would get the assistance she
needed but that some very sick people were being worked on right now. She was
appreciative of someone telling her what’s going on and it helped her continue to
remain calm. One of the nurses had also checked on her and between our efforts
she had been greatly relived of some of her anxieties.
The hypothermia patient’s condition was stabilized and was being closely
monitored while he was being gently re-warmed. The physician shared with the
crew that, baring any cardiac complications; the patient’s prognosis was for a full
recovery.
The attention of the physician and staff from the ER had turned to our “code”
victim but all efforts to revive this patient had failed and the physician had
stopped “working the code” by pronouncing the patient dead.
We restocked the drugs and supplies we had used and figured that this was a
good time to leave the hospital and return to the firehouse. Sort of the right time
to “get out of Dodge” before we encountered any more dramas.
I think it is a good policy to “de-brief” after an unusual or traumatic incident,
especially when we have someone with us that is new to the emergency field.
Whether we debrief formally or in-formally it gives everyone a chance to review
what we did “right” and identify things we would do differently next time. It also
gives all crewmembers an opportunity to express their feelings, to reassure
themselves that we are out they’re doing good things. A new member on the
crew, or as in this case a ride-along observer, may have questions that they are
hesitant to ask about, but within the setting of open and frank discussions they
frequently open up and express their concerns or feelings. Burn out is very
common in this field of work so it is therapeutic, helpful, and down right stress
reducing to vent in de-briefing rather than keep things bottled up inside. New
people are relieved to find that the “old salts” are inclined to have the same or
similar feeling as they do about a call.
On this series of calls we had experienced quite a few of the emotions that we
undergo while working on the squad; we don’t regularly run into all of them on the
same night. Our “convict observer” as we joking called him was really impressed
with the work of the men and women in the rescue squad. He had developed a
new appreciation for our work. I never heard from this young man again. He was
an upright fellow and I’m sure has done well in his life; I’m equally sure that he
still remembers his night on the rescue squad with us.
The ambulances are financed through donations from the general public,
governing bodies, and sometimes by the State in the form of surcharges on your
automobile license tags. We were alerted to the emergency by Sheriff Department
communication personnel, assisted with identification of our mystery patient by
the Town police, and could not function at the ALS level without the support of the
hospital and it’s staff. The good works that we were able to accomplish were the
products of the joint efforts of all the agencies in the emergency service field.
Section B. “Ambulance Down”
O

Over the course of my 33 years actively participating in providing emergency

medical care I was mixed up in at least five misadventures where I “lost” the
ambulance out from under me.
The drivers of emergency equipment go through a program called EVOC, which
stands for Emergency Vehicle Operations Course. This curriculum entails both
classroom work as well as an obstacle course driving test. It is a very good course
for drivers of emergency vehicles of all types and sizes.
It is fortunate that none of these accidents resulted in serious injury to any of the
people involved.
Chapter IV My First Accident
E

Early on in my career with the local Front Royal Volunteer Fire Department I was
teamed up with two of the Rescue Squads “founding fathers”; Ray Winn and Jim
Rock. These two “old salts” had served as a team on the rescue squad many years
before I joined the Fire Department in 1969. Ray and Jim were the two that first
aroused my interest in serving on the rescue squad as I admired their
steadfastness in the face of emergencies. Over the next couple of years I secured
a great deal of pragmatic talents from this pair. The indoctrination they provided
was of the practical variety. I learned to remain calm, to always be in control (or at
least act like it), and to always use the common sense approach when addressing
obstacles in the field.
One of the expressions that I retained from them was “What we do is 95%
common sense and 5% skills”. Over the years as I became involved in providing
more and more advanced emergency care this idiom of theirs proved true in the
various aspects of my treating the patient.
As the emergency medical care that we were able to provide in the field
progressed in it’s complexity and value I could still apply the lessons learned from
using common sense in 95% of the situations I encountered. In fact, as we were
taught to perform the advanced skills the instructors in the classes would
frequently repeat the advice “ remember, don’t forget to tend to the basic needs
of your patient”. Medics who earned the reputation, within the environs of
emergency medicine, for being exceptional at their craft never forgot this
common sense factor that Jim and Ray had instilled on me in my early years on
the ambulance.
I’m really straining my brain cells to recall some of these finer details about this
period of my time in the squad as it was over 30 years ago. As best as I can
remember, Ray Winn was serving as Captain of the Squad and Jim Rock was one
of his three lieutenants when I was voted into the Department in 1969. In those
days the Captain was the highest position within command structure of the
Departments Rescue Squad. As Captain of the squad Ray had overall oversight of
the ambulance operations and Jim had the responsibility for maintaining the
mechanical readiness of the Departments three ambulances.
We had one Travelall converted panel truck, a 1966 Cadillac ambulance as a
backup ambulance and our main “distance” transport piece was a new 1969
Cadillac ambulance. The Cadillac ambulances would come off the factory
assembly line as either an ambulance or a hearse; and often as a combination of
the two as area funeral homes provided transport to the hospital in many areas.
The converted truck was our main response piece and I might add that it was
stocked with the most up-to-date modern equipment of the times, although it
pales in comparison to how the squads are stocked today. It was also so top heavy
that there was a real danger of the ambulance toppling over if you took a turn too
fast. Too fast was often below the posted speed limit. In these early days of EMS
there were no standardization on the height of the patient compartment and you
could bearably sit-up in the back of most ambulances.
The two seats in the drivers’ front compartment were joined together by a
homemade wooden cover to provide a bench seat type of arrangement. Seatbelts
had not been invented at this time, or at least were not common in most vehicles.
Our Radio designation for that ambulance was “Car 4” and we were on the same
frequency as the police in the Town of Front Royal. The radio communications
were gravely limited, as we couldn’t talk to dispatch if we went much out of the
Town limits. It may sound as if I’m bemoaning how deficient the ambulance was,
but in it’s day, it was the envy of the departments in our neighboring Counties.
We were proud of our state-of –the-art ambulance and kept it washed, waxed and
ready to respond to any call for help.
We had an average of one ambulance call every two days and a fire call every
three days; we considered ourselves “swamped” if we had a fire call and
ambulance call on the same day. That’s meager compared to over 3000 calls in
the Front Royal department last year.
The on-call crews were organized a bit differently back in those days. We did not
have assigned crew teams and each week Ray would call every member that was
active on the rescue squad and ask what time slots they could fill on the schedule.
Caller ID wasn’t invented yet so if you didn’t want to run call the next week you
just didn’t answer the phone on Wednesday nights. You were not always with the
same team members each week, in fact new members were encouraged to float
around the different crews so that you could be exposed to how the different
styles the experienced members used to handle patient care.
“Cruising the loop” was a popular activity in the mid 1960’s and 70’s, it’s where
teenagers in town would ride around in their cars looping around through the
parking lots of the area’s three fast food businesses. We were looking to see who
was out and about, where the party was at and what young ladies were out
looking at us looking at them. Back then you could buy gas for .32 cents a gallon
so riding around in your car was an inexpensive way to spend the evening. I was
driving my Dad’s 1962 Mercury Comet sedan “cruising the loop” with a couple of
my friends one night in the fall of 1970 when we witnessed (and maybe partly
caused) a car accident on Royal Avenue.
We were headed south on Royal when a pick up truck passed us and tried to turn
onto 5TH street headed east. The truck was being driven by a friend of ours who,
with another high school buddy, were also “cruising the loop”. He turned too fast
and when he hit the dip where the two roads joined his pick up truck flipped over
on it’s side and skidded 25 feet down the middle of 5th street. Seeing the pick up
truck flip over seemed almost surreal. I’d responded to vehicle accidents in the
ambulance and saw the aftermath, but this was the first time I witnessed a real
live vehicle rollover right in front of me.
I stopped the old blue Comet on Royal Avenue and we ran over to the pick-up
truck to see if anyone was injured. My thoughts were more to “how bad are they
messed up” rather than “if anybody was hurt”. We found that the passenger had
“self-extracted” himself from the accident [that really means he jumped out].
Unfortunately, the driver was not as lucky. He was complaining of back pain and
had several cuts and scrapes on his face from broken glass (the improvements in
safety glass in vehicles was a few years coming). I snatched the little first aid kit I
had started carrying in the car and threw it to my friends to do what they could to
help the driver of the truck while I drove up the street and to get the ambulance. I
figured that somebody would be there to drive the ambulance while I would ride
in the back and provide emergency care for the injured driver. The firehouse was
on Royal Avenue then, attached on the right side of the Town Hall office, just five
short blocks away.
As I pulled up in front of the station I noticed Jim Rock and Ray Winn, dressed in
their white squad jumpsuits that we wore on calls, arriving at the same time as I
did. In the days before radio dispatching the Town police dispatcher would call you
at home on the telephone to respond to the firehouse in order to get the
ambulance and go to the scene of the emergency call. As hindsight will show, I
didn’t think things out too clearly but I did say “Wow, that was sure fast” meaning
that Ray and Jim had a very quick response time for this accident. Considering
that they needed to be notified by land-line and then drive to the firehouse from
their homes.
I jumped in the front of the ambulance and slid over to the middle makeshift
bench seat we had installed in the unit while Ray got in beside me and Jim got
behind the wheel as our driver. We drove out of the station and turned left onto
Royal Avenue headed in the right direction for the accident site that I had just left
from. Jim was a cautious operator and because the ambulance was “toppsy” we
weren’t going very fast but I noticed that Jim wasn’t slowing down as we neared
the scene on 5th street. As we started to pass the turn off from Royal Avenue to 5th
street I said, “it’s over there” and pointed to the accident scene.
You guessed it, Jim and Ray knew nothing about the accident as they had been
called out for another medical emergency call in the northern part of the County.
When we left the fire station Jim had turned left towards the truck rollover and I
assumed that we were going to the same place; as it turns out the other call just
happened to be in the same direction as the accident I had witnessed.
Next, three things happen at almost at the same instant; Jim caught sight of the
accident at about the same time I alerted him and he “hit the brakes”. There was
a car right behind the ambulance on Royal Avenue and as we were not going too
fast they were keeping pace with the ambulance just driving within the normal
speeds. The driver of this car choose the same moment in time to glance away
towards the accident scene as Jim did, so he didn’t see us stop until it was too
late.
The rear end impact wasn’t that bad because of the slower speeds; but even so
we took quite a jolt. The center seat was homemade and was not designed with
safety in mind. I was not actually injured, but I did hit my head on the dome light
behind me and then was thrown forward into the dash. No one else, in the
ambulance or in the vehicle behind us, had any complaint of physical damage
although Jim Rock did look a little sick when he was looking at the damage to the
rear of the ambulance.
Ray Winn was in charge, whether he wanted to be right then or not, and he made
some quick decisions. The damage to the ambulance was not that bad and they
still had a patient needing emergency care waiting on them. They had no way of
knowing how severe the need for help was until they got to that scene and did an
assessment of the situation. Ray had to weight the need to stay at the accident
scene until the police were there to investigate our accident against the need to
continue their response. It would be difficult for the police to analyze the accident
after the ambulance was moved. Ray instructed me to take the first aid kit off our
ambulance and stay with the patient in the pickup truck while he and Jim went on
to take care of the original call. A second ambulance crew was scrounged up and
they came to the accident scene to transport my patient to the Emergency Room.
I’m pleased to report that both of the patients, from the original call and from the
pick-up truck accident, proved not to have life threatening problems and after
treatment in the Emergency room they were released from the local hospital latter
in that same evening.
Chapter V. Over the Hill

Quite a few years latter Hal Shaner and I were on our regular Friday night call duty
when a call came in for “the injured man” in a part of town the is called Royal
Village. Hal and I had started the practice of staying at the firehouse when we
were on call. This was partly due to the desire to increase our response time to
emergency calls and because we didn’t like to have to get up in the middle of the
night at our homes and run out into the freezing winter nights.
We didn’t have very specific or detailed information about the nature of this call
but we did understand that the injuries were from a altercation that had
transpired earlier in the evening. These types of calls require a little more
attention to the “environment” at the scene so that we do not enter into an
ongoing melee. We prefer that the situation be under control and calmer emotions
prevail before we arrive on the scene. It’s best if those individuals involved have
had a chance to calm down and the scene safe for the ambulance crew to enter
the area with out fear of becoming entangled in any confrontation. None the less
we are extra careful to perform a thorough size-up at the sight of the emergency
call before committing ourselves. As we approached the scene we look for an
escape route, we looked for by-standers and we looked for any possible hazards or
encumbrances.
On this particular night we did not observe any activity around the address. The
porch light was on and that is a good sign to us that this is the correct address.
Also, if someone in the house had the foresight, and the time, to think about
turning on the front porch light it is one more small indication that at least one
person in the house is capable of rational thinking and therefore a safer
environment for us to enter.
I was the driver for this call and my partner, Hal Shaner, was in the passenger
seat functioning as navigator and communications operator. As is our normal
habit I drove just slightly past the entrance to the front door of the residence. This
gives us the opportunity to look over the entire situation before we get out of the
ambulance. There was no fence around the yard and while that does not eliminate
the possibility of a dog to contend with it is better than pulling up to a scene and
seeing a fence with a “beware of dog” sign.
The house was located on the left-hand side of the road and was the last house on
that street before the road took a sharp turn to the right. I pulled the ambulance
to the side of the road directly in front of the house, just passed the sidewalk
entrance.
I got out of the ambulance, which was a van style ambulance that was popular at
the time, and Hal exited on his side furthest from the house. I paused for a second
giving Hal time to get the bag of equipment that we needed to take into the
house. This slight pause allowed me to finish up the scene size-up and I lead the
way into the house.
The front door was open and I entered while calling out “Rescue Squad” loud
enough for those in the house to hear me and identify who we were. This is a
standard practice in an effort to keep from startling anyone and to let them know
we are the good guys and do not need to shoot at us. When I entered the house I
noted that there were several people in the front living room of the house and one
male , who appeared to be in his mid 20’s, sitting forward in a chair. This young
lad had several scrapes or scratches to the side of his head and had a lip that was
swelling up but that had quit bleeding. I was able to complete the primary survey
and had begun the secondary survey when I noticed the tension in the house
beginning to fester up as the family of the injured person began to argue among
themselves about the problems that their son had encountered with some of his
friends. I believe they perceived, or wanted to perceive, that the injuries to their
son were much worse than what I had identified on the patient. I had been
conversing with the patient in a calm voice in an effort to keep him as calm as
possible so we could take care of him without adding an apprehensive patient to
the mix.
Because the family was getting upset and because we had negative findings of
substantial injury from the secondary survey we decided it was time to P.U.H.A.
(Pick Up, Haul Ass) with the patient.
Hal and I went outside to the ambulance to retrieve the stretcher and returned to
the patient’s side so we “load-an-go”. The patient was able to stand and pivot to
the stretcher from the living room chair he had been sitting in. Watching the
patient ambulate even the short distance to the stretcher confirmed some of my
earlier impressions on physical condition of the patient.
As the standard practice on the ambulance we strapped the patient to the
stretcher using the two belts that are attached to the stretcher. There is one at
about the waist level and one nearer to the knees. There are other straps that
come with the stretcher from the manufacturer, but we seldom used them. The
straps were meant to give the patient some sense of security and to keep them
from sliding off the stretcher if it tilts some when we are moving it. These straps
are not meant to be used for patient restraint or to force the patient to stay on the
stretcher; there are other, more secure methods for doing proper patient restraint.
I reassured the patient that he was in good hands and as a method to reduce the
anxiety of being moved on the stretcher I would often crack a small joke all the
while with a big smile on my face. “ Don’t worry, we haven’t dropped anybody in
over a week!” Being moved around on a stretcher is a different sensation that
most people are unfamiliar with and it can be disconcerting. The straps on the
stretcher help some, a little reassuring , and I will often ask the person to hold
onto the waist strap or the side of the stretcher for that little bit of extra
encouragement.
One little tidbit I always did when training new squad members was to have them
lie down on the stretcher and we would carry them around the fire hall just so
they could see for themselves how it feels to be the patient on the stretcher. We
would also dip one corner of the stretcher while they were on it just to reinforce
how unsettling it is when it feels like you are about to be dropped.
As we started out of the front door of the house I was walking backwards carrying
the stretcher while my partner, Hal was walking forwards. This is when I heard
what sounded like a car door slam, I couldn’t see what it was but the patient
hollered “they’re back” and commenced to struggle to get off the stretcher.
