As seen on CNN

After reading a short article on CNN.com, this was the "Ads by Google" that I saw at the bottom:

I have one thought about this: Fucking bottom feeders. God forbid we try to educate ourselves about the H1N1 virus, or that we talk about proper hand washing and prevention techniques. No. We have to put up with vendors trying to sell $179.95 (plus free shipping!) 5+ Person Flu Pandemic Kits. This "amazing" kit, a $279 dollar value, includes:

• Box of 35 N95 Masks (Latex Free): N95 Masks are the respiratory masks that are rated the best for preventing the spread of contagions (N95 masks are also good for chemical spills, wild fire, etc.)
  
• Box of 100 Exam Gloves (Latex Free, Powder Free)
  
• Box of 50 Disposable Isolation Gowns (Latex Free)
  
• Box of 100 Disposable Shoe Covers (Latex Free)
  
• Box of 100 Bouffant Cap Disposable Hair Covers (Latex Free)
  
• Five Pairs of Protective Safety Glasses (Latex Free)
  
• Five 4-oz Bottles of Epi Clenz Hand Sanitizer Gel

All this can be conveniently yours at a special discount price to make sure that your family is pandemic flu ready.

Gack! I think I've just thrown up a little in my mouth...

Modest Recognition

So I was standing in line at the vet's office the other day. I was in my uniform since I'd just gotten off shift and was getting some prednisone for Boomer. Dr. Goza's office is always packed with people and pets; he's a great doc and very reasonably priced.

As I'm waiting, one of the vet techs walks out from an exam room, looks up from his paperwork and sees me: "hey, you saved my daughters life!"

My first reaction was to look around for who he was talking to. I know I had that are you talking to me? "I'm sorry?" was the only thing I could say. Usually, I can remember the 'we saved a life' calls.

"Yeah, it was during the snow storm this winter." He was all smiles as he was talking to me. I felt awkward because I didn't have clue what he was talking about and now I was holding up the line.

"I'm sorry, but are you sure it was me?" I didn't want to be rude, but I didn't want to be taking someone else's credit, either.

"Yeah," he went on. "Remember, you gave her an epinephrine shot after she had some peanuts. You saved her."

"Oh yeah! I remember now." And I did. We had been dispatched for an allergic reaction on top of one of the hills in town. I was concerned about making it to the scene since the roads were still snow covered and we'd already had a few instances of slipping and sliding.

But we pulled up to the house without incident, grabbed our kits, and headed up the front steps. Dad met us at the door, his little 18 month old in his arms. She was crying quietly, swollen in her faces, arms, and legs--all over really. It wasn't a matter of hives per se, but swelling all over. She looked miserable, but still awake and afraid of me, so I heaved a sigh of relief.

Dad told us he'd fed her some peanut butter, no big deal since she'd had it before, but she quickly developed a reaction. He had given her benadryl before calling 911, but she hadn't gotten much better in the last 45-minutes. He said he would have taken her to the ER himself, but he had a 3 year old to look after also.

I sat dad and baby down and took a quick listen to her lungs. They were tight and wheezy, so I had my partner get the epi ready while I talked to dad. A quick shot in the rump and we were ready to go. Dad sat in back with me with his other little girl in the airway seat. And within a minute or so of leaving the scene, baby was crying her little head off and sounding much better than when we first walked through the door.

***

I stuck out my hand for the vet tech, "how's she doing?"

"She's great--no more peanut butter for her, though."

We chatted for a few moments more. "I just wanted to say thank you. You guys do such great work."

"You're welcome." It was the most modest thing I could think to say. I front of an office full of people, I felt pretty humble and didn't want to ruin it by saying something non-challant like, "just doing my job, sir."

One of my EMT instructor used to tell us that if we were in teh job for the pay or the recognition, then we should best look somewhere else. I have to say though, it's nice when the recognition happens.

"Free" Health Care

Oregon has what's called the Oregon Health Plan--in essence, Medicaid for those without medicaid. Only a certain portion of the population have access to it and you must meet a certain low-income level to be eligible. It provides access to the health care system that some folks otherwise may not have had. Plan participants get extremely low premiums, low co-pays, and prescription drug coverage. Sounds great, right? Health care for those who wouldn't normally have it.

