My Relief

I live in a small town, part of a small county. I know most of the firemen and EMTs in the county by first name. I'm familiar with dozens of frequent patients, care center staff members, and nurses. Because of the closeness of it all, I've also run calls on family members and friends.

I've run on my uncle when he had a massive heart attack, I took my brother to Portland for an appendicitis, I've been on friends of my wife and parents, and just last shift, I transported my sister in law.

I was on the phone with my mom last shift while my mom and dad were driving back from Portland over highway 26. We had to cut our conversation short because cell phone reception tends to cut in and out over the pass. About 10 minutes after hanging up, my partner and I are dispatched to an MVA on highway 26 at milepost 26, a very common milepost for accidents. Now, it took a moment or two, but then I realized that milepost 26 would be right where my parents would have been.

Code 3 out to accident, I couldn't shake the terrible feeling in the pit of my stomach that I would be seeing my parent's crumpled car off the side of the road. I thought about terrible scenarios like having to intubate my own mother. I prayed the entire drive out that the size-up we'd get from fire would be a positive on. One vehicle, two injuries is all that we heard.

We rounded the last corner approaching the scene, numerous fire and police cars parked along the shoulder, next to a steep embankment. We slowed to park and I saw my parent's car parked on the shoulder between a state police cruiser and a rescue truck, but it didn't look damaged. Still, I was fearing the worst. The firemen had two patients c-spined on the shoulder of the road, but I couldn't see the patients because the firemen were crowding around them. I placed us on scene, then exited the ambulance and approached the commanding officer.

He began giving my a brief report as I surveyed the scene. There were skid marks on the highway, crossing both lanes. I saw flashlights a hundred feet down the embankment where a car had landed. Then I start looking over towards the patients and I see a familiar white haired head suddenly look up, a stethoscope draped around his neck. There was my dad, a First Responder with Seaside, directing patient care. The relief that I immediately felt took over completely and for a few moments, I wasn't even listening to the firefighter. But I recovered quickly and went to work on the patients.

Looking over to the second patient, there was my mom, no medical training whatsoever but wearing a pair of medical gloves and holding c-spine on the second patient. Relief again as I walked over, touched mom gently on the shoulder to let her know I was there, then continued to work. We transported both patients, minor injuries that had self extricated from the vehicle, back to Providence Seaside.

I talked to my dad the next day and he told me they came across the accident just minutes after it occurred, before police or fire had arrived. He always carries a small jump kit in his car and he grabbed it and went to work assessing patients. He said when he turned, my mom had a pair of gloves on and was asking how she could help. Right then, I couldn't have been more proud of my mom and dad, or more relieved that they were okay.

My second biggest fear in this job is running a call on family member or friend (my first biggest fear is not being able to find the address). I live in such a small place that there is no paramedic back-up, no one to take over when I find myself caring for a loved one. It's a difficult thing and one of the things that makes working in a small system so unique.

Paramedic Pedal Power

This Memorial Day weekend, I got to see a personal project of mine take off with a very satisfying start. Following discussions with my fire department's EMS Officer, I put together a pilot program for a EMS Bike response team.

Bike response teams are in use by multiple fire and EMS agencies nationwide and provide an alternate (and often times faster) response time in pedestrian crowded areas such as special events, large parks, and promenades. Seaside is a very tourist friendly town with a 1.5 mile promenade and downtown core area. During holiday and summer weekends, the population can increase to 20,000 or more. During certain events, the downtown area can be closed completely to vehicle traffic and turned into a pedestrian parkway. Access to 911 calls during peak summer activity is extremely difficult by ambulance and often, we have to park a block or more away before reaching the patient.

This weekend was the program's pilot weekend and I worked the first two 6 hour shifts. My partner and I staffed a pair of bike's equipped with an AED, oxygen, IV supplies, BLS equipment, and ACLS drugs and patrolled the downtown area and prom. The response from the community and visitors was astonishingly positive. It was our goal to provide EMS service but we acted more as public relations than anything else. We gave out directions, answered questions, assisted the Seaside Police, and even helped to promote a neighboring fire department's annual fund raiser.