Problem was we were carrying the stretcher and were half way out the door of the
house when this commotion started. We had to be careful not to drop the
stretcher, keep the patient from hurting himself, not hurt our backs straining with
the stretcher, figure out what was going on, and we had do all this at the same
time.
We had sat the stretcher down and Hal tried to calm the struggling of the patient,
this is when I turned my head to look at what was happening outside. What I saw
was our ambulance drifting slowly down the gravel road that was in front of the
patient’s house! I was equally perplexed to distinguish that there was no one in
the driver’s seat.
Hal was trying to help the patient get untangled from the stretcher straps, if the
patient wants up that bad Hal wasn’t going to try to stop him; there was no
medical need to restrain the patient against his will.
At the same time I noticed the ambulance rambling down the road I heard another
car door slam and a car speed off.
Well, I had my end of the stretcher on the ground; Hal was helping the patient in
the doorway, so I took off running in the direction of our ambulance. It was picking
up speed as it rolled down the hill and I’’ not sure what I would do with it if I had
caught up with it; but I took off chasing the ambulance none the less.
This is when several more problems popped up at nearly the same instant;
certainly in no more than 5 or 6 seconds the situation took a real turn for the
worse.
I hadn’t taken more that a half dozen running steps when I stepped in a hole in
the front yard and fell while turning my ankle. We all have sprained an ankle at
one time or another and you know how bad it hurts the first few minutes. Plus I
had quite a bit of forward motion, and weight, behind my fall. My glasses got
knocked off as I fell to the ground.
So I’m laying on the ground, rolling around in immense pain – holding my ankle,
can’t see anything past three foot away without my glasses, all while watching an
out-of-focus ambulance disappear down over the hill. The next event turned the
situation serious real quick.
The patient’s father, believing that the people who had beat up his son were back
to finish what they had started, came running out of the house. I still had not
found my glasses so he was a bit blurry but I heard the very distinct sound of
shells being jacked into a shotgun barrel. I didn’t know if he had come outside to
protect his son, or to get even, I never ask him, I just knew that I was in a bad
spot with no ambulance, hurt foot, not able to walk, not able to see and some nut
running around in the night with a loaded shotgun. I looked around for that little
hole in the ground that I stepped in to see if I could squeeze all of me into it.
We run ambulance calls as partners, we look out for each other, help each other,
cover each other’s backs so to speak. So I looked around for Hal to see if he was
in danger. I took notice that Hal was “holding the fort down” inside the house. It
was the right thing to do, protect yourself and be available to render aid to those
hurt after the situation has calmed down. One of us needed to attend to the
original patient but I sure wish I were the one inside the house at this point.
I was lucky to have found my glasses. My ankle still hurt but the sound of a
shotgun shell makes as it goes into the chamber produces a lot of motivation to
ignore the discomfort. I stood up and noted the gentleman was loading more
shells into his shotgun. I turned in his direction, I had already established myself
as a good guy, someone there to help his son, and with much more authority than
I really had, I ordered him to put the gun away. He looked like he had a split
second of indecision so I advised him that if he didn’t go inside with the gun I
would “charge” him with an offence. The bluff, and it was all ruse, worked and he
went inside to where Hal was, at least I was rid of the problem.
Hal had pushed the stretcher out of the doorway, and as he had settled the
patient as best as what was going to be done. At this point he came outside to
check on me and to assess the situation. The fact that the man with the gun was
headed inside helped cement his decision on where he should head next.
“Dad” had gone back inside the house with the shotgun, I had my glasses so I
could see again, my ankle hurt but I didn’t care, and there were no apparent bad
guys around. So Hal and I decided we should go and try to find out what
happened to our ambulance as it had disappeared down over the hillside. The
road made a sharp right hand turn at the bottom of the hill and the ambulance did
not make the same turn as the road did. We could see the glare from the red
lights but the entire ambulance was down over the hill and we could not see it
from the front of the patient’s house. This time though I took off walking [limping]
to the ambulance rather than risk twisting the other ankle.
When we got to the edge of the roadway we could see that the ambulance had
drifted about 25 feet down the hill and had come to rest against a tree. On the
good side of this is that the hill was a gentle slope and the ambulance never got
up a full steam of speed. There did not appear to be a lot of damage to the
ambulance that we could see from the road. The motor was still running and the
red lights were still flashing.
I worked my way down to the ambulance and looked to see how much damage
the front end had suffered when it was stopped by the tree; there was almost no
damage apparent. Next I looked into the cab of the ambulance and noticed that
someone had moved the gearshift lever to drive. Nothing else seemed to be
amiss.
I reached in through the window and shifted the transmission back into park. I had
some reservations about doing that because I thought the police might want to
see it for themselves during their investigation; but for safety reasons I choose to
drop the gearshift into park so the ambulance would not shift anymore. I also had
a desire that the ambulance be stable before I got in it to use the radio; this being
before the age of everyone having a cell phone the radio was my best choice to
summons help for us.
Our radio system by this time was being dispatched by the Warren county
Sheriff’s office and the frequency that we used is referred to as “the fire
frequency”. I called ”MAYDAY, MAYDAY, MAYDAY on fire frequency….. Medic one is
involved in a vandalism situation….. We request additional ambulance from Co.1;
police assistance; and a tow truck be dispatched to this location” I knew that my
call for help would get the troops coming.
Come running they did! In next to no time we had police protection as well as a
back-up ambulance on the scene. The second crew came in and took over care of
our patient and they transported him to the emergency room at Warren Memorial
Hospital. His injuries proved to be superficial and he was treated, then released
from the hospital.
About 20 minute latter the tow truck showed up and was able to wench the
ambulance back up the hill without any additional damage to the body of the unit.
I was surprised that the ambulance had gone on it’s adventure without any
damage that could not be buffed out. We were very lucky that the hill was shallow
and the ambulance had not gained much speed.
The patient who was on the loosing end of the argument would not cooperate with
the police as he now changed his story and said he did not know who his
assailants were. This is different that what he told us during the primary
questions. This often happens. People tell us things and then as they calm down
they decide to tell a different, often more self-serving story.
The motivation of why a person is calling out for help has some bearing on how
we treat the patient, from a medical perspective, but my personal opinions have
no bearing in any way. My interpretations are that this patients injuries were very
minor and I would not be surprised if they were not exaggerated upon when the
young man was surrounded by his family.
All turned out with a positive result as there was little damage to the ambulance, I
was not injured severely, and the father didn’t shoot anyone. The police
investigated the incident but were unable to charge anyone for sabotaging the
ambulance.
Chapter VI. What Goes In, Comes Out
I

I was working with Valley medical Transport when the next ambulance I was in
was “lost”.
We had been dispatched to transport a young man who had very severe burns on
his front torso, both arms, and involved some of his facial area. These burns were
mostly second-degree burns with some, more serious, third degree burns on his
neck and hands. These burns tend to be very painful and life endangering to the
patient.
The physician on duty in the emergency room at Warren Memorial Hospital choose
to send this patient to a hospital that was better suited to care for these extensive
burn injuries. We were transferring him from Warren to the Washington Medical
Center’s burn treatment center. The standard procedure is to take the patient to
the trauma center at Washington Medical Center where they would stabilize the
patient and assess for any other injuries before the patient was moved up to the
burn center within the hospital. This was just fine with me because the burn
center was a very serious place where the patients are often in horrible condition.
It was so emotionally draining to see these very sick people in so much pain that
it would haunt you for quite some time after going into the burn center part of the
hospital. It is intensely distressing to see folks suffer that much.
Mr. Howard Young was my partner and driver on this call and because of the
severity of the patients condition I ask for a “second set of hands” to ride along in
case the patient needed a lot of intense emergency care. This second person in
the back of the ambulance can come in handy if the patient needs a great deal of
attention and if their condition makes a turn for the worse it’s a lot of work for one
person to have to do by themselves. I was fortune to be able to get a very capable
EMT that had several years of experience, Gordon Foster, to be my assistant on
this transport.
We had about a thirty minute notice before the patient would be ready to be
transported. In particular the physician in the emergency room wanted to observe
the patient for a little extra time before we took off so that he could see in the
patients airway was going to swell as they sometimes do when a person breaths
in the hot gases from the burn. The burns to the patient’s neck and face were the
signs that make the prospects of this inhalation of superheated air a concern.
We could have taken off on the transport right away and if the airway became
blocked or impaired I have the skills to insert a tube into the airway so the patient
could breathe. This is a technical skill that has the potential for grave
complications and it is much better, if it has to be done, to have a Respiratory
Therapist do it as they are more experienced in this procedure. Plus, if there are
complications when inserting a tube in to the lungs of the patient there is the
availability of the operating room or the emergency room physician may choose
to perform a surgical procedure right there in the treatment room.
This patient was breathing on his own, for the moment, but the physician just
wanted that extra half hour to be a little more convinced that the patient was
going to be able to make the trip without airway intervention.
We needed to know how the patient got burned, both from a medical point of view
and from and for our own safety. Our “need-to-know” is medically important as
our treatment will differ in the field if the burns were caused by fire or chemicals
or if they are electrical in nature. In each case there are both similar and distinctly
different complications that can evolve even hours after the person is injured. We
need to know what to look out for as we are monitoring the patient during
transport. We also need to know the circumstances of how the patient received
the injuries for our own protection.
Chemical burns have there own set of dangers and we will want to find out what
the substance was that caused the injury. Radiation burns require treating the
patient as usual but we would carry a device with us to monitor any radiation
emitting from the patient or the clothing. Thermal burns do not have as many
possible endangerment’s to us but we like to know if the burns were accidental of
if they were caused by another person. If someone else did this to the patient we
would be extra vigilant to be aware of our environment and who is around us.
Who knows, if someone tried to burn the person the first time they may lie in wait
to come back and finish the job they started. I have seen this exact situation
transpire on more than one occasion over the years.
The story on the patient’s injuries was that he had been burning some brush and
threw some gas on the fire to make it bigger and the fire “woofed” on him. That is
the fumes ignited and the gas fumes engulfed him in a ball of fire. This story
seemed to be possible and we had no reason not to believe it. No matter what the
cause of the injury we would not reduce the level of care or alter the medical care
that we provided. We found out after we returned from the transport that the
patient did not suffer the injury as he had told us it to the staff at the emergency
room. It turns out, after a sheriff’s department investigation, that the young man
had sold someone some fake drugs and the buyer retaliated by throwing a cup of
lighter fluid on the patient and setting him on fire. We would expect that the
injuries from either situation would be similar and other than taking some
preventive steps for our safety we would have treated the patient the same.
We had a little delay before the transport so we stopped off at one of the shops in
town, Bo’ Belly Barn was where we gassed up whenever we could and they gave
us free soda drinks from the fountain dispenser, it worked out well for both of us.
Gordon and I got a big soda while Mr. Young’s drink of choice was coffee. That
man could get a full cup of steaming hot coffee, without a lid, and I never saw him
spill a drop of it in the many years that we worked together. He told me once that
it was a matter of training and experience that he acquired this handy skill.
We were not supposed to eat or drink in the back of the ambulance, for obvious
reasons of personal safety and professionalism. However no one from the
management ever took us to task for having a drink in the back of the ambulance
on long trips. I tried to be sensible about this and kept my drink out of the view of
the patient and always kept a lid on my drink as protection from germs or
anything getting into my drink. A transport could take hours depending where you
were going and it could get awful dry in the back of the ambulance.
When I arrived at the hospital we got our equipment ready and still had a little
wait on our hands while the patient’s paperwork was being assembled. I took this
opportunity to speak with the physician on duty in the emergency room to get any
special orders for the treatment of this patient and to inquire if there was any
special signs or warning symptoms I should be extra vigilant in looking for during
the transport. This was a common thing for the medic to do before going on a
transport. We have standard written orders to administer medications or to
perform certain medical procedures when we see that the patient needs them but
the transferring physician may alter them based on the patients needs. The
emergency physician did have some special instructions for me in that he wanted
the patient’s airway monitored a little more closely than usual, in particular he
wanted any signs of swelling in the mouth or throat to be addressed as soon as
they occurred. He didn’t think this was going to be a problem because he had held
the patient in the emergency room some extra time to look for this problem and
nothing had developed at this point. Swelling post a facial burn can be deadly and
the complications can manifest themselves rather quickly.
The burns the patient had received were very critical and extremely painful. To
address this condition the physician gave me orders to administer morphine at a
rate and volume that exceeds our normal written treatment orders. Since I was
going to be watching the airway closely he was comfortable in increasing the
dosage we would normally give. A possible complication with morphine is that it
can reduce the volume and rate of respiration of a patient, even to the point that
they quit breathing. This possible complication was outweighed by the amount of
pain the patient was experiencing and the physicians desire to keep the young
man calm and to ease the transportation anxieties that he was experiencing. The
increase in the amount of this drug was substantial so the physician had to write
an order for the pharmacy at the hospital to give us some extra morphine to take
with us as we didn’t even have that much on board the ambulance.
The physician also ordered a large volume of intra-venous fluids to be infused into
the patient. One of the complications of these burns is that skin surface is
damaged and often can leak body fluids. This is a particularly dangerous situation.
We were infusing fluids that had the tendency to transfer from the circulatory
system into the body tissues as well as different fluids in the other arm that are
designed to remain in the circulatory system longer. The physician had chosen
what fluids and at what volume they needed to be infused at based on the
patient’s degree of injury, weight, age, and overall condition. It is important to
continue these fluids as ordered and so during the transport we administered
quite a bit of fluids into the patient; just remember that what goes in also comes
out at some point, some may leak out and the body expels some as well.
We packaged our patient taking into mind the tenderness of the burns, the
dangers of infection and fluid loss, and the need for continual narcotic
intervention for pain management.
The transport was relatively calm but busy with me having to push morphine into
the patient’s IV every five minutes and change the 2000cc bags of IV fluid twice in
the first hour. Gordon was a big help in monitoring the blood pressure, pulse, and
oxygen concentration of the blood; all important vital signs that would effect
treatment options. We were both busy through out the transport and didn’t have
time to do much of anything except taking care of the patient; this includes
getting a chance to drink any of our soda’s we had picked up before the transport.
I had a hidden “emergency” candy bar in one of the compartments and would like
to have a chance to take a bite or two.
Our patient was groggy from the narcotic painkiller that I had been giving him but
he was awake and reasonably alert. Even with the painkillers he was still in quite
a bit of discomfort. I did not think it advisable to give him any more morphine
than what I was already pushing even though he was in pain.
With all the IV fluids that we had been giving the patient he had to relive his
bladder several times during the transport. We carry plastic urinals for this and we
take whatever steps we have to in helping the patient with this normal body
function as well as give the person as much privacy as possible. I see no reason to
get involved in this act any more than I have to. So I avoid it whenever possible by
asking the patient if they can hold it or in some cases of really long transports I
will make sure they take care of this need before we leave the hospital. This also
will allow the nursing staff to be the ones to get involved in helping the patient if
they need it. Another reason to avoid having the patient relieving their bladder, or
bowels, in the back of the ambulance is that I don’t care how careful you are
something is going to be spilled or not cleaned as well as it should be with the
ambulance in motion. In the case of this patient it was especially important not to
contaminate the burns if we could avoid it. Both arms were burned as well and
they were bandaged up rather fully so he could not use either hand to hold either
his penis or the urinal; I had to do both for him. We know this is no big deal and
the patient does not want us to have to become that involved in his urinating any
more than we do, but he’s hurt and needs help. We go to great extents not to
make the patient feel any worse about this than necessary. We remain
professional and reassure the patient that we understand. It is important to
reduce as much anxiety as possible under the circumstances. Some people can’t
go when another person is looking let alone when they are aiming things for
them. It’s even worse potential when it’s a member of the opposite sex involved;
it happens and it simply must be taken care of. We had three full plastic urinals
from this patient. I was glad that we were in the city and not too far away from the
hospital or we would have to pull over and dump one of the urinals someplace;
another problem in itself.
Mr. Young was an exceptionally good driver and with him driving we had a
relatively smooth ride plus since he had spent many years working in this part of
Washington DC Mr. Young knew the best route to take considering the time of day
and traffic flows. I knew we were in good hands; but everybody can have a bad
day.
Gordon had just finished taking the patient’s blood pressure, something he had to
do every five minutes and I had finished administering what I figured would be the
last dose of narcotic before we reached the Washington Trauma Center and then
the accident happened.