Here's my problem:

My partner and I took a call for back pain. We were in this closet sized apartment, packed to the breaking point with a couch, queen bed, recliner, kitchen nook, and big-ass TV with stacks of X-Box and Playstation games. All of this in the same little, tiny space. We could barely find a place to set our bags down, let alone stand.

Our patient was sitting in the recliner, moaning and with three yappy dogs circling around us. "So, what's going on?" I ask with a smile on my face.

She was a slow talker and while I felt impatient listening to her get to the point of her story, I listened attentively, taking occasional notes on my glove. But the gist of it all: she had a whiplash injury from about a week ago, had shoulder and upper back pain, and her prescribed pain meds weren't working. It hurt when she moved, hurt when she was lying down, hurt when she was just sitting up.

"So whiplash from a week ago, huh? What happened? Was it a car accident?" Just a curious, conversational, innocent question.

"No... I fell asleep in my recliner and pulled something." Now trust me, given my overall impression of the patient, this was a WTF? Seriously? You called for this?

I know that my partner had the same thought because I could see it in his face across the tiny little apartment. But, I thought that I could use this as an educational moment.

"You know, I'm more than happy to take you to the ER now, but this is something that can easily be followed up with your doctor. Do you have a primary care physician?"

"No. I'm in between doctors right now."

"Well, that's okay. Did you know that there's an urgent care clinic at the hospital and you can easily follow up with a physician there?"

"No. But I'm on OHP and I want to go to the emergency room. That's where I went first, they have all my records, that's where my caseworker knows I'm going to go."

So there it was. I tried to reason once more, explaining that records can be shared, but she wasn't having it.

From personal experience, I'm irritated with the mindset of the 'average' OHP clients that I've run on. They look at EMS and the ER system as their only option and in some cases, as free health care. Now, I know that there are OHP clients that use the system appropriately and I've run on them too, but from my experience as a prehospital care provider, they are the minority.

But the story goes on. I ask her to walk outside to the gurney because there was no way the gurney would fit into her little apartment. She used her cane and I let her hold my hand as we slowly made our way outside. She sat down with a huff, slung her legs onto the cot, and handed me her cane. Then she turned to her son, shouting over me shoulder: "I'll call you when I'm done so you can come get me."

I was left asking myself the question if she's able to walk to my cot (which is next to her parked car) and junior will be coming to pick her up from the ER, how come junior couldn't drive her up to the hospital? I could make the assumption that she just wanted pain medications, but I had already told her up front after looking at her pain medications that I had nothing stronger than what she was already taking. May she simply didn't know better, but I find that doubtful since when I tried to educate her, she wanted nothing to do with it.

Nope, I think it all has to do with her OHP Golden Ticket and her (nearly) free access to healthcare--no matter how unnecessary the access might be.

JEMS State of the Science 2009

The Journal of Emergency Medical Services (JEMS) has a great supplement for download on their website. Called "State of the Science 2009," the 32-page insert has great articles on CPR, the changing roles of MS, lasix, and beta-blockers, the wide spread use of field 12-leads, research into hypothermic induction in a cardiac arrest, and other topics. You can find it on the JEMS website here. Look for the Download This Supplement link near the bottom of the page.

Drunks 2

The second in a series of 3 on drunk cases.

“Medic 2, code 3 for an unknown medical, possible psychiatric problem.”

It was 2:30 in the morning and I rolled out of bed with a groan. I looked at the address on my pager: Warrenton. Great. I knew I’d be up for an hour, at least. I pulled my pants on, then sweatshirt, and finally my boots, then trudged out to the rig. My partner already had it running and put us en route as I climbed into the passenger seat. Dispatch repeated the address and nature of the call as we pulled onto the highway, our red and white strobes casting about us in the light fog.

We made for the roundabout, then south across the bay towards Warrenton. Rescue would be responding also, so I punched the SCAN key on the radio, but all was quiet—either they were already responding, or no one was. We’ll find out when we get there I thought to myself.

Going through Warrenton, we took a left at the main light, and shortly approached the scene. The fire department’s rescue unit was parked in the driveway of the single level house, its red rotators mixing with the pulsing blue and red of the police cars parked opposite the house. Everyone had come out for the show.

My partner marked us on scene, I pulled on a pair of exam gloves, then got out of the unit. We piled our equipment on the cot and wheeled towards the open front door. A police officer met stopped us short of going inside and gave me the rundown.