Unfortunately, the weekend overall was slower than anticipated and the bike team was not kept very busy. However, during the single 911 call in thier response area, they did arrive ahead of both the transporting ambulance and the fire department's rescue on a chest pain call.

Support from the police department, business owners, Seaside lifeguards, and local ambulance service has been very positive and it made for a very promising and bright weekend. Our next operational event will be the June 14th Muscle Beach Cruz car show, an event where downtown is closed to vehicle traffic.

I'm looking forward to a fantastic program this summer. I'll post more on this soon, or check on the Seaside Fire Department's website in the next week for a page to go live with all the details.

My Storm Story, Part III

My Storm Story, Part I
My Storm Story, Part II

The entire drive home was like watching clips from CNN storm coverage. There were very few houses that were spared any kind of damage. The highway was clear but I could look down side roads and see them carpeted in green and brown. I would learn later that in some parts of the county, it would take over a week for some people just to get off of their property because of trees down in their driveways.

Turning onto my street and pulling up to the house, I was relieved to see there was no storm damage to my house or any of my neighbors. I was weary as I headed up the front steps and let myself in. Meghan's mom, who lives alone, had driven over before the worst of the storm to spend the evening with Meghan and keep her company while I was at work. They were both sound asleep in bed as I let myself into the bedroom. Lilly gave a slight woof when she saw me, then settled into sleep again. I changed quietly, putting on a fire department sweatshirt and jeans, then kissed Meghan on the forehead before driving down to the fire station. There was still plenty of work to be done.

Weather forecasts said we were only in a break and that more high winds were expected that evening. The city was doing its best to mitigate damage and help the community. The community center had set up a soup kitchen and shelter, which we checked in with throughout the day and resupplied. The Fire Marshall was handing out assignments to fireman as they trickled in that morning and when I reported, I was put on a debris crew and also put in charge of home oxygen needs. It was anticipated that power would be out for at least a week and numerous citizens on home oxygen would be in need in the coming days.

Before going to work that morning, I headed upstairs to the department's kitchen where a few of the firemen's wives had put together and soup kitchen for us. Breakfast was up and they were starting to set out sandwich fixings for lunch. During the week, these wives would cook, feed, and take care of the department's 40 volunteers.

My crew set out shortly after lunch to help a resident clear a tree that had partially fallen and was now threatening his house. The tree hadn't caused damage to the house yet, but if left, it would surely blow over that night into the gentleman's living room. It would be dangerous to fall the tree as the winds were picking up, but we were dealing with each tree on a case by case, risk assessment type system. Using the rescue truck's winch, we pulled the tree away from the house to direct its fall then set to work cutting. In a little less than an hour, the operation was done and we were recalled to the station. Upon returning, I began doing oxygen checks and visited one of our frequent patient's who had called into the station earlier about his oxygen.

The second night of the storm was nothing like to first. It was comparable to our normal winter storms and therefore tolerable. We wouldn't be getting up that night for down trees or lines--we figured the work could wait until morning.

All week was like this; fireman reporting to the station in the morning, receiving assignments and working all day. In the 3 day period of the storm, we responded to over 40 alarms, over 10 times our daily average. In the 5 day period of the storm and clean up, we responded to 65 alarms, enough to set a new monthly and yearly record.

As for myself, I went in to work after having only one day off as I picked up an extra shift. All day long we responded to calls and had to take alternate routes because of road closures, or wait for fireman to clear a driveway. Several elderly patient's called because of oxygen problems, others called because of general illness associated with having no electric heat in their homes. On a county wide level, several people died as a result of storm related injury or accident, including carbon monoxide poisonings due to using gas grills inside as heat.

I keep a mental note of the worst shifts I've ever worked and the winter storm of 2007 certainly takes top honors for me. In a strange way, it also made my partner and I local, strange celebrities. Everyone in town had heard of the ambulance crew that was stuck on 202 during the worst of the storm and wanted to hear our story. Really, there wasn't anything too exciting or heroic about it. It's just a story of a couple of EMTs doing their jobs.