We were jarred hard in the back of the ambulance. I was knocked out of my seat
onto the floor of the ambulance. Gordon was sitting on the bench seat opposite
the patient and he was shoved sideways into the wall of the compartment that
holds the oxygen bottles. The patient was strapped onto the stretcher, the only
one of us three in the back with a seatbelt on, and was jarred hard but was not
thrown off the stretcher because of the restraints. I was on the floor, a bit shaken,
and I could not see Mr. Young to see if he was injured. I knew that we had been hit
or that we had hit something very hard. I called out “are you OK?” to Mr. Young
because I could not see him. I was relived to hear him holler back that he was OK
and that a car had ran into the ambulance. Next, still on the floor I ask Gordon if
he was OK and noticed him moving around a little; he too said he was OK. That
was when I started to take notice of my surroundings down there on the floor. I
was lying in a pool of yellow fluid.
I just knew that one or more of the urinals the patient had used were no longer full
and just what yellow fluid I was wallowing in. I held up my soaked arm and said
something rather unprofessional, like “AWWW crap”. Gordon had taken notice of
my plight, especially since his pants were wet as well, and came to my aid.
About the same time I also noticed that the “fluid” had a particular odor that was
not consistent with urine. You see, when we stopped for sodas before leaving
Front Royal Gordon had got a 32 ounce cup of Mountain Dew and he hadn’t the
time to drink any of it; this is what I was lying in. Gordon confirmed that it was his
soda that had spilled and the three plastic urinals were still intact. I felt comforted
and concerned at the same time. Now all I had to contend with was sticky soda
pop the rest of the day. At least the soda pop would smell better than what I had
thought it was in the beginning.
My attention turned back to the patient and I working to make sure he had not
been injured in the accident and just didn’t feel it because of the narcotic he had
on board. I also wanted to be sure that none of his bandages had been knocked
loose or either of his IV lines been disturbed. While I was doing this Gordon
stepped out the back of the ambulance to see what had happened and to offer aid
to the folks in the other car if they were injured. I knew Gordon and Mr. Young
would take care of things outside the ambulance while I stayed in the back with
our patient.
Mr. Young opened the back door to give me a report on the situation. He said a car
had run the red light in the intersection and had hit us on the front left-hand side.
He also said that there had been a police officer in a patrol car at the intersection
and had seen everything. He also let me know that the ambulance was out of
commission, we could not continue in this ambulance. Having the policeman so
close by was very lucky for us because he had called for a D.C. medic ambulance
to respond and take us the rest of the way to the hospital.
It did not take very long for the D.C. ambulance to show up and we transferred the
patient to their ambulance. I needed to stay with the patient since I was familiar
with his condition and had been pushing so much narcotics to ease his pain.
Gordon got in the DC ambulance with me and I advised Mr. Young to stay with the
ambulance, notify Valley Medical Headquarters about the accident involving the
ambulance and then try to meet up with us when he was finished, if he could find
us.
I was surprised when I stepped out of the ambulance to transfer our patient to the
D.C. Fire Department ambulance that we were in front of the China Town Arch that
stand at the beginning of the area known as Chinatown in Washington D.C. It is an
interesting sight but I did not have time to look around very much.
We had forgotten to get the three urinals from the wrecked ambulance. It would
have been preferred to have them with us because the physicians at the trauma
center would want to know how much output the patient had produced. It would
be preferred to have the samples there so they could run some lab work on the
urine to establish the volume of emzynes and nutrients the patient had lost. But
the need not approach the level I would ask the driver to turn around or ask a
police officer to get three containers of urine for us.
The patient was being given the same treatment now as before the accident and
as par for the course he once again advised me that he needed to pee; oh what
joy. I ask the attendant with the DC Fire Department where they kept the urinals
and he told me that they didn’t use them. They were always either close enough
to the hospital or they told the patient just to go ahead and they mopped it up
afterwards. I didn’t want our patient urinating on himself due to the burns and
possible contamination problems; but we had no urinal. They did have 100-ml
bottles of sterile water stocked in their ambulances so I took one of them and
dumped the water into the step well in the back of the D.C. ambulance. I was glad
that this patient was not so well endowed that I couldn’t get him inside opening of
the empty bottle.
We arrived at the Trauma center with our patient no worse for wear and his care
was taken over by the staff of physicians in the center. I understand he survived
the burns and I’m sure he learned a lesson not to try to sell fake drugs. Maybe it
even scared him to the point he would not go back into that type of activities
again.
The ambulance had to be towed back to Winchester and was declared a total loss.
The police officer that had witnessed the accident charged the other driver with
reckless driving and failure to yield the right of way to an emergency vehicle.
I was a little sticky but uninjured, Gordon and Mr. Young were not injured either
but all three of us were stiff and sore the next day.
Valley sent a ambulance down to get us after a short delay while they freed up a
ambulance to come and get us. This transport would normally take about four
hours from start to finish, 8 hours latter we arrived back at base only to sit down
and fill out another forty-five minutes worth of paperwork about the accident.
Chapter VII “We’re On Fire!!”
Valley Medical Transport was called to the Intensive Care at Winchester Medical
Center to transport a patient from there to the hospital at the University of
Virginia in Charlottesville VA. The Crew consisted of Tim Brogan as driver and
myself as the medic. We knew from the first reports that this was a critical patient
and that a RN from the intensive care ward as well as a Respiratory Therapist
would be going along with us.
I always enjoyed working with Tim Brogan because not only is he a good guy he is
also one of the best and most capable operators we had. If I needed help in
treating the patient I was comforted knowing I had Tim with me.
When we arrived at the Intensive Care Wing of the hospital we parked the
stretcher, with all the equipment on it, to the side and went in search of
information about the patient and to confirm that we had all the equipment was
going to be needed for the transport. We never would go straight in and load a
patient like this without getting all the details about the patient’s condition and
whatever we could find out about the transport first. Everything I heard about the
patient’s medical condition and his current situation I was amazed that they were
transferring him out of the hospital. Even if you are going to transfer a patient to a
hospital of higher care you do not do it if the patient is as medically unstable as
this one was.
As it turns out this person is well known to me as he was my neighbor in Front
Royal for about 10 years; he was a very nice guy who would always stop and
speak to the neighbors. Also, while on call one Friday night I had picked up his
daughter when she was killed in a car accident some 7 years earlier.
The patient was being transferred AMA. That is Against Medical Advice. He had
been treated at Winchester Medical Center for a heart problem, undergone open
heart surgery just the day before and was not responding well to the treatment
that he was being given. The family had decided to have him moved even though
the physicians at the medical center did not think it was medically wise to move
him nor could they say that he would survive the transfer. I was not a happy
medic to hear all this negative information. The only good thing about it is that it
sounded as if the Medical Center was going to send some good help with us on
the transport. This would prove to be only partly true as events unfolded later on
in the transport.
I ask the question “why is this patient not being flown to UVA?” and I didn’t care
for the response; “because we don’t think he could survive the vibration in a
helicopter”. What did they think? That an ambulance rides like a Mercedes? An
ambulance must carry a lot of weight and therefore has a heavy-duty suspension;
all ambulances shake around some. I don’t like it when people die in the back of
“my” ambulance; that holds even truer when I know them.
To top it all off the patient was not responding to the various medications that
were being pumped into him; the drugs didn’t seem to have the desired effect as
they should.
I took stock of the situation we had and addressed what had to be done. The
patient had been intubated and was on a respirator doing all the breathing for
him. There were 7 IV lines with medication being pumped into the patient, that
means 7 IV pumps [multi-line pumps were just starting to come out in the field].
The patient had a chest drain with fluids that were building up on in his chest
being drawn off. This also required suction to be connected as soon as we got to
the ambulance, it would be OK to just clamp it off for the short while going to the
ambulance. Plus the suction device had to remain below the patient’s chest level
and in an upright position 100% of the time. It’s not overly difficult to do, but is
just something else important that you have to keep track of, and without fail.
He had been catherizied which was a good thing in that we didn’t need to worry
about helping him with a urinal. It does require some attention so that the bag is
lower than the patient and goes with him as you don’t want to pull it out, that can
be very painful if you don’t deflate the retaining bulb that is on the bladder side of
the device. If you start to move the patient over to our cot before moving the
urine container, it can be very uncomfortable for the patient and the “tugging” it
results in on the guys “wenner” makes me hurt as well.
He had a temperature probe and monitor stuck up his rectum and a oxygen
saturation “pulse ox” attached to his finger. He was on a heart EKG monitor, and
what is known as an A-line pump to help keep enough blood flowing through his
body. To help increase blood flow and to help reduce the chances of a blood clot
forming in his lower legs he also had pneumatic stockings that were inflated on
both legs. We don’t normally transport with these devices inflated but in this case
the physicians informed us that it was desired. On top of all the above he had a
gastric drain to prevent fluids from collecting in his stomach, and it also needed to
be hooked up to suction that while in transport, we could cap it off going down to
the ambulance because a few minutes without it was not a problem.
All this equipment was a bit much for one person to handle and I contemplated
asking for a “second set of hands”, that is another EMT to ride with us in the back
of the ambulance. But I had two personnel from the hospital going on the
transport so I made the choice not to ask for the extra help; that decision would
prove to be costly in about ninety minutes. I did call for a second crew to come to
the hospital and help us get loaded. We had a great deal of equipment to load and
care for just getting from the patient’s bed to the ambulance. In all my years of
transporting patients this was the most equipment attached to one patient that I
had ever transported. Like I pointed out previously, they do not normally transport
someone this unstable in a ground ambulance; or at all for that matter.
Unfortunately there were no crews in the area to come help us get the patient
loaded in the ambulance, so we had to do it by ourselves. The first consideration
was to figure where we were going to put everything on the stretcher and still
have room for the patient. Some of the medical equipment attached needed to be
in a certain location; lower than the patient, above the patient, at the head or at
the foot end. All this had to be figured out, which we were going to have to move
first and how to keep all the lines and wires hooked up and no get too tangled up.
You don’t want the IV lines or wires tangled because something can get pulled out
or if you have a problem with one device it’s a lot easier to track down if you can
rapidly identify which tubing is which. We also had to consider where we were
going to plug everything in when we got to the ambulance; there are a limited
number of outlets in the back of the ambulance. We had so much stuff to plug in
that I had to call maintenance and borrow a plug-in power strip to expand our
capabilities. The next concern was to identify if the electrical generator could
produce enough power to run everything. This is not a normal concern but in this
case we had to be sure. I know very little about power draw and the minimum
electrical needs of the medical equipment that we had to carry with us. But it was
our best guess that the ambulances power converter could handle the load.
After we finished with our planning we addressed the needs of the two hospital
staff that was going to ride with us. How much extra equipment did they have
besides what was connected to the patient? How were they going to get it down
stairs to the ambulance? Could they carry all of it or did they need to get a cart?
Did either of them get carsick and if so what preventive measures had they taken.
I let them both know, in certain terms, that if they got sick and puked in the back
of the ambulance that it would make me sick as well and I would be vomiting in
their direction. There are a number of drugs that you can take to keep you from
vomiting but they tend to either make you sleepy or are a mild narcotic, neither
was a good choice when you needed your wits about you. There is one other drug
that works to prevent motion sickness and does not have the complications of
most drug treatments. The only draw back is that it only comes in a suppository
form and there is reluctance from most people to take this medicine because of
where you have to shove it. Bathroom breaks before we go? Drinks? Special
orders from the physicians? Paperwork? Extra or different drugs needed apart
from what we carry? Do we know where we are going? Not only which hospital but
to what physicians care and to what part of the hospital? All these are the little
things that need to be addressed before we load the patient.
With the careful planning we had done the transferring of the patient from the
intensive care bed to our ambulance went fairly smoothly. We were finally under
way to the hospital the University of Virginia. There are several routes that we can
take to get to the hospital in Charlottesville and it is collaboration between the
medic and the driver as to which route we take. Smoothness of the ride, speed in
getting to the other hospital, back-up hospitals if we have to divert because the
patient get a lot worse , and the patients condition are all factors in deciding
which way we go. On this trip we choose to stay on the interstate for the
smoother ride and for the most number of choices of hospitals should we have
trouble and need to divert. It takes about twenty minutes longer than the shortest
route but is the better choice sometimes.
The three of us got the patient settled in the back of the ambulance and we had a
busy but basically uneventful ride for the first thirty minutes. One practice I was in
the habit of doing was to figure out the drip factors for each of the drugs that I
was transporting in case the electrical IV pump failed, as they sometimes do, and
we had to administer the medicine without the machine. An IV pump is optimal
because it pumps a very controlled volume and rate of fluid to the patient. In the
case of this patient that we had on board we had to be careful of the volume of
fluids infused because it was the drug therapy that was important and too much
fluid was counterproductive. The drip factor, of how many drops of fluid per
minute or hour introduced is a different number than what the pumps are set at.
When counting drips the size of the tubing, the type of base fluid, the strength of
the drug and the volume of fluid that the drug is mixed in are all factors that need
to be calculated. It’s a lot of math and “brain power” but since I was in the habit
of doing it on every transport, just in case I had problems, it didn’t take very long
to do. You just have to be very careful not to make a mistake. A misplaced decimal
point can have disastrous results.
The patient’s blood pressure and other vital signs were not doing well, they were
deteriorating. He was not responding to the drugs we were using to increase his
cardiac output so the nurse from the intensive care choose to change some of the
drug types and dosages. The respiratory therapist had the patients breathing
under control; the “breathing” machine was doing it’s job well. The oxygen
concentration, as reported from the pulse ox attached to the parents earlobe (I
had moved it from the finger to make it easier to monitor in the ambulance), was
well below normal limits but was being maintained within the range of values that
was the best that we could hope for in this patient.
I found the Respiratory Therapist to be very competent while the nurse from the
intensive care ward was indecisive as what to do next. She commented that it was
unusual that she had to make these choices about treatment of the patient. In the
hospital setting there are physicians in the ICU, or just a phone call away, that she
could defer a lot of decisions to them. I explained that we could reach a physician
on the radio, but the reality is that it takes a lot of time to set-up that
communication. No physician will want to advise you on the care of the patient
when they have not been the one taking care of them; they don’t know the whole
story of what’s been done so far for the patient. It can easily take thirty minutes
to either find the right physician or to fully update another physician about the
patient’s condition. By that time the parent’s condition may very well have
changed or deteriorated too much. That is why we are trained to make decisions
on our own, within the guidelines that the physicians have established. I like to
say that as a medic we encounter a problem with a patient, we think, we plan, we
act, and we overcome. The nurse did not like my way of thinking, she was not
comfortable being without physician support. Since we didn’t have a physician on
board I let her know she had to figure something out on her own. She didn’t care
for that either. She had some problems working in the back of the ambulance also.
She had a Doppler stethoscope with her even though I had advised against it
because that device picks up a lot of road noise which makes it very hard to hear
through unless you stop the ambulance beside the road. I had no plans to pull
over every time she wanted to listen to heart sounds. She couldn’t hear through a
regular stethoscope either; it’s nothing against her because it is difficult to hear
around the road noises and sometimes it takes a trained ear.
As we progressed into the transport the patient was getting worse. I leaned
forward and ask Tim if he could speed it up a little. I was confident that Tim would
drive the ambulance safely and not be reckless with using the need to get the
patient to our destination as an excuse to go too fast. I did notice that we picked
up a little speed and I guess we were riding on the interstate at about 75 miles
per hour; slower than some of the other cars on the highway.
The vital signs were still in gentle, but continuing, decline and I was thinking
about the possibility of diverting to another hospital that was closer to us. Getting
to the hospital at the University was what was the best choice, but not the best
choice if the patient could not tolerate any more of the ride or if the patient is not
going to make it that far. In that case another hospital may be able to stabilize the
patient a little bit and get his vitals to improve so that we could continue the
transport. It is a difficult question, continue or divert to someplace that can give
the patient better care than we can in the back of the ambulance vrs the better
choice of care in UVA. I was about to say something when the ambulance shook
violently and the back of the ambulance filled with smoke.
The RN screamed “we on fire” which was kind of pointless because everyone was
aware of the smoke that filed both the patient compartment and the cab of the
ambulance. I glanced up front and noticed that the view out the windshield was
blocked by something on the window. To this day I an astonished that didn’t run
into something, with any other driver we might have but Tim is an exceptionally
experienced driver with emergency vehicles as a Deputy Sheriff in his full time
job. Somehow he got us off to the side of the interstate with killing us all. He had
drifted the ambulance well off the side of the road on the right had side. We had
loss all power from the motor and hence we had loss all electrical power to the
various medical equipment we had plugged in the back as well. The respirator
that was breathing for the patient is powered by the pressure of the oxygen in the
tank; however the regulator is electric powered as well and we loss the machine
that was breathing for the patient too. Alarms were sounding from all the medical
equipment and the nurse kept yelling about the fire.
There was nothing I could do about the fire right then, I knew Tim would see to
that and would let me know what kind of danger we were in. I was occupied
disconnecting everything we had plugged in or attached to the walls of the
ambulance like suction and IV lines. When we lost power the patient was not able
to breathe either and that’s not a good situation. The respiratory therapist had
disconnected the respirator and had started “bagging” the patient by hand using
an Ambu bag that she attached to the patients breathing tube. It sure was good to
have her in the back of the ambulance, as the intensive care nurse was not
accomplishing much. She did not appear to know what to do next and without
someone telling her she was lost. I had other things on my mind and other things
to do rather than supervising her.
Just as I had gotten everything unhooked, and it didn’t take me very long, Tim
opened the back doors and I was ready to jerk the stretcher and patient out of the
ambulance when Tim advised that we were not on fire. The smoke had come from
oil spewing out on the hot motor when the engine blew up, but the oil had not
caught fire as we all had thought was the case at first.
In fact, with the back doors open the smoke cleared out quite a bit. I hopped out
of the ambulance to take a deep breath of clear air and to try to figure out where
we were. I could see a road sign there on the interstate that said the Stanton exit
was one mile away and Tim confirmed this information. I went to our main radio
and called “MAYDAY, MAYDAY, MAYDAY, Valley Medical ambulance is in distress”. A
message like this will usually get a response from anyone that hears it, but no one
responded to my call for help. I tried several times and with our other radio as
well and I got no response. We found out latter that this strait of highway is known
by the locals to be a notorious “dead spot” for radio communications. I just
figured something happened to the radios that prevented me from getting out.
I needed to get back to the care of the patient and I needed to take some action
to get us help as soon as possible. I made a quick decision and told Tim to flag
down a car and go to the next exit and call 911 to come to our rescue. I was
headed back into the rear of the ambulance as Tim said, “OK, just as soon as I put
out these road flares”. I knew Tim would get us help.
I was able to get the power back on in the back of the ambulance. We only had
whatever the two batteries had in them and no way to recharge them. IV pumps
have some battery life in them but are well known for their unpredictability as to
how well they have been charged or how old they might be. Suction was of major
importance so I hooked it back up first and then addressed the other equipment in
order of importance. The RN with us was now able to hear with her Doppler
stethoscope so she was busy taking vitals. I took the opportunity to step out of
the back of the ambulance to see if I could some how by-pass the oxygen
regulator that I was afraid would fail again soon because of the battery situation.
That’s when I noticed that Tim’s efforts to be safe by sitting out the road flares
had backfired on us.
The wind had picked up and blew one of the road flares into the dry grass and
started a brush fire around the ambulance. I was trying to identify which way the
wind was blowing to assess how much danger we were in when a car pulled over
to the side of the road behind the ambulance. I had determined that the wind was
taking most of the smoke away from us and the grass fire, while burning around
us, was also moving away from the ambulance. The RN form the intensive care
ward had smelled the smoke from the grass fire and once again thought we were
on fire and started yelling about us being on fire again. At the same time the
citizen that had stopped ran towards the ambulance with a blanket yelling for me
to help him put the fire out. I know I could have been a little more understanding
and professional when I answered him; but I was also very stressed by the events
of the past fifteen minutes. Plus I had the RN hollering at me from the back of the
ambulance as she was afraid they were going to burn up or be choked to death by
the smoke. I told the kind gentleman in no uncertain terms what he could do with
the fire. As it turned out this upset him and he copied the toll free number off the
side of the ambulance and called in a complaint to the office about how rude I had
been.
When I jumped back into the ambulance I was able to calm down the RN and I
took notice that the respiratory therapist was sitting on the bench seat quietly
doing her job.
About ten minutes more pasted, it seemed like hours, when a fire truck pulled up
to combat the increasing grass fire and behind them was an ambulance from
Buena Vista Rescue Squad. The crew from the squad was very helpful and they
agreed to take the patient, and us, to either the hospital in Charlottesville or the
closer one in Stanton, which is Augusta General. I choose to go by the closest
hospital and get a physician to assess the patient before we continued on. The
respiratory therapist was help in making this decision but I could not get the nurse
from the intensive care to give me much input that made sound advice.
Our stretcher was much different than the type that the squad had so ours would
not fit into the mounting hardware of their ambulance. All the planing we had
done to get the equipment and patient on our stretcher had to be done again.
This time we would be making the switch along side the interstate highway rather
than in a hospital room.
The patients condition had stabilized a little bit, even with all the commotion, as
his vital signs had not gotten any worse, no better but no worse either. We
continued to monitor the patient until we arrived at the emergency room at
Augusta General. We did not have to unload the patient at the hospital because
the physician agreed to come out to the ambulance to do his assent of the
patient. He decided that we were doing as much for the patient as they could do
in the emergency room. I inquired if he felt the patient was in shape to continue
the trip and he was not willing to go that far but agreed with me that the best
place for him was in the university hospital. So we took off once again in the
rescue squad.
From here on the trip to UVA hospital was uneventful. The crew from Buena Vista
Squad stuck around until we had unloaded our patient and given report on what
treatments that had been provided.
I contacted VMT headquarters and they agreed that the best thing was for us to
return to the Stanton exit, buy supper for the hospital staff that was with me at
Cracker Barrel and wait for a ambulance from Winchester to come down to pick us
up. There was a bit a delay in coming down to pick us up as there were no free
ambulances available so it took about three hour before anyone came down to
pick us up.
The patient did survive for about two and a half weeks after the trip and it was
determined that our loss of the ambulance was not a factor in his death. I was
glad to have the respiratory therapist with us and I was glad Tim was the driver.
The RN out of intensive care was probably a good nurse in her own setting but in
the field you have to learn to adapt and overcome problems as they present
themselves and this was not something she had been exposed to in her career.
Ambulance motor blowing up, grass fire all around us, very sick patient that was
“going down the tubes”, all made for an interesting transport.
Chapter VIII. Not A Good Way To Wake Up

We had been dispatched to transport a patient from the OB/GYN section of

Winchester Medical Center to the hospital at the University of Virginia. The patient
was a young lady who was 7 months in gestation that was having some labor
pains. Her history was Para 3 – Gesta 6 and the physician wanted to delay the
birth of this baby [she had three children carried to term and had 2 miscarriages
previous to this pregnancy]. They had given her a medication which can prevent
or reduce the labor from progressing.
The drug the patient had been given has a complication that it can cause the
patient to stop breathing in some rare cases. This complication does not
necessarily present itself when the drug is first administered. The labor can
spontaneously resume, even with the administration of the drug. The instances of
this type of problem are very limited and the drug is basically considered safe to
use, but with some caution and extra attention on the part of the medic to
monitor for possible complications.
The hospital was going to send a nurse from the OB/GYN department with us in
case a problem developed. Some hospitals and some physicians have established
the practice of sending a specialty nurse on transports when this medicine has
been administered and some facilities never did provide someone to go with us. It
just depended on the hospital policy and the physician’s preferences. I was
usually happy to have one of these nurses because most of them, maybe ninety
percent, were very good and very helpful. Every now and then you would run into
a nurse that couldn’t cope in the field, but that was not the general rule.
My partner Hal Shaner had run into an event on another transport where the drug
had built up with his patients system and she quit breathing. His fast action in
identifying the problem and knowing what to do, what drug to administer to
counter the original medicine, is what saved that young ladies life.
We also had another rider with us on this transport, a new VMT employee and this
was going to be her first transport with us. I was the Team Leader, or station
manager, at the time and this was going to be one of her orientation transports. I
wanted to see how she preformed on a transport, how she interacted with the
patient and to determine how much training it was going to take to get her ready
to be by herself in the back of the ambulance. Our driver was Robbie Sealock, a
young man that was a good driver. He didn’t have too good of a sense of direction
and had gotten us lost a couple of times but with a little experience he “outgrew”
that problem. I did check with him to be sure that he knew the route we wanted to
take on this transport. A smooth ride was more important that the fastest
approach to the hospital in Charlottesville. I was never concerned when Robbie
was the driver as he is particularly cautious and safety minded. He can make the
ambulance “go” when he has to, but he never abused that ability.
On this transport we were fortune to have an experienced nurse with us. She
proved to be a real trooper in an emergency.
We loaded the patient, after the usual preplanning, and took off for Charlottesville
VA. The ride was uneventful and we moved the patient to her new hospital bed
while the nurse provided the physician with the treatment history and report on
the patient’s condition.
When we got ready to return to Winchester I offered to let the nurse ride up front
in the passengers seat. In fact, I kind of wanted to ride in the back in order to
spend the time with the new employee going over some of the equipment in this
ambulance. However the nurse said she preferred to ride in the back and I didn’t
argue with her. She had been talking to our new attendant and she wanted to
continue her conversation. No problem on my end so I got in the passenger seat
and buckled up my seat belt.
Whenever I was in the front of the ambulance I always wore my seatbelt. For one,
it is required by both the state and is a Medical System policy, which we came
under. More importantly to me the seatbelt and shoulder strap kept me upright
when I fell asleep. I could settle in on the return from a transport and be asleep
before we left the parking lot of wherever hospital we were leaving. Especially
when I had trust in the driver’s ability as I did with Robbie.
As we left the hospital at UVA I heard the two in the back engaged in conversation
and they had settled in for the ride home. The return from Charlottesville takes
almost two hours in normal driving.
This trip was no different although I did stay awake long enough to be sure that
we were on the right road back to Winchester; but soon I was fast asleep. I had an
experience of falling asleep right away with a new driver on the return from
Charlottesville some time ago; he make a left turn instead of a right turn and I
didn’t wake up for 2 hours and we were almost to Lexaton!
I was dozing nicely in the passenger’s seat when I was rudely awakened by the
sound of the grooved “rumple” strips on the side of the interstate. They are
designed to alert the driver that he is headed off the roadway and they do their
job well. I’m sure they have saved lives because they make a noise that would
wake anyone; they certainly woke me up.
As I looked up I could see that we were traveling at a high rate of speed for the
shoulder of the road and in front of us was a drop off of about twenty feet into a
valley in the middle of the two roads of the interstate. I knew we were about to
plunge over the side of the ravine when a large sheet of mud and water splashed
up on the windshield and obscured the view.
I let out a scream, Robbie describes it as a shriek---- like what would come from a
little girl, and I describe it as a shout for someone who is about tom plunge to
their death.
About two foot from going over the edge we had sunk into the mud down to the
axles of the ambulance and that is what stopped us from going over the edge. In
fact we were jolted to a stop!
This is a very poor way to wake up from a nice nap! Although we had taken quite
a jar when we were stopped by the mud I was not injured, nor was Robbie. It did
take me a few breaths to calm my nerves down a bit.
I then turned to see how they had faired in the back while Robbie got out and
surveyed what the damage was. The two in the back had not come through as
well as we did in the front. Both had been knocked onto the floor and the nurse
had some how got tangled up with the mounting on the floor for the stretcher.
I got out of the unit to go back and see if I could help them off the floor and to
treat any injuries I found. The nurse had some minor complaints and against my
advice she got out of the ambulance and walked around a bit. I would have
preferred to do an assessment on her before she got out of the unit but that was
not her preference.
The nurse’s injuries were minor and were treated in the emergency room of
Winchester Medical Center. Our new employee was not injured but I wasn’t too
sure she was going to show back up for work again.
The wind was very strong and a gust of wind had pushed the ambulance off the
road and into the median. A state trooper pulled up and as he had Robbie in his
cruiser talking with him the patrol car was rocking from the wind.
While Robbie was being entertained by the trooper I called VMT headquarters and
advised them of the situation. We were going to need a tow truck to get the
ambulance unstuck from the mud and they called one for us. We were also lucky
that we had another VMT ambulance and crew in the area so they responded to
transport the nurse to the emergency room so she could have her injuries,
however minor, checked out. She didn’t really want to go but understood that this
was System policy and she cooperated. We were fortunate that her injuries were
not severe.
The trooper knew how hard the wind was blowing and understood how a gust of
wind could push the ambulance off the roadway. He described it as the same thing
that truckers fight against sometimes. No ticket was issued.
A tow truck showed up and with some strain was able to get our truck unstuck.
We had mud flying off the wheels for the next thirty miles. The truck sustained no
lasting damage.
I stayed awake for the rest of the ride back to Winchester; that rumble strip is a
lousy way to be awakened up from a good nap.
Chapter IX. Medic Tricks & Tips

Medics learn to operate in the field under all conditions. Sometimes in perfect
weather, and sometimes in the worst weather that you can imagine. I’ve treated
patients when it was so cold that the adhesive on our tape would need to be
thawed out before it would stick; conversely, I’ve treated patients in 110° heat
when the sweat stung our eyes to the point we could not see. At night, lying on
your back in six inches of mud and muck, trying to start an IV on a patient that is
entrapped in her vehicle is a difficult environment to apply our skills in, but it’s
happened. Performing first aid on a patient in a driving rainstorm is another “fun”
experience that I will not miss having to do.
Randy Frankin and I once worked a “code” that is performing CPR and advanced
lifesaving care, on a person outside of his house during the only full eclipse of the
sun we had in over 100 years. That was surreal!
In the field you have to perform some procedures a little different than you might
do under perfect circumstances. A good medic has also learned some tricks and
shortcuts that make accomplishing the job safer and healthier for all.
I’m recounting some of those “tricks of the trade” that I have learned over the
years. Not that I’ve ever done these things, it’s just that I’ve heard about them.
Cussing And Squirming:
When you are working on a patient that is belligerent, “cussing and fussing” as
some people refer to it, I have a trick that works ninety percent of the time to
calm them down and gain a degree of cooperation from them.
It’s almost always the patient that has some alcoholic beverage on board, and
isn’t thinking too clearly, that uses foul language and is not cooperating with you
for their own medical care. It’s not always the drunks as there are several medical
conditions, physical and mental, that can produce the same type of actions from
your patients. The patient can have AOTB [alcohol on the breath] and still suffer
from one of these medically rooted conditions; so it’s not always the alcoholic that
gives a difficult time. On a “betters edge” I place my money on the foul mouthed
being intoxicated. We are trained to ignore, and work around, these obstacles as
best we can.
When I have someone “cussing and fussing” I like to look at them and with a mild,
non-aggressive voice say “you know, that’s not the way to talk in front of a
preacher”. Ninety percent of the time they will calm down, at least for a few
minutes, and become more cooperative. Sometimes I’ll even get an apology
“sorry Father”.
I didn’t say that I was a preacher, just that the language they were using would be
offensive to one, if they happened to be around.
Stairs
It seems that the heaviest patients are always located on the upper floors of a
residence. These patients need to be carried down the steps a lot of the time. We
have specialized equipment on the ambulances that make this task easier for all
involved; but it’s regularly hard work.
We run into situations where the patient may be able to walk down the stairs on
their own power, but it is often not medically wise for them to do that. We may be
concerned about the strain of the excursion on the heart or be influenced that the
person may not have the strength to walk down the steps. There also can be a
concern that the patient may loose consciousness or become faint if we allow the
person to ambulate on their own and the chances that this would cause additional
injury is prevalent.
The method of choice to get some down a flight of stairs is the “stair chair”. This
device permits the patient to sit in a special chair with wheels attached to the
back legs and hand holds for the medics. If the patient’s condition warrants it we
can remove the patient from upstairs on a “backboard” or stretcher but this is
much more difficult.
No matter what method is chosen to extricate the person down the stairs the
experienced medics always vie for the upper end of the stair chair or cot. It’s not
that there is less weight on the attendant holding the higher position, in fact that
person carries most of the weight of the patient and equipment. The problem is
that the person on the lower end can not let go for any reason. If they drop their
end of the stretcher both the patient and the other rescue worker can suffer
serious injuries. They also become “flying objects” down the steps and can cause
a real problem to anyone in their way. So the person holding the bottom can not
move.
No matter what the patient does it will come “down hill” to the person holding the
lower end of the stretcher. If the patient vomits, bleeds, looses control of their
bladder, or has problems with their bowels it all runs downward and onto the
attendant holding the bottom of the equipment. Even if the patient coughs the
medic on the bottom gets it in the face. Body odor smells drift right into the face
of the person on the bottom as well. It’s no fun carrying someone down the stairs
with runny diarrhea dripping off your elbow.
When you see a crew from the squad carrying someone down the steps, it’s a
good bet that the person at the top end is the senior medic.
Restraining A Patient
It’s illegal to kidnap anyone. It’s illegal to tie up someone and it’s not legal to
provide emergency medical care to an individual if they don’t want it. There are
some exceptions to this rule, but they are very limited in scope. If the medic
chooses to violate a persons rights and force them to accept medical intervention,
then the medic needs to be prepared to justify their actions in a court of law if it
should come to that point. Restraining someone is not to be taken lightly at any
time. If it become a necessary act then it’s also important that you do it right so
as not to cause more harm to the patient and to protect yourself from injury.
If the patient is not in control of their faculties or is unconsciousness there is an
implied consent from the patient that they would want treatment. If the patient is
a minor or is under arrest by the police there is an implied consent. If you can
determine that the patient is a serious threat to themselves or to others you have
a bases for implied consent. Otherwise a person can refuse treatment.
There are some other limits and exceptions within the law, but in general the
medic has a duty to act in the best interest of the patient and the general public;
they just had best be sure of their actions to prevent liability. I never took this
obligation and responsibility lightly.
Having said all that as preamble, I have always felt that it was important to me at
least, to protect to myself and the others serving on the squad against injury.
There are a number of ways to humanely and safely restrain someone in order to
provide emergency care. These methods are effective most of the time. I would
conduct a training class on these procedures for any new member riding with our
team on Friday nights.
There are two other techniques that are not found in any of the textbooks and are
a bit aggressive, but they are very effectual when other process are failing.
With a gloved hand a medic might stand behind the patient laying on the
stretcher and hook the index finger and the middle finger into a reversed C shape.
Then insert these two fingers as far up the nose of the patient as you can. This will
get their attention every time. With your fingers up their nostrils you can then
control which way their face is pointing and if you control the head the upper
torso of the body will follow. Using this method someone might turn the patients
head to the side and hold it down on the cot so they will not get up. With your
fingers in their nose they easily forget about the others who can complete their
assigned task in securing the patient to the cot.
The other “trick of the trade” is more than just a bit aggressive, it’s also most
illegal, but [I’m told] it works well. A patient on certain drugs can be incredibly
strong, stronger than they would be in normal circumstances. I’ve seen patients
lift amazing amounts of weight and even break metal arm restraints while under
the influence. These people are a real danger to the medic as well as others
around. If the person has become so violent and is at risk of getting free of the
restraints one might tie a cravat (strap) to one side of the cot and drape it across
the patient’s neck. Then loop the other end under the bar on the other side of the
cot and pull as hard as you can until the patient passes out from lack of oxygen. It
may not be a nice thing to do to somebody but it’s far better than me getting my
butt kicked by some deranged patient.
Bedpans
People poop and pee. It’s just a fact of life and we have been trained in the
emergency medical services that it is important to understand how to assist the
patient and how to diminish the patient’s anxieties as best we can. Privacy and
understanding are important to all concerned. We try to reduce the
embarrassment most folks experience at situations like this. I found that an
attitude of “hey, it happens, no big deal; lets see what needs to be done” works
best. Although, I would prefer to avoid as much personal involvement as possible.
Bedpan usage is the more problematic regarding the equipment that is sometimes
required. Urinals and Texas catheters are other devices that I’ve used and they
have their own complications but not as frequently as the use of a bedpan.
A female patient needs the use of a bedpan for either of the elimination activities,
where a male only needs the bedpan for one function. When a patient needs to
use the bedpan, and there is no way to delay this endeavor, it’s best to pull the
ambulance over to the side of the road. There is a certain amount of sloshing
around that happens if the ambulance is in motion, and that is something that you
want to avoid that if possible. It also takes two attendants to help a patient with
this bedpan business.
First you raise the back of the cot to the upright position so the patient is sitting
up right, if at all possible. This is the best position for them to be in. Next one
attendant stands behind the cot and will lift the patient by placing the hands on
both sides of the body and lifting. The patient is instructed to help as much as
they can in raising up about three or four inches. The more experienced medic will
jump at this task; you may have to do a little straining to lift the person but it’s far
better than what the other guy has to do.
The second attendant has to perform several tasks. First, if the patient has on
underwear they will need help removing this article of clothing. Secondly, this
attendant will need to place the bedpan in the correct spot (this necessitates
looking at where you are placing the pan). At this point the patient would be
lowered onto the bedpan and both attendants will give the person as much
privacy as possible.
There is at least one complication to the privacy issue. If the patient is a cardiac
patient there may be some concern about the vagel response that is normal
during this maneuver; it is a natural slowing of the heart that may occur. If the
patient is on the cardiac monitor then the EKG must be observed by the medic.
After the patient has completed the tasks at hand the experienced medic will once
again stand behind the patient and lift while the second attendant removes the
bedpan. This is where the real problems start.
First, you need to be very careful about the spilling of any contents of the bedpan
as you remove it from under the patient. Then there is the problem of what to do
with it after you remove it.
Secondly, there is a certain amount of cleanup involved. Since the experienced
medic is tied up lifting the patient up off the cot, the cleanup job is left to the
second attendant.
The cleanup detail is basically the same in all situations. It does require a little
more involvement if the person had a bowel movement; but the task is essentially
the same.
I mean no disrespect to any patient we have ever had to assist in this exercise.
However the simple fact remains that the second attendant is going to have to
look at what they are doing. Some of these sights can turn you against sex for
weeks!
So the tip of the trade is that the seasoned medic will tackle the physical
demanding task of lifting the patient rather than being exposed to something they
really didn’t want to see.
Too Wet
A condition were the patient develops a total body sweat is called diaphoreses.
This is a serious medical condition and indicates to the medic that advanced life
support care is needed right now. One of the first things that needs to happen is
the application of EKG electrode patches so that an EKG patterns and be obtained.
The results of the interpretation of the EKG will have a significant impact on how
the patient is treated in the field.
One complication of the total body sweat is that the adhesive on the EKG patches
does not stick to the skin of the patient very well. The contact of these electrodes
is critical in obtaining a clear EKG pattern (a representative of the electrical
activity with the heart). The wetness of the skin is what prevents the solid contact.
A trick of the trade is to ask the family if they have any deodorant around. Spray
on Right Guard is the best but any anti-perspiring agent will do. This dries the skin
and allows for the firm attachment of the EKG electrodes.
A request for deodorant can cause some confusion on the family’s part as it is a
bit unusual. The medic is not concerned about the patient’s odor, just making a
good electrical connection.
Second Hearts
A patient that says they have a “second heart” is usually indicating that they have
a pacemaker implanted. Especially older patients. The pacemakers are normally
implanted under the skin on the right side of the chest in an area refereed to as
sub-cavicular. Seldom do these devices fail.
A patient may have some anxiety that their “second heart” has stopped working
because of some discomfort they are experiencing. We have no intent to ignore
this discomfort; it may very well be an indication of additional problems that are
developing.
If you can find a transistor radio, they were much more popular years ago, all you
need to do is place the dial off any radio station it will receive and hold the radio
near the chest of the patient. You will hear a “thisp” sound every time the
pacemaker fires and this will be reassuring to the patient.
Vital Signs
A patient’s vital body function signs that you obtain will help you decide what
treatment will be provided. These are objective numbers or information that you
obtain during the primary and secondary survey of the patient.
It may be difficult to remember these numbers with all the other information the
medic must remember. One trick I have used is to attach an eighteen-inch to two-
foot strip of two-inch wide tape to my thigh. This gives the medic a convenient
place to write down the values of the vital signs as they are obtained. Writing on
the latex gloves or directly on the back of the hand works, but not as well as
having that white writing space on your thigh. The tape on your leg is not subject
to smear or having the rain messing up what you wrote.
If you see a medic with a piece of tape on their pants leg this is a sign of an
experienced medic.
The information that is gathered in the secondary survey is very important.
Decisions on their treatment may be preformed, or not preformed, often are made
on what “values” you obtain. These objective values can impact what treatment is
provided at the hospital emergency room. For instance, if you took a blood
pressure three times over the course of a twenty-minute transport and each time
the numbers you got were a little lower than the set before; well, this can indicate
internal injuries. If you were wrong, and the blood pressure wasn’t deteriorating,
then valuable time might be lost on a “wild goose chase” that would best be used
in treating other injuries. Even worse, if there are poor vital signs and you miss
them; a patient can have disastrous results stemming from your error.
I always lectured that there is only one time in a EMT’s career that’s it’s OK to
“make up” blood pressure reading; and that’s when your taking the Virginia State
EMT Examination, which is not a good time to start to be honest. If you can’t hear
a blood pressure, then say so. Never make up values just because you don’t want
to look bad or you fear someone may say something smart to you about your skill
level.
Taking a blood pressure is a relative easy task. Sometimes due to outside noise
interference, too much wax in your ears, or any one of many reasons, a EMT
might have problems getting a true reading. It happens to everyone at some time
or another.
The numbers are marked on a standard blood pressure cuff gauge by even
numbers or slash marks. These slash marks are very close together, too close for
someone to “hear” the blood pressure in-between the marks on the dial.
If A “newbie” reported a blood pressure in odd numbers, say 107/53, then I had a
very high degree of suspect that I was needed to do a check for myself; and
mores the pity to anyone I caught feeding me fake vital signs. That could be the
one last piece of information I needed to form what treatment I was going to
provide. My treatment could have the weight of life and death on it and I had
enough problems that I didn’t need misdirection from someone on the ambulance
crew. It happened from time to time, thankfully not very often.
Barf Bags
Vomiting, emisses, puking, up-chucking, throwing up, spewing your guts, barfing,
or call it whatever you want, I never liked it. I could not be around someone who
had vomited, was vomiting, or was even seriously thinking about it. I too would
vomit if I smelled it, saw it, heard someone vomiting, or even thought someone
had done it.
People say “how can you handle all that other stuff and have such a strong
reaction to somebody up-chucking?” I have no real answer for them. Blood, guts,
poop, and all the gross stuff we encounter on the squad never troubled me, just
don’t puke anywhere around me.
My “weak stomach” is well known throughout the local emergency services field.
When I am working on a patient and can not leave their side [as in, I’m the only
medic there and it’s a life or death situation] I will call for a trash can. When this
happens it’s because the patient has regurgitated, and everyone on the squad
knows it’s best if they can find a can soon, because I’m about to spew. If the
patient absolutely has to have advanced medical care, right now in order to save
their life, I would turn my head and puke all-the-while continuing to provide aid to
the patient.
The guys at the fire hall knew this “weakness” of mine and would go to extremes
to make me throw up. They would never do that on the scene of an emergency,
my fellow EMS workers would supportive in times of an emergency, but whenever
we had “down time” I was fair game. They knew if they talked about vomiting
with enough enthusiasm, and long enough, they could make me retch. It was
quite the jovial game for some people. I learned that I could reduce my exposure
to this “jolly” by aiming my vomit towards the ringleaders, this tended to diminish
some of the humor in the situation.
One time in particular Randy Frankin, one of the foremost medic’s and top-notch
firefighters in the history of the Department, played a practical joke on me.
Although I was busy throwing up my guts, afterwards we all had a good laugh at
this little prank he had devised.
I was cleaning up the table in the dayroom at the firehouse when I inadvertently
picked up a glass that one of the guys had been using as a spittoon while chewing
tobacco. Snuff and chewing tobacco are two disgusting habits as far as I am
concerned, but some folks enjoy it and as long as they keep it to themselves it’s
none of my business. Leaving your used spittoon on the lunch table is not what I
call “keeping it to yourself”.
I picked up this glass, without giving it a good look first, and it was warm! I knew
in that instant what was in the glass and took off running to the bathroom and
“got sick” in the toilet. I heard their laughter as I was occupied in the bathroom
stall. When I came out of the restroom there were several guys standing around
grinning, Randy being one of them. He walked up to the table and picked up the
glass asking me if this is what made me sick. I still felt a little “green around the
gills” but I told him that it was; and he drank a couple big gulps out of the glass!
Back to the bathroom for me.
What I didn’t know is that while I was busy throwing up the first time Randy had
removed the offending glass and had poured some coffee in another glass. Randy
had drank some warm coffee, but that’s not what I thought he had done. I must
have lost 10 pounds throwing up that afternoon. The gag was done in fun, and we
all had a good laugh afterwards; although from that day forward I never picked up
a glass at the fire hall without taking a good long look first.
Barf bags, or “body waste receptacles” as they are properly called, come with a
large funnel shaped cardboard opening and a clear plastic bag attached to catch
the product of the vomiting. The bag is clear so that medical personnel could see
what had been regurgitated. Was there blood mixed in? Pill capsules not
completely digested? Objects that shouldn’t be in the stomach? All this is
important and useful information for someone to know; but not for me. I covered
the “barf bag” with an empty pillowcase and when the patient was finished with it
I would tie the top tight and take it to the emergency room in case they wanted to
look at it.
They also make the suction hose in the ambulance clear so that you could see
what was being sucked out of the stomach. As for me, I covered the hose with a
towel or something so I didn’t see it. It was better for me, and for the patient, if I
didn’t have to look at it.
I got tired of getting sick on the squad so one day I ask the emergency room
doctor if there was something I could take that would help me stop throwing up
whenever a patient did. It had to be fast acting and could not be a narcotic
because I was on the rescue squad. Well, he gave me some TIGAN, which is a
drug that worked wonders for me. Whenever I took this drug and a patient threw
up I had much better control.
I didn’t take this drug very long because of how it is administered. It comes in
suppository form and after a bit I just decided that I would rather throw up than
have to stick that little pointed thing up my butt anymore.
About the same time Hal Shaner was having some pretty severe problems with his
knees and was taking a pain killer/anti-inflammatory before we would go out on a
call. It just looked bad that when a call would come in the two medics would run
into the bunkroom; Hal to retrieve his painkillers and me to get the “no-vomit”
medicine. He would then run off to the water cooler to wash down the pills and I
would go into a stall in the bathroom to insert the medicine in private. What a way
to serve your community.
My Name is Larry Oliver
I’ve been cussed at and threatened with bodily harm many times over the years.
It’s not that I am that despicable of a guy, it’s just that we encounter our fair
share of drunks while pulling rescue squad call.
Drunks and drugies aren’t the only ones that sometimes look upon those in the
squad as enemies. Rev Bill Betts and I were on a call one time when a lady
accused him of selling drugs to kids and then put a “she-devil” hex on us. A real
nice way to show your appreciation for those whose only agenda is to come to
your aid and be helpful to you.
But if I had a drunk give me a hard time I would invite them to meet me after this
was all over. I would only do this if I were reasonably sure that they were really
“potted” and would, most likely, not remember these events the next day. I also
counted on their vision being a little blurred, or so I hoped.
“I’m gonna kick your ass” is the usual type of comment I would hear. I would then
look straight at the “patient” and say: ”When you get out, come on down to the
fire house and well settle it”, “by the way, my name is Larry Oliver! ….And I’ll kick
your ass from here to next week!”
This exchange would get quite a bit of attention from any of the rescue squad
members that hadn’t heard it before. Larry, who is a good guy and not the type to
invite trouble like this, also has a bit of resemblance to me; or at least he might to
a drunk. He’s a bigger fellow, not anywhere near as big as I am, and he wears
glasses like I do. I figured if any of these drunks did remember the exchange that
Larry could hold his own against them. Better him than me, even if I was the one
who caused it. Gee, it was a fun thing to do.

Chapter X. The Long and Short of It

The longest emergency, lights and siren, rescue call I ever participated on was
while I was working at Valley Medical Transport. This emergency transport was
from Winchester Medical Center to Cleveland General Hospital in Cleveland, Ohio.
The patient had a rare cerebral dysfunction that could not be treated locally. There
were only three physicians east of the Mississippi River that could handle the
surgery that was required to save his life. One of them was somewhere off the
Florida Keys on vacation and the other was also in Florida but had just begun the
steps necessary for his annual colon exam. After you’ve started drinking that stuff
it’s too late to schedule any kind of work. To confound matters, the life saving
operation needed to be preformed within the next 24 hours if the patient was to
have any chance of survival.
Not that there needed to be another complication mixed in for this patient, but
the weather forecast was rather dismal. We were expecting one of the worst
snowstorms of the year and this storm was coming down from the north and
mixing with a storm from the south that results in heavy snows and challenging
winds. In fact, we looked at the national weather map and this storm was coming
into our area from the north following a track of south by southeast. This storm
was gliding into our exact direction of travel to the other hospital.
A patient in this critical of condition would normally be flown by any one of several
Air Ambulance services. An Air Ambulance would get him to the surgeon in time
and greatly reduce the time the patient would be in transit; which is a perilous
segment of his journey. Because of the snowstorm, that was already blanketing
Cleveland, there was no chance of getting the patient in the air; ground transport
was the only choice available to the physicians at Winchester Medical Center.
There was little that could be done that would be truly beneficial if the patient
“crashed” while in transport, other than the normal life support that is provided by
the crew of the ambulance. The physicians were certain that this patient would
not survive if any life support “insult” occurred to his body systems. The way they
worded it is just a fancy way of saying that the guy was C.T.D. (circling the drain)
and would, most likely, A.R.T. (assume room temperature) if we had to try to
resuscitate him. As the Medic in charge of his care during the transport the
physicians authorized me to discontinue all life saving efforts if the patient did not
recover within the first few minutes of “crashing”. Our standing orders are to
follow A.H.A. (American Heart Association) guidelines that call for aggressive
advanced life support, including both dynamic drug therapy and energetic
physical interventions.
On this trip I was delighted that my driver was going to be one of the most
competent operators that we had at Valley Medical. With Tom Derflinger driving,
even through a snowstorm, I was sure we would be O.K. Tom would also be a great
help in patient care if it came to that because he exhibits an unusual proficiently
and calmness when engaged in patient care.
We had a few challenges in preparation and planning for this transport that do not
come up very often.
I had our dispatch center call and get more specific weather conditions and
forecast from the US Weather Service. They also called the state police from the
various states that we would be traveling through to get the most current
information for us.
We needed to map out the most direct route as well as some planning for
alternate routes if our first choice should become closed because of the snow.
I calculated the rates of flow for the IV fluids and medicines that were being
pumped into the patient. We need to make sure that we had a sufficient supply of
these first-line drug choices and I asked the physicians to identify what would be
my second line of medicines if the patient stopped responding to the preferred
drugs of choice. We had to make sure we had a sufficient stock of those as well.
Pre-arrival to the hospital Tom and I made sure we had something to drink and
snack on. An 11-hour transport is a long time for me to go without eating
something. We also made some arrangements for the patient to have some
nourishment; but we did not want to have to eat the same hospital health food as
the patient.
We knew fuel for the unit would be an issue [our concerns proved to be
warranted latter on].
There needed to be method pay for the hotel room if we got stuck on the return
trip. I was certain we would get the patient to the hospital; there was no way I was
going to check-in a critically ill and dying patient into an interstate hotel room!
Our families were accustomed to our traveling a little when we were at work; but
this transport was gong to be 30 hours or more, if we didn’t experience any
problems. So a phone call home was appropriate.
The eleven or twelve hours that we expected it to take us to get to Cleveland
General was a long time for this patient to ride on our cot so we checked with the
folks in Physical Therapy Department for some foam wedges and supports. That
way I could at least shift the patient’s weight around so it would not be too tiring
on the patient.
After all the extra preparation, we were ready to proceed on this transport. The
patient was not attached to any specialized medical equipment other than two IV
pumps and the EKG monitor. This made transferring him to our stretcher relative
easy.
I had some other concerns that I didn’t have time to address before we took off on
this little excursion. What were the medical/legal problems if the patient
“crashed” in route? Did we need to shop around for a funeral home wherever we
were if and when he died? You can not transport a dead body across state lines
unless they have been embalmed. What were the implications for us providing
advanced life support care in states that did not have an arrangement with
Virginia; similar to what allows us to practice in West Virginia and Washington
D.C.? I’m only licensed to practice my craft in Virginia and the ambulance is only
licensed in Virginia. If the patient had problems and we diverted to a hospital in
another state, what legal problems would that physician have in giving me
specific medical orders when both the Medic and the ambulance was not licensed
to practice in that state? You might ask why the concern about these
manifestations when they haven’t occurred yet and this mans life in the dispute.
Well, I didn’t delay the transport so I could find a legal opinion. But it’s just this
kind of legal entanglement that can ruin a Medic’s career. There is an enormous
amount of liability that medic’s are subjugated to while practicing their trade. A
medic sometimes takes calculated risk, like this one, but in the back of your mind
there are rumblings of all the possible legal consequences I prefer to avoid. When
we returned to our base, and after I had a good long nap, I did seek answers to
these questions. I never did find an absolute explanation to some of my concerns.
The patient was unconscious for most of the transport. I am pleased to report that
we made it through the snow storm and delivered our patient, none the worse for
wear, to the surgeon at Cleveland General. Our patient tolerated the trip well and
arrived in time to undergo the emergency surgery. We heard a few months latter
that he survived and was doing well.
Our return trip from Cleveland was not without it’s own little drama. I had
complete faith and trust in the ability of Tom Derflinger to drive us back through
the storm in safety. At points we were traveling the breakneck speed of fifteen
miles an hour on the interstate highway. The problem was that the storm was
getting worse and a lot of the gas stations along the way were closing up. Those
that we found open had gasoline only and of course our ambulance had a diesel
motor in it.
Tom had to drive some 50 miles out of our way in order to find diesel fuel.
Fortunately the ambulances have dual tanks on them so once we found fuel we
were set for the return to Winchester without having to re-fuel again. The entire
transport took us 34 hours to complete. That’s 11 hours transporting the patient
with running emergency lights/siren and 23 hours coming back through the
thickest part of the storm. We might have stopped at a hotel but we knew that the
transports tend to take longer to complete in bad weather and Valley Medical
often would get busier than usual when it’s nasty outside. So with the concern
that the unit may be needed back in the local area Tom drove straight back.
I don’t think it’s necessarily appropriate for me to make observations about Tom’s
butt, nevertheless he was in the driver’s seat for 34 hours. I’m sure that part of
his anatomy was pure tuckered out. Mine was, and I had the chance to move
around a little bit.
When we got back we both took the next day off work.
My shortest transport was from the road in front of Warren Memorial Hospital’s
emergency room all the way inside the ER’s doors. I was on rescue call with Hal
Shaner, my regular Friday night squad partner. Hal and I have worked side by side
for many years on the volunteer squad. This transport, however short, was a
challenge to our skills as medics and was a threat to our emotional wellbeing as
well.
We had a full crew of four on the ambulance that night, one of them was my
eldest son Bryan. He had just turned 17 years old and had joined the Junior
Firefighters program a year earlier when he first met their minimum age
requirement of 16. Bryan had taken to fighting fire like a pro, wining several
awards during his first year for his efforts. He enthusiastically enjoyed “putting
the wet stuff on the red stuff”, but he did not have quite the same amount of
eagerness for the “gut bucket”. He would ride on the ambulance when necessary
but didn’t go out of his way to get too involved in patient care, even though he
was a “natural” at it.
We had been to one of the Warren County High school’s fall season football games
where we “stood by” in case a player was injured. Since Hal and I were on call
together on Friday nights I had attended just about every home football game the
High School had for close to 25 years. We had followed them from when they had
the school night games down at the field in Bing Crosby Stadium and then, in the
later years, out to the Middle School athletic field. I enjoyed watching the football
games, even in the years that our home team would loose almost every game.
Hal and I also took pleasure from being able to pull the ambulance close to the
field and turn on the heater on the cold nights as well as turn on the windshield
wipers on the wet nights. There were nights that I had other things to do or wasn’t
really interested in attending the games, but I went anyway. The Athletic
Association required that the home team provide EMS coverage at games for
safety precautions in case someone was hurt.
I kept this Friday nigh exercise up until one night in 1999 when, at a game there
was a short delay in the football play so the announcer was talking to fill in the
gap. He thanked the players for being involved in sports; he thanked the coaches,
the school board, the player’s teachers, and the janitors at the school where the
players studied. He then expressed the Athletic Association appreciation to the
parents of the players; and to their brothers, sisters, aunts, uncles, or friends who
attended the games. He thanked the grandparents of the players and the
physicians that kept them well. He noted the dedication of the field referees, their
spouses, their families as well as the physicians that treated their illnesses. He
thanked the workers of the concession stand that had snacks available for those
in attendance and to the farmers who grew the food. He covered the Sheriffs
Department and the Town Police Department for traffic control; he even
remembered to thank the road crews that kept the streets in good repair so
everyone could get to the games. He included the Associations appreciation to
members of the Board of Supervisors and Town Council for their support. The
newspaper staff and the employees of the local radio station were mentioned. The
physicians family who attended the games, the fans, the parents that drove the
students to the game, and even the pizza shops in town that prepared extra pizza
for the after-game customers received recognition. He never got around to the
Rescue Squad.
I didn’t attend these games for any recognition. I did it because they needed an
ambulance to stand by at the football games and it was our night on rescue call. I
provided that volunteer service because I enjoyed watching the games.
Nevertheless, it sure did burn me up that the Fire Department’s Rescue Squad
was skipped over; especially since they did say “thanks” to just about everybody
else in the Town. For years I watched the referees and those in the announcers
box get free hot coffee delivered to them during half-time, but never to those who
volunteered their time on the ambulance; and this annoyed me, but nothing like
the night the Squad was snubbed. So I quit going to the games. I never spoke
contra to anyone else that wanted to stand by at the games; but it was my
personal form of protest that I quit going to the games after 25 years of
volunteering my time to be sure there was an ambulance at every one of the
football games.
On the night of this “shortest call” we were returning from the “football game
stand-by” when we were dispatched by the Sheriff’s Department to a “motor
vehicle and pedestrian accident” on Shenandoah Ave.; whenever a motor vehicle
and a human come in contact the human is always on the loosing end of the deal.
When we arrived on the scene, which was a very short response time since we
were in the area already, we saw a person lying in the roadway.
Hal was driving and following our habit he parked just past the accident scene so
we could get a look at the scene from several angles. The car that had been
involved had been moved away from the patient and that made it easier for us to
gain access to all sides of the patient. It was important for us to locate the car
involved, if possible. Our interest in the vehicle is not from a legal point of view.
We wanted to be sure that the vehicle was stable, that we didn’t need to worry
about it rolling over us as we worked on the patient. We also need to look at the
vehicle to check for signs of where the patient made contact. High or low impact,
multiple sites of damage, windshield damage or other indicators that may help us
identify what types of injuries we want to be sure we check for on the patient.
Hal Shaner and I worked as a team for so long that we just knew what the other
was going to do at the scene of an emergency. We did this without verbal
communication with one another. I knew that Hal would make sure the vehicle
involved was safe and he knew that I was going to glance around to identify who
the “players” were at the scene; and to take notice if anyone was pointing a
weapon at us. We did all this in the few seconds as we walked to where the
patient was lying on the ground. We both looked around the scene for hazards
that might need to be addressed; kind of covered each other’s backs. We also felt
a duty to sort of look out for those other rescue crewmembers that were with us.
We were the senior crewmembers and we took this responsibility serious. Neither
of us wanted to explain to the families of our fellow Squad members how they got
killed, plus it would make us look bad to loose one of our group.
Hal, by habit, migrated to the “foot” end of the patient and as usual I migrated
towards the head end. Hal would work upward identifying injuries as I worked
from the head down. We would “meet” somewhere on the body. Sometimes that
would be the middle and sometimes the mid-line shifted based on which of us ran
into injuries or problems on the body of the patient.
I preformed a quickie primary survey of the patient which resulted in the finding
the patient did have a heart beat, was breathing, and that while the patient had
lost a considerable amount of blood there was no current blood flowing that might
be deemed life threading. From the primary findings, which were encouraging, we
began the secondary survey to identify other injuries that may endanger the
patient’s life or impact the recovery from the accident. We also would plan and
start treatment of any insult to the body we found.
On this patient it would take a while before Hal and I would “meet” at this
patient’s middle, there were too many obvious injuries. Hal was faced with
multiple fractures to both legs and with extensive amounts of missing flesh. One
leg was so badly broken that while the patient was lying on her stomach her toes
were pointed straight up to the sky; and that was the less injured leg of the two.
The lower torso was severely mangled and bent at places that God had not
designed to be bent. Hal was going to be busy treating these massive injuries in a
timely fashion. Hal had to weigh his care against what was the best way to treat
each injury with the need to get the patient into the hospital where more
definitive care could be initiated.
The patient was conscious but did not really comprehend what was happening
around her. I had began to speak to her in a calm and reassuring voice that we
were here to help and that I would let her know what we were doing along the
way. I tried to issue “orders” to the other crewmembers in that same controlled
voice in an effort to be reassuring to the patient. Hal was very good at doing this;
he very seldom became excited and rarely raised his voice at an emergency
scene. Our demeanor while giving instructions to the squad members on the
scene also influences their actions and professionalism.
I noted a scalp/facial laceration running from the patients outer eye orbit
transcending across the top of the head to mid-line on her nose. Even though this
wound was “full thickness” and some of the bone of the skull was visible, there
was very little blood loss and only a trickle at this point. The lack of blood flow on
a wound like this can indicate some very bad things are going on with the
circulatory systems. She was primarily lying on her stomach so her back was
presenting to me. The arm closest to me had apparent open fractures to the
shoulder blade; not a bone that is injured very often, which resulted in the
patient’s arm to be extremely deformed. There are three “long bones “ in the arm
and each of these bones had exposed compound fractures to them. Her arm was
twisted backwards behind her neck and was rotated in an confounded position. I
couldn’t inspect much of her other arm because she was lying on it; what parts of
it I could visualize had multiple exposed fractures.
I did not identify any prominent spinal injuries although we would treat her as if
there was an injury to her spine based on the mechanic’s of the accident and
force of the trauma to her body. The physicians would do a more precise
examination and they would “clear” the spine when they were sure there was no
unseen damage.
The patient was breathing and there was no apparent embarrassment to the
airway. This was a huge relief because any difficulty in this area would require
immediate life saving intervention and require additional time for treatment and
time was something that was in short supply. We needed to keep our “time-on-
scene” to an absolute minimum. A good medic, even when a patient that has as
many injuries as this one did, will be able to survey the injuries, provide
treatment, and package the patient in no more than 15 minutes. We do not want
to consume any more of the trauma patients “Golden Hour” than is justifiably
necessary. The survival, and recovery period, are immensely improved if the
victim of trauma is availed the services of a trauma center within the first hour of
the injury.
The trachea was midline and there were no apparent injuries to her neck. I
checked her ribcage for obvious signs of damage and found none. These were
quick surveys and some minor injury may be overlooked in the field but latter
discovered by the physicians; we are addressing the life threatening issues in the
field. It’s very possible that there are life threatening internal injuries present and
need to be addressed; but we have limits of what we can do in the field. If
necessary these problems can be addressed by a surgeon after we get the patient
to hospital.
Hal and I conferred briefly about the desire to turn the patient onto her back so
we could visualize the rest of the body; we needed to see if there was an injury
that we should be addressed. This action plan had to be weighed against the
necessity to keep our on-scene time down added to the consideration that we
may actually do more harm to the patient by flipping her over. The uncertainty of
hidden injuries outweighed our other concerns and we initiated preparations to
execute this maneuver. We wanted to get the patient onto a backboard so we
decided to turn the patient over onto the board, thus saving some time and
accomplishing two things at once. Turning this patient was not to be taken lightly
as we needed to maintain the patient’s body alignment and the broken limbs
required stabilization to prevent additional trauma to the limb. The move had to
be organized so that each person that was to be involved knew what he or she
was assigned to do and when they had to do it. The patient needed to be
informed as to what was about to happen, and we needed to get all the
equipment we were going to use at hand. If all this sounds like a lot to accomplish,
well, it is. To complicate matters everything had to be done correctly the first time
and we must be ready within a very limited time frame. We were able to achieve
all this safely because of our experience and skills that were aptly supported by
the other crewmembers. Their knowing what the equipment was that we were
asking them to get for us, and where it was on the ambulance, added to their
value on the team. Their skills and aptitudes is what made things go smoothly
when it came time to make our move.
I’ve described most of the injuries that this patient had suffered. Visually it was a
horrendous sight to look at a human being this mangled. We are trained to
overcome the impact to our psyche; but I can tell you that every member of our
rescue crew is jolted by the enormity of the damage done to the patient on the
roadway. At most accident scenes there are a number of by-standers that crowd
around looking at what happened. This patient’s injuries were so violent that after
one glance the by-standers were nowhere to be found because they didn’t want to
be exposed to such a horrible sight.
One person that did advance to the patients side was recognized by Hal and
myself as being a nurse that worked on the second floor of Warren Memorial
Hospital. She was not working that night and had just happened to drive by the
accident site; so she was generous enough to stop and offer her help. We knew
this nurse as being a very proficient nurse that knew what she was doing. I was
glad to see an extra set of hands approach right when we were getting ready to
move the patient. As she approached the accident site she took one look at the
patient and shrieked “Oh my God!! Is she still alive?” “Oh, my God”. At which
point she turned and made a hasty retreat. I have no displeasing words to say
about this nurse. I know she is very good at what she does in the hospital. I would
have no reservations about her taking care of me or someone in my family in the
hospital setting. She was just outside of her environment in this situation.
However, it wasn’t the best thing for the patient to hear. It would prove not to be
the only negative words the patient heard that night.
We were prepared to turn this patient over onto a stabilizing backboard. We were
short some people but there were not a whole lot of folks around who wanted to
touch the patient. Hal had his end of the operation planned out and had so good
assistance in stabilizing the lower exterminates when we moved the patient. Hal
had quite the challenge in rotating this patient while maintaining the body
aliment; but I was sure that his end would go well. I was not so sure about my end
of the patient.
I needed to stabilize the head and neck and my son Bryan was going to stabilize
the massively mangled shoulder and arm. I showed Bryan where to place his
hands and how to move them as the patient was rolled to the backboard. I had
complete confidence in him that the patient would roll over as I wanted her to.
Bryan swallowed hard and took hold of the patient as instructed. On the count of
three we were going to make the transition.
One, Two, Three, Move. As we completed the transition onto the backboard the
patients other arm came into view. There simply were not enough hands to
properly control the entire second arm. As we turned the patient her lower arm,
from midway between the elbow and wrist, began to “flop”. Since both bones in
the lower arm were compound fractures the arm kind of swung in the air like a
pendulum on a grandfather clock. Bryan, seeing this and concerned for the
patient wanted to be sure I was aware of what was happening. I heard him call out
to me: Dad! Dad! Dad!. Until I reassured him that it would be O.K.
We now had the patient on a stabilizing backboard. Hal completed his secondary
survey and treatment of the lower end of the patient as I did the same on the top
end. Our crewmembers strapped the patient to the backboard using Velcro
“spider straps” and we were ready to transport the patient to the hospital.
Since we were only 50 foot from the hospital we didn’t load the patient in the
ambulance as it was faster to just wheel the stretcher into the emergency room.
The four members of the rescue team each took a corner of the stretcher and
started walking to the Emergency room. The patient had remained conscious
throughout the time we had been preparing her for transport and was conscious
as we rolled her into the emergency room. I had been talking calmly to her and
trying to revive as much of her anxiety as possible. Where she was conscious I’m
not too sure how much she comprehended about what was happening.
As we rolled her into the emergency room she looked up at Bryan and said “ my
arm hurts”. Bryan looked down at her and with compassion in his heart, with a
show of concern for her overall condition, he looked down at her and said “ Lady,
your arm is the least of your worries!”. This is not the kind of reassuring response
that I would have preferred him to utilize, but it was the reality of the situation as
he saw it.
Some six months latter I ran into this patient again while I was working on the
wheelchair unit of Valley Medical Transport. I was taking the patient to her regular
rehab appointment. I was surprised that she had survived and it was satisfying to
know that the Friday night call team had a role in her survival.
Chapter XI. Sex --- It Can Be Hazardous To Your Health
S

Sex is usually a normal, healthy human activity — however private, and

enjoyable. Most people do not need to involve the rescue squad in this merriment;
but sometime we do get called out for sexually related problems. We’ve been
trained how to respect our patient’s feelings and taught skills on how not to
embarrass them when they do call for help; even if it about kills us not to have a
little “jollity” with these situations.
It is important to remember that people call for the rescue squad only when they
have encountered a predicament they can not resolve on their own. At least this is
true for most folks. It’s human nature to desire to resolve your own dilemmas;
when you have to call for help you are admitting failure to being self-sufficient and
calling out to someone else is usually the last choice. Again, this holds true for
most people. When humans call out for help it’s because they don’t know what to
do or don’t have the ability to fix what ever the problem is on their own. I have
found this to be doubly true when the crisis involves something as personal and
private as a sex act.
Hal Shaner, Jr. Kisner, and myself were on our regular Friday night of being on
rescue squad stand-by. Our team was rounded off this night by a fourth
crewmember that was a newcomer in the Department that latter proved to be a
rock-steady team member, Tom Derflinger.
We had an earlier ambulance call that evening that did not take long to complete;
might have taken us longer to do the paperwork than it did to treat and transport
the patient. The rest of the evening was spent watching TV, doing paperwork, or
just sitting around “shooting the ****. [Rhymes with poop]
About 11:30 that evening we were dispatched for a “person having difficulty
breathing”. This wasn’t very much in the way of information about the situation
we were going to encounter. While Jr. was driving us to the location I called the
dispatcher on the radio and asked if there was “anything further”.
I was asking if maybe she had some additional information that came in after we
had been dispatched or maybe the dispatcher did not have time to relay all of the
information they had in the initial announcement. The dispatchers can really get
busy at times and at times it can be a struggle to announce enough for you to get
underway while they are handling other calls that come into the dispatch center.
It’s a difficult job they have to do and my hats off to them for the professionalism
that the vast majority of dispatchers demonstrate. In this case, the dispatcher
advised us that the husband had called 911 and stated that he didn’t know what
was wrong with his wife, but that she couldn’t seem to get her breath. This is a
potentially perilous predicament that can endanger someone’s life and the report
of “difficulty breathing” calls for us to expedite our efforts in getting medical aid
to the patient.
A “difficulty breathing” call is unfounded to be a true emergency eight out of ten
times. Of the remaining two “distressed breathing” calls at least one will be
urgent but is not what we consider to be a true life threatening emergency. But,
it’s that one out of ten times can be scary as hell for the patient and often places
them in danger of loosing their life. It’s that one out of ten times that the quick
action of the ambulance crew can make the difference between a hospital bill and
a funeral bill for someone to have to pay.
I routinely held training classes on Friday nights for anyone that wanted to learn a
little bit more than what they picked up in EMT class. One of these brief training
classes was designed to demonstrate to the new rescue squad person how the
patient often felt during one of these “breathing difficulty” calls and to
demonstrate to them the need for quick response and faultless action once you
reach the scene of the emergency. A safety expert would probably wet his pants
over my lesson methodology; but in all my years I can report that I never killed a
student performing this exercise.
First I would have the group sit in chairs on the apparatus floor beside the
ambulance. It wasn’t really necessary that they sit down in the chair but it added
to the aura or impact, of the lesson. Then I would have them cover their mouth
and nose with a black trash bag to seal off their breathing. Then we played a
recording of a “difficulty breathing” call being dispatched. I would have someone
acting as driver of the ambulance run out to the unit, start it up, wait 20 to 30
seconds for the imaginary crew to get into the unit and then pull off. The student
was holding their breath this whole time; almost every one of them would have
the bag off their nose and mouth by the time it took just to get the ambulance out
the door. This was after we had first been informed of the emergency situation, let
alone how long it took for someone at the scene to react to the emergency and to
call 911. I tried to impress on the “students” why it is important not to waste even
a second when someone is having trouble breathing.
I then would have them lie down on the ground with their nose and mouth
covered by the black plastic. While the unit would pull up to the scene and the
pretend ambulance crew would get out of the unit, quickly check for dangers, get
the first aid kit, oxygen bottle, and other equipment out of the unit. As it is our
standard practice, we walked over to where the student/patient was laying and
start to treat them. Of course before you can treat a problem you have to
recognize what’s going on; after all, the “ambulance crew” just got there.
Difficulty breathing is a condition you search for in your primary survey of the
patient [in this case, one of the students] and you correct this problem post-haste.
Positioning of the head of the patient is sometime all it takes, but this also takes
two or three seconds to do; that may not seem like a lot of time but don’t forget
these folks have been holding their breath! Then you have to get the oxygen
bottle out and turn it on; select the appropriate mask (the correct mask does
make a difference) and put the oxygen mask on the patient. This too only takes
five to ten seconds to do. But that’s a lot of time if you haven’t been breathing.
I’ve never seen a student still have the plastic over their face by this point. This
exercise really drives home the validness that if a person is not breathing the
ambulance crew must act without waste of even a few precious seconds, and they
must be prepared to do their job without flaw or failures of any kind.
In the drill I also tried to reinforce the importance of checking your equipment at
the beginning of every tour of duty. “How would it make you feel if you rolled up
on a true emergency breathing call only to discover the crew before you left an
empty oxygen bottle; and that you hadn’t taken the 15 seconds to check that
when you started your shift?” I would add, with enthusiasm, “ Now you know how
it would make the patient feel!”
For the next part of this presentation on breathing difficulties I would ask the
“greenhorns” to loosely roll a 4x4 gauze pad into a “log roll” and insert one into
each nostril. They could open their mouth and breath anytime they absolutely
needed more air to stay conscious, but when they did so they were “admitting
defeat”. I ask each of them to breathe through their nose, partly blocked by the
rolled up gauze pads, for as long as they thought it would take for the ambulance
to get from the firehouse to their homes. [As a side note, using their estimates of
time while they could not breath unimpaired, you might be surprised to know that
our ambulance could spring wings and was jet powered.] As soon as they told me
that “the ambulance has just arrived” I would place an oxygen mask over their
nose and provide them with 10 liters of 100% oxygen flow through their blocked
nose. This way they could experience first hand what a positive impact that
providing oxygen has on a patient, and to drive home the significance of doing
this early on in your treatment modality. This was an important lesson that I think
was effective in substantiating what their instructors had taught them in EMT
class.
I also used this same training drill to make another point to those who would be
operating/driving the ambulance. I tried to get them to think in advance so that
when they were driving the ambulance they would realize that the way they
preformed their job skills directly effected the patient and ambulance crew. For
this part of the class I would have the student/patient lie on the ground with
another classmate acting as the ambulance crewmember there to help them. I
would then impersonate the operator of the ambulance and drive the unit to the
scene of our pretended emergency. As our standard practice, I would drive slightly
past the site of the “emergency” so the crew could get a view of the total scene.
Except, this time I would purposefully stop the ambulance a little short, a common
error for new drivers; while the cab of the ambulance had past the patient I had
also parked so that I had pointed the vehicles exhaust right toward the “patients”
and their caregivers. It only took a few minutes of breathing in the diesel exhaust
to make my point. After experiencing first hand what happens if you park the
ambulance too soon, I never saw those crewmembers make that error at a real
emergency scene.
I would like to go back to a point I glossed over a few paragraphs ago. I mentioned
that eight out of ten “difficulty breathing” calls were unfounded to be true
emergencies. While I stand by those figures, I should point out that anytime you
or someone you are around has any trouble getting their breath it can be a
freighting experience. Some of these calls were unfounded because the problem
had resolved before we arrived. Some were clarified as being some other type of
emergency, and a few were just plain old, unfettered bullshit.
Savvy, or so they thought, patients knew that a call for breathing problems would
get them an immediate response of the rescue squad, and a direct pass into the
emergency room. So that they would be placed in a treatment bed direct, without
the normal processing in the emergency room, some fakers would call in that they
were having trouble breathing as a ruse. Whenever I discovered this contrivance I
would make sure that their experience was as difficult on them as I could, within
the constraints of the medical profession. If anybody admitted to me that they
had called the rescue squad, just so they could avoid spending time in the in the
waiting room, then I would work hard at finding justification for starting a large
bore IV. If that wasn’t possible I might look for medical rationale for securing them
to an uncomfortable wooden backboard, until a physician could clear any “unseen
spinal injuries”. If I identified that a patient fabricated their emergency on me I
would go to all possible efforts to make their time spent in “my” ambulance as
difficult as possible, without crossing over the “line” and becoming totally
abusive.
When we arrived on the scene of the emergency “difficulty breathing“ call in my
story, I observed none of the possible negative warring signs that this might be a
call that fit into that, eight out of ten, category. In fact, everything we saw
screamed at us that this was a true emergent situation.
A gentleman dressed in shorts, with no shirt or shoes, met us at the door of the
residence and directed us to the bedside of his wife.
This patient was unconscious, but breathing, when we first set eyes on her. The
husband, as he identified himself, was presenting to us with a great deal of
anxiety and concern that his wife was unresponsive; this condition concerned us
as well.
Our very first investigative efforts were to determine that the scene was “safe” for
us to maneuver in. Secondly, as a function of the primary patient survey, I
observed that the patient was truly having difficulty breathing and knew I needed
to speak to that issue forthwith. I was comfortable knowing that my long-term
team members would be addressing the question getting information from the
husband as well as checking for any possible bystanders that may be able to help
shed some light on what happened to the patient.
We needed to correct the breathing problem that this patient was having, and
although I had determined that this situation was not life threatening, it was
surely a case of hyperventilation at its worst. This was a medical problem that we
could “fix” in the field. This patient did not need to suffer until we were able to get
her to the emergency room, as we could treat her predicament at the scene and
expect dramatic improvement on the patient’s condition within minutes of our
interventions. She only needed some help to slow down her breathing rate and
reduce the volume of air she was pulling into her lungs. The solution to this
women’s problem is much easier to say than it is for her to do. The “drive” to
breathe in and exhale as deeply and strongly as possible, once a person starts to
hyperventilate, is very strong and difficult to overcome.
One of the “issues” we needed to determine was what caused the onset of these
breathing problems. What was the factors that influnced this condition? Then we
could do a better job at treating the root of the condition, which would also bring
about the positive transformation to the immediate questions as well. Hal had
made a quick observation that something strange was going on in that the patient
had her shirt on but it was inside-out and her shorts were on her, but askew and
they didn’t look “right”
I was working with the patient, identifying and treating the issues that this patient
was presenting; my partners would address the rest of the information that would
prove to be important to the “cure” of this dilemma.
As it resolves, after a little exploration by Hal and JR, the patient’s husband finally
shared that he and his wife were having a sexual encounter when, as he tells it:
“she was about to finish, when she started to breathe funny like she is now!!!”
Now, that statement was a real mouthful. The husband was reluctant to share this
information about the events prior to his wife hyperventilating and he came
forward with this admission out of a deep concern for his wife’s medical
difficulties. Hal and I could both discern, from the way the husband was acting,
that he was serious.
Hal and JR’s reaction was one of total professionalism. They took the revelation of
what made this lady “breathe funny” without adding to the husband’s
embarrassment. Hal took the husband to the side to calmly, privately, and
respectfully dig a little deeper into the circumstances of what had happened. He
wasn’t being nosy or trying to get his “jollies”; he breached only those questions
that were medically driven.
I, on the other hand, was struggling to control my mouth. I wanted very much to
ask this guy why he wasn’t doing a whole lot more bragging. Hell, I would have
been running around pointing and telling everyone “look at what I did! Boy am I
good or what!!” . I was agonizing with a “sight picture” that kept replaying in my
head; and I had serious work to do to help these kind folks overcome a distressing
medical condition. I was able to pull it together and concentrate on the task at
hand.
We were successful in getting the patient’s respiration’s under control and this
medical emergency had been resolved. We still needed to transport the patient to
the emergency room so she could be evaluated by the physician. He would want
to perform some lab work to ensure that the blooda gasses were within normal
limits.
We did delay the transport a few short minutes to allow the patient to better dress
herself. While involved in having sex with her husband she had been nude and her
husband had attempted to put some clothing on her before we arrived to preserve
her modesty. Unfortunately, he had not done a very good job of dressing her while
she was “breathing funny”. There were no medical counter indications to allowing
the patient to make herself a bit more comfortable.
I never saw either of these people again, but I bet they had one heck of an
anecdote they shared between themselves.

I ran another sex related rescue call a few years earlier that was also a trauma
call. This female patient was known to me and to the others on the ambulance as
she was locally active in the nursing profession. I must be somewhat vague and
elusive about the background of this emergency in order to protect the patient’s
identity. This person is still in the area and has interaction with some that may
read this document.
This patient was not forthcoming about how her injury had occurred. In fact, she
out and out lied to us. Although I can understand her embarrassment concerning
the events that lead up to the injury and her preference to hide the truth in order
to “save face”. I have never seen a member of the rescue squad deliberately try
to embarrass someone that is truly sick or injured.
Misleading the members of the ambulance crew is really not a smart thing to do;
it can effect their medical treatment. How we protect ourselves from injury or
exposure and how we protect the patient from additional injuries can be adversely
affected by misinformation. It’s really appalling that a patient suffers additional
trauma, pain, or suffering that could have been prevented if only they were open
and truthful with us.
The call was dispatched as “a woman fell”. We really wanted more information
and I called back to the dispatcher for “anything further”; asking if there was
additional information about the nature of the call. The dispatcher advised that
this was all the information available. The dispatchers do a good job of coaxing
information out of caller’s even when they are upset and excited. But sometimes
you can’t pry much out of the “complainant” no matter how skilled they are or
how hard they try.
When we arrived on the scene I preformed a scene size up of the outside of the
residence looking for possible dangers. Seeing none, I proceeded up the walk to
the front door, which was open. After looking in the door I opened it up while
calling out “rescue squad” in a loud voice. I still wasn’t sure that the entire scene
was safe for us and I did not know who was in the house, but I did want them to
know who I was and that I represented the “good” guys.
After entering the doorway I took notice of someone I knew. This eased some of
my concerns because this person was known to me to be level headed and “OK”.
This was our patient. I could tell by the pool of blood at her feet.
The patient reassured me that the bleeding had stopped, and that she had really
lost a very small amount of blood. Since she was in the medical profession I took
her at her word. Her account of what transpired was that she had been taking a
shower and when stepping out of the tub she slipped and fell onto a shampoo
bottle, that was sitting on the edge of the tub, and the top of the plastic bottle
had “gone up inside” of her. The impact with the shampoo bottle had caused a
small tear in her private parts.
She said that she was extremely embarrassed about having to go to the
emergency room for this problem. Taking all she had told us at face value I could
understand her position. Then again, she worked within the medical world and she
should know that we would treat her condition with the utmost respect; the same
applies to the emergency room staff.
Normally I would insist on making a visual inspection of the injury site just to
check on possible complications that we needed to manage. I’ve had to do this
many times and do not grin, point, take pictures, make comments or produce
inappropriate noises when this sort of inspection is medically indicated. In this
case, at the patient’s request, I skipped over this part of our secondary survey of
the patient. I was lulled into cooperating because of her medical background; a
mistake I never repeated.
But not every part of her story was adding up. While the other crewmembers were
loading her onto the stretcher and accessing her vitals, I sort of wandered around
the house and into the bathroom [it was a small one bath, one bedroom
townhouse]. My goal was to see for myself how much blood loss there had been
where the accident had taken place. To my amazement there was no blood in the
bathroom at all. It did not make sense to me that she had taken the time to clean
up the bathroom while she was still hemorrhaging. It just didn’t add up.
I next stuck my head into the bedroom and there was a fairly large puddle of
blood on the bed with huge drops of blood smeared on the floor around the bed.
Subsequently, I noticed a glass bottle on the floor, near the end of the bed, and
the “neck” of the bottle was broken off. The remaining part of the bottle was
heavily coated in blood. Now, things were starting to become clear and were
adding up correctly. I could kind of guess what had been going on when the glass
bottle broke.
I grabbed a clean towel out of the hall closet and picked up the part of the bottle I
could find and took it with me. The physician in the emergency room would want
to see this evidence to help him form a proper plan on treating the patient and to
make sure all the missing glass parts were accounted for.
At the hospital the patient repeated her original story to the nurses in the
emergency room. I didn’t correct her, if that’s the story she wants told, then it’s
her business.
The physician in the emergency room was a different issue altogether. He had a
legitimate need to know as much as I did about the conditions at the residence
where we picked up the patient; and then he could make his own conclusions and
would handle the information in a way that he felt was best for the patient. I
spoke with the physician in private and shared with him what I had observed; I
also gave him the part of the glass battle that I had recovered. He would need to
go “a-lookin” for the rest of the bottle on his own.
I did not confront the patient with what I had discovered in the house, nor did I
share what I surmise really did happen to her. There would have been nothing to
gain by humiliating her, just to let her know that I knew what she had been doing.
I was the senior member on the ambulance crew and the only medic; there was
nothing to be achieved by letting the others on the call know what had really
happened.
I would have confronted her and told the others on the squad if there had been a
medical necessity or if anyone on the ambulance was in any form of danger. But,
since that was not the case I choose to keep quiet.
I would see this person from time to time over the years and of course I would
remember the call, “sight pictures” and all. I never did mention the true events
surrounding this call to her. I probably would not have even remembered very
much about the call, if it weren’t for the misdirection she had given us.
I did not think any less of her for my knowledge of her “secret”; I just wish she
had had enough trust in my professionalism to be honest with me.
We are exposed to a sundry of these very personal circumstances while active on
the ambulance. You have to learn to keep these episodes in a proper context or
after a while they can “pile up” and mess up your mind. I think that I developed a
healthy approach to these situations and I tried to pass this on to any new
member of our ambulance crews.
“It’s natural, it’s private, it’s personal, it’s confidential, it’s life, and shit happens.
Keep events to yourself, with two notable exceptions, and don't gossip about what
you know [the two exceptions would be if a medical necessity existed or if
children are involved in any way.] Act towards the patient as you would want them
to act towards you in a similar circumstance and finally, don’t laugh in front of the
patient or their family.”
Chapter XII Have You Seen The Little Ones
Bob Cook and I were dispatched to Page Memorial Hospital in Luray, VA to
transport a patient from there to the hospital at the University of Virginia in
Charlottesville, VA. The information we had was that the patient was located on
the medical wing at Page and was going to the “psychic” ward at UVA. We did not
know if there were other medical predicaments that the patient was suffering
from, not that it mattered too much as we were equipped and trained to handle a
very wide variety of different transports. I used to say that we were very “fluid” at
Valley Medical in that we could and would adjust to whatever the tasking that we
faced.
As Bobby and I arrived at Page Memorial we parked the ambulance at the
Emergency Room entrance and gathered our basic equipment on the cot to wheel
to the patient’s room. If we needed additional equipment or something specialized
then Bobby would make another trip to the unit while I gathered as much patient
information as possible. I would rather make only one trip into the hospital but
that was not always possible.
When we were walking through the emergency room I noticed that two of the
nursing staff from the patient care wing of the hospital were laying on beds in the
ER. Not wanting to be overly nosey and understanding that they were entitled to
their privacy I did not inquire why they were being treated in the ER. If I had, I
might have reconsidered the transport that we were there to take.
Bob had been with Valley Medical Transport several years at this point and so had
I. We knew most of the regular staff in the hospital, either by name or by face. We
would always speak or acknowledge someone in the hallways when we met.
Being friendly with folks was one way to keep the job pleasant and to encourage
others to work with us if we needed help. Plus it was just more in keeping with the
way Bob and I worked together, keeping it light and sociable. As we were heading
down the corridors to the patients room I started to pick up that we were in for a
real “treat” on this transport. We were stopped twice by someone on the hospital
staff that looked at us and said “They only sent the two of you?’ That happened
twice in one hallway; it should be noted that I’m kind of a big fellow and Bob was
no small turkey either, we had to present as a formidable pair. One RN shared
with us that the two staff members in the ER had been injured by this patient, and
that our patient had been in “four point restraints”.
It is rare that a patient is physically restrained on the medical floor. It’s not so
unusual to find someone in one of the critical care units to have their hands tied
down so they will not pull out their IV’s or airway tube, as while they are under
sedatives they often will do things that they would not normally do. If a patient is
in four point restraint it means that each arm and each leg is tied down, usually
with leather wrist and ankle cuffs. Sometimes they use foam padded restraints
but they can be ripped loose, while I have never seen anyone come out of
properly applied leathers.
A physician must write specific orders for a person to be restrained, both on how
it’s to be done and for how long the patient is to be restrained against their will.
Almost every hospital requires that the doctor review this status on a daily basis.
Plus, there is another check in the system to prevent abuse of a patient; and that
is that the hospital and physician need the support and authorization from the
legal system to restrain someone for any length of time. A patient that is
restrained with either physical, or chemical, restraints requires extra care because
as long as we have them controlled the medical provider is obligated to ensure
the proper care for the patient and are assuming the obligation for their protection
from harm. It takes a serious state of affairs for a patient to be in “four point
restraints”.
When we approached the patient’s room I peeked around the corner and saw a
smallish sized, 50’ ish looking lady sort of sitting up in the bed with both arms tied
down and both legs restrained as well. There were three or four family members
in the room with her as well. I turned and looked at Bobby as I was expecting a
much larger or much more malicious looking person. This lady didn’t look like she
could or would hurt a flea. Bobby then took a look around the corner and he also
looked back at me with the same questioning look. We were about to get our
questions answered.
It seems that as we approached the patient’s room she was just taking in a good
breath and resting for a moment. I parked the cot by the patients door way and
was heading back towards the nurses station when the patient noticed that
someone was in the hallway. I had never heard someone use the English language
in quite the same way as this little old lady. There was a stream of “descriptive
words” and combination of crude cuss words directed towards us, and I hadn’t
even met this person yet. I stepped around the corner of the room and
acknowledged the presents of the family, all the while this lady was cursing me
with wild abandonment. I looked over at her and in a calm and unassuming voice
said “Oh my, that’s not the kind of language you should use in front of a
preacher”
She responded “fu*! A bunch of preachers!” and right then I knew we were in for a
grand old time with this transport. I had not said that I was a preacher, just that
you should not talk like that if one had been around. This “slight of words” often
works to make the offending patient take a breath and calm down a bit.
The patient continued to cuss and fuss, scream and cry, as well as trying to work
her way out of the four point restraints. As you read this please remember that
this lady does not weigh 100 pounds soaking wet. Her family tried to calm the
patient down but to no avail.
Bob and I left the room and sought out the nurse in charge of this patient’s care
so we could find out a little more about what was going on. As we approach the
charge nurse she also commented that she was surprised that they had only sent
two of us to transport this patient; she was convinced that it was going to take
more personnel to safely affect the transport. Although she was mainly concerned
with getting this patient off her floor and out of the hospital before she caused
any more problems.
I lined up the patient information, made sure we knew where to take the patient
to at the University of Virginia Hospital, and called the receiving nurse that was
going to care for the patient to be sure she was prepared to accept a restrained
patient. Most hospitals have stringent rules about a restrained patient and we
wanted to be sure they were ready so there would be no delay at their end while
they looked for a physician to come and observe the patient to write specific
orders for their care; if not prearranged this is something that can cause quite a
delay in our handing over the patient.
The nurse rounded up two or three others to help us move the patient over to our
cot; they all were willing to help just to get this noisy, abusive patient out of their
hair. Moving this kind of patient over to our cot requires some intensive planning
so as to prevent harm to the patient or to one of us. Everybody needs to know
what is expected of them and the person in charge needs to be convinced that
the person assigned to a task is capable of doing what is being ask of them. You
might wonder why it takes 5 adults to move this one little old lady; it’s because
we want to do it without hurting the patient. I could take a hammer or something
and knock her out and then we would have no problem, but that kind of thing is
frowned upon.
We were able to make the switch without any real problems and got underway
with this kicking and screaming patient. The transport was stressful to say the
least. The patient was loud, fighting the restraints, and tried to bite me anytime I
was close to her. She ask me over and over if I had “seen the little ones”. We are
trained on the best way to handle this kind of patient and that is to be honest and
patient with our answers. The patient does not realize they are asking the same
question over and over so it is not appropriate for the attendant to become rude
or sarcastic in the responses. “Just like I told you the last 50 times, I haven’t seen
the little ones”, this kind of reply is not necessary. “No, I haven’t seen the little
ones, where did you see them last? Is the more appropriate retort.
The next hour and a half was a repeat of the same theme; first, cursing the
ground I walked on and blaming me for any problem she ever had, followed by
asking 50 or so times if I had seen the little ones, and finally 5 minutes or more of
pleading with me to release the restraints before another massive break with
reality and beginning the same cycle over again. It was a fun transport .
After we arrived at the hospital in Charlottesville we transferred the patient to
their care and left the hospital for Front Royal. It was lunch time when we dropped
off the patient and we decided to stop at one of our favorite spots to get a bagel
to go. We then would eat lunch while riding back to our station.
Just as a bit of a stress reliever Bob and I ask each other “have you seen the little
ones?” Over and over after we had dropped the patient off, it’s a kind of humor
that acknowledges the stresses we have encountered.
We stopped at the bagel shop and got in line to place our order. I heard someone
get in line behind me, but I didn’t think too much of it, I kept on talking to Bob in
front of me. I turned around and was quite surprised by the person standing in line
behind me.
This young gentleman was expressing his personal preference in clothing by his
choice of attire; as well as expressing his choice in hair color(s). He could not
possibly go through a metal detector with the 30 pounds of metal ear rings and
eye brow rings.
He had a purple Mohawk spiked haircut, Thick black eyeglasses and as much
metal jewelry in his face as a small car. Striped pants with flower power shirt and
“thong” shoes were a bit much.
He was the weirdest looking thing I had seen in a long time. He was the best
stress reliever I could have run into. I started to laugh at him and could not control
myself.
His buddy that came in with him looked at me and said to the weird guy, “I think
he’s laughing at you” at which time Bob replied “I know he is!”. This was the best
thing that could have happened to us! We both had the stress from the high
tension transport taken from our shoulders by this funny looking guy. It was great!
I guess this guy was expressing his personal taste in fashion, but it sure was funny
looking.
Chapter XIII The End Of A Long Career
Thirty-three years is a long time to do anything; much less serve all that time in
an operation as stressful as the rescue squad. The average “life span” of a medic
is seven to ten years, due in a large part, because of the strains of making not
only the occasional life and death decisions but the daily strains of making
decisions that effect the well being of the sick and injured. There are many, many
good people that go beyond those years, but the hard truth is that most get
burned out before they reach their tenth anniversary. If you look over a group of
ambulance providers you will see a few “older” ones; but the vast majority will be
under 30 years of age. There are other factors, the physical stresses inherent to
the work and the sad fact that as you get older your immune system slows down
and there is added concerns about “catching” something.
Why? The anxiety of making life and death decisions, knowing that if you screw
up people can die; that commands a heavy emotional toll. Knowing that if you do
your job 100% without error a patient may have a much shorter recovery period;
equally knowing that you can also be the cause of someone having a much longer
rehab if you mess up even a little. The strain of constant training, the many hours
of being on call, the in-house politics, and other factors all compound on each
other to wear a medic down. There is also the physical toll that you pay over the
years, very few long-term medics do not suffer with back problems from having to
lift and carry patients from difficult angles. Fewer yet have escaped the mental
toll that working in the emergency service field takes.
These stories have been about some of the many episodes I encountered over the
years while serving in the local rescue squad. All of these incidents are true-life
experiences and I have endeavored to share them with you to the best of my
recollections. Although the ravages of time dampened my memory and I have not
tried to recount the names of every member on the crews.
There are innumerable people that I have had interactions with in my days (and
nights) on the squad. I would like to think that those who rode and worked with
me on the ambulance had their life enhanced a little by something I showed
them; just as every one of them taught me something. As for the patients I’ve
given aid to, I can only hope and pray that their lives were made a little better.
As far as those folks who, over the years, tried to do me injustice; John F. Kennedy
said it best: "Forgive your enemies, just never, never forget their names”.
I reached a point that I was simply disillusioned about being around sick people all
the time, weary of seeing all the pain and anguish that can invade our lives. It’s
not just the patient’s suffering that can take a toll, but also the misery of the
patients friends and family. A little bit of this “pain and suffering” is easy to
absorb, but when you are exposed to it on a daily basis it can get tough. When
you reach that “burn out” stage, then nothing really matters and I just wanted
out, [even if I didn’t know it at the time]. I always “preached” to new members of
our ambulance crew that you could tell when it was time to get out of the rescue
business by using this guide: “when you loose your compassion for the suffering
of others, then it’s time to get out before you kill some one”. This adage is as true
today as it was when I first started going on calls in the “gut bucket” back in
1969.
My time in the rescue squad was a richly rewarding one that I enjoyed a great
deal and I learned a lot from these experiences. Did I make some mistakes? Sure,
some that I know about and some that may have happened and I never knew if I
had screwed up or not. Some people differ from my line of thinking and Lord
knows I differ from their thinking; but that’s what makes life go round.
I’m often ask: “I bet you’ve seen some pretty bad things on the rescue squad”.
Unless they are eating and I want to gross them out, I have a standard response
that illustrates my overall perspective of working on the rescue squad; “Yea,
plenty of bad things but I try to remember all the good things I saw over the ugly
stuff.”
May God bless all those who choose emergency services as their vocation, be it as
a volunteer or as a “paid guy”.
Would I do it all over? You damn straight I would!
Hoss Feldhauser