“So this kid shows up at these people’s home, completely drenched and drunk. He pounds on the door until they open up, then starts rambling about how it’s his parent’s place and he wants in. He’s in the living room, but he’s tweakin’ pretty good. I think he’s on mushrooms or meth.”

Our patient, a male in his early twenties, sits in a living room recliner. He’s dressed in his work uniform from a fast-food joint, soaked to the bone, and wrapped in one of FDs wool blankets. He’s fidgety and anxious, partly because he has no clue what’s going on, partly because the firemen are crowded around him, and partly (I thought) because he was high. I made a hole through the firemen, then crouch down so that I’m was at least eye level with him.

“Where are my parents?” he starts. “I don’t know who all these people are. What’s going on? Why are you all in my house?” He’s angry with us.

“Listen, partner. This isn’t your parent’s house. You woke up some poor folks and they called us. We’re going to take you to the hospital to figure this out.”

I questioned him some, tried to figure out what he’d been up to. He thought it was only 11pm. He didn’t know how he’d gotten to this house, if he’d gotten into an accident at all, or if any one had been with him. He denied drug use and—image this—denied drinking. He still thought it was his place and we had to argue back and forth a little that the homeowners had no idea who he was. I think at some level, he finally just gave up the fight and allowed us to walk him over the cot. It was when we started to put the seatbelts on him that things start to get out of hand.

“What the fuck is going on?! Fuck you people! I want to know what’s happening!”

Now, most everyone there knew my rules and I made no hesitation to educate the patient. Forcefully and sternly I told him, “you need to watch your mouth. You need to calm down and cooperate with us, or things are going to turn out badly for you.”

He was still angry, but he apologized through clenched teeth and we continued to belt him in. During this time, he’d lost a pocket full of change and as I bent down to collect it for him, he opened his mouth again. “Look at me! You need to tell me what the fuck is going on!” When I raised my head up to look at him, he was pointing his finger at me and he was red faced with anger.

“Listen. That’s your second warning about your language. You dropped your money and I was picking it up for you. We’re taking you to the hospital because you’ve had too much to drunk and you don’t know what happened tonight. Calm down, trust me, and cooperate, or things will not go good for you.”

But it didn’t stop, his bad attitude and loud mouth persisted. We had a 15 minute transport time ahead of his, so after we loaded the patient, I told my partner to just get going, that I’d handle everything in route.

Several times during the transport, he’d go from compliant and amicable to verbally combative and verbally abusive. At one point, he took his cell phone out of his pocket and after finding the battery dead, threw it against the rear doors. This was the point that I thought that’s it. I opened up my drug kit and pulled out the ampule of inapsine and a 5cc syringe. I had one eye on the patient and the other on the drug as I drew up the sedative.

“ Whoa, hey! What are you doing! What the fuck are you going to stick in me? You’re not sticking me what that fucking needle!”

“If you don’t calm down and get your language under control, that's exactly what will happen.”

“Are you trying to threaten me?”

“Nope, just giving you fair warning.”

And warning it was. Look, this is the way I see it. When you watch Cops on TV and they bring a suspect back to their car, they tell them to put their hands on the hood and not to move. After a few seconds, the suspect will take his hands off the hood and try to reason with the cop. The cop will warn him to put his hands back on the hood. This repeats three or four times before the cop finally cuffs the suspect and sits him on the curb. The cop does this to control the scene—he does this by controlling the suspect and thereby controlling his safety. My tact with this kid was the same—I needed to control the environment to keep myself safe.

Lucky for him, he kept his mouth shut and his hands to himself for the rest of the transport and the syringe of inapsine sat next to me on the bench. We unloaded him at the ER bay, and while he looked angry as a hornet, he still kept his mouth shut. The ER nurses had prepped the psych room for him and waited for my partner and I to transfer him to the ER cot, only he wasn’t getting off of the cot.

“I’m not getting off this fucking thing until somebody tells me what’s going on!”

He had a death grip on head bar of the cot and he’d spread his legs, wrapping his feet around the frame of the Stryker. We tried doing to easy things at first, just lifting him over using the bed sheet, but he wouldn’t budge. And so my patience broke. I forcefully unwrapped his feet, roughly slamming his legs back onto the cot, then I loosed his grip, throwing his arms back onto his chest. Then we roughly tossed him to the ER cot in a kind of “1-2-3-heave!” motion.

Afterwards, I told me partner “sorry. I know I lost my cool, but guys like that really just piss me off.”

“You know, you were way too nice to him,” he replied.

Too nice, huh. I guess I’d broken my own rule. I should have used to inapsine, drawn up and sitting next to me on the bench, as it was.

Drunks

The first in a series of 3 drunk cases that have given me problems over the last few months.

There's a reason that I don't like drunks. I never get called to the happy drunk, the one that wants to buy you a pint and hang out. I don't get called to the funny drunk or even the silly drunk. No, I get called to the guys too drunk to walk, too drunk to stay conscious, too drunk to be a nice. And it's never at a convenient moment, always right before or after the bars close--in other words, past my bed time. So when I'm paged out at 0230 for an unresponsive male in the parking garage of the Ocean Inn, I'm not thinking diabetic problem, stroke, or cardiac arrest, I'm thinking--I know--it's a drunk.

We had to park on the street and hike the gurney and equipment into the garage. The cop gave us his name as we walked up, Brian, from the military dog tags around his neck. He was still sitting in his enlistment bonus when we arrived. A brand new Ford Mustang Cobra, black with the twin gray racing stripes. It was a sexy ride, aside from the douche-bag in the driver seat.

The hotel worker said he'd seen the guy earlier in the day and that he'd already had a half gallon of Captain Morgans. The cop said he'd already tried honking the car horn and doing a sternal rub, both without effect. The driver's door was open and you could smell the alcohol from 10 feet away. Brian was passed out... completely... the “I just bought myself” an intubation kind of unconscious.

So I turn to my partner. "Look, we're gonna pull him out, put him on the cot, and then we're going to put in an nasal airway. We'll see if that'll wake him up."

My partner and I pulled him out of the car, roughly setting him to the ground so we could readjust our grip. Coming up under his shoulders and knees, we hefted him to the cot, then started to strap him in. His button down shirt was open at the collar, I could see a set of dog tags resting on his chest, and a couple of tatoos. His jeans were wet at the crotch.

As we strapped him in, he woke up--wide eyed and with a scrambling of his limbs. "Easy there, partner," I started to soothe him, "we're the paramedics."

"What happened?" he asked, still wide eyed and confused.

"You had a little too much to drink tonight and the hotel called 911 when they couldn't wake you up."

"I haven't had too much to drink!" he tried sitting up and getting off the gurney and only got himself tangled in the straps.

"Easy, soldier. You had enough tonight that you're either going with me to the hospital, or going with this nice police officer here to sober up," the cop raises his hand and gave a little hello.

So Soldier Boy complies and relaxes a bit on the cot. The fire department had arrived then and I told them, "we got it guys, but thanks for coming out." My partner and I slung our kits onto our shoulders, and then rolled the patient out of the garage and into the ambulance. My partner sets up the IV bag, while I go about getting a blood pressure and setting him on the pulse ox. With the IV bag set up, I told my partner we can get going, that I'll start the line in route. My partner jumps up front and we start towards the hospital.

Brian passed out again, his head rolling onto his left shoulder. We weren’t more than fifty feet down the road. My partner is eyeing me through the rear view mirror as I put the sternal rub into Brian again. He awakes with a violent start this time, flailing his arms, kicking is legs, and getting enough momentum going that he crawled right up the head-end of the gurney and wound up wedging himself into the airway seat. Honestly, it reminded me of that scene in Signs where Joaquin Phoenix sees the alien on the news clip and backs himself into the closet out of shock.

“Park it, Shane! Get back here!” I yell up to my partner. I felt the rig lurch forward as he hit the brakes and parked it.

Brian was thoroughly freaking out right now, “what’s going on! What happened! Where am I?” Over and over he kept asking as I tried to talk him down and soothe him. My partner had crawled in back and was awaiting instructions. I was trying to calm Brian down, to get him back onto the cot, at the same time I gave instructions to my partner to get the Inapsine and a syringe.

Brian had calmed a lot and was now moving back to the cot as Shane placed the drug onto the bench next to me. I settled him onto the cot, securing the straps around him again, explaining that I wasn’t trying to restrain him, but keeping him safe. He was calm enough at that point, so I told Shane to get back up front and we’d get going again.

On the drive in, I talked with Brian trying to get a little more history out of him, the entire time the Inapsine and syringe on the bench next to me. I talked him into letting me take his blood pressure and to hook him up to the monitor. He even said it was okay to start an IV, which I wrapped copiously with coban to keep it