-----

The History Channel show "Ax Men" just aired an episode that covered the Great Coastal Gale of 2007. Ax Men, Episode 11: "The Storm of the Century" has many great clips of how highway 202 looked the first morning after the storm hit. Darrel's property is out on 202 the the footage of driving back into Astoria is the devastation my partner and I faced that night on the highway. Ax Men can be downloaded on iTunes here.

Exposure

Sunday evening while my wife and I were catching up on Battlestar, I received a phone call from the south station crew who had just transported a patient to Providence. The crew member wanted to inform me that the hospital was putting together a contact list of all health care workers who had come into contact with a certain patient because this certain patient was positive for meningitis. Not only did I have contact with this patient, but I also spent two hours in the back of an ambulance with her on a transport to Portland.

So I paused Battlestar, got out my little contact book and started making phone calls. First I called the ER to speak with the doctor directly. Sure enough, I'd been exposed to meningococcal meningitis and they want me to come in and start cipro right away. Great I'm thinking. Next phone call is to my shift supervisor to let her know about the exposure. Third phone call is to the supervisor who was working the day of the exposure as it was an extra shift for me. The fourth phone call was to my partner for that particular shift, who would now have to drive an hour into town to the ER.

Now, I understand that paramedics (and all health care workers) run the risk of exposure and I can run down a short list of recent ones.

• A hepatitis patient had explosive, bloody vomiting in an ambulance and the ER, contaminating a number of nurses and EMTs.
  
• An ambulance crew transported a confirmed pneumonic plague to Portland.
• A fire lieutenant was recently splashed in the face by contaminated IV fluid after the catheter was pulled from the patient's arm and subsequently sprayed around the scene until it was clamped.
• An EMT Basic received a needle stick after being in the wrong place as an EMT Intermediate was handling the IV catheter.
• I was splashed in the face by potentially contaminated IV fluid after the spike was pulled from the bottom of the bag and the sprayed all over my partner and I.

All these have occurred in the last 4 months between my ambulance company and my fire department. Thankfully, there have been no confirmed cases of any hepatitis, or plague, or meningitis in any of the exposed responders. It really makes me worry about the odds though. One day, my partner, or myself, or one of my coworkers may get more than just a scare.

By the way, Sunday was my birthday. What a hell of a thing to have to deal with...

What I Get for Taking Vacation

It's been a hell of a week. I took a shift off on Tuesday to spend a few days away with my wife celebrating our 4th anniversary. I paid for it though, before and after.

The shift before my anni-vacation, my partner and I ran 5 calls before noon. One of which required cardioversion for SVT after two unsuccessful rounds of adenosine. In the middle of all this, dispatch is paging us that there are return medivans waiting at providence ER. We made three round trips to Portland that shift.

I had to paralyze and intubate a stroke patient while nervously waiting for additional personnel from rescue. We took him to Portland on a vent.

Upon returning from my anni-vacation, I had a first ever experience as a patient went from a 3rd degree block to cardiac arrest in front of me. I was setting up an oxygen mask and not looking at teh patient when a fireman said "I think he just went out on you!"

"No he didn't." I replied as I double checked the monitor leads (one of them had fallen off). It was then the patient went from pale to purple in 10 seconds. Fuck I thought.

"Code 99." My partner calls into the radio. Immediately this is followed by the FTO sitting at post "Medcom from Medic 3, does 1 need our assistance?"

In the middle of applying defib pads, setting up for the intubation, and IV, I grab the handset. "Negative 3, fire is already on scene." I don't need another medic to drive 15 minutes from post to 'assist' me on a code when I'll be off scene in less than 10. (I have a problem with second ambulances responding as "back up," something I'll rant about later.)

That shift was rounded out with a transfer for gall stones at midnight. Something I truly considered a valuable use of my emergency medical skills.

Today, it continued with a trauma system entry from the memory ward at one of the local adult care facility. The patient fell outside and was in the rain for 10-20 minutes before the caretakers found him. He had a huge hematoma on the back of his head and was supposedly altered from his normal state of dementia. Turns out he had a subdural bleed as was a trauma transfer 30 minutes after arriving at the hospital.

And this afternoon, I took my second vent transfer of the week, an acute MI with complications. I just took a vacation, but really, I need another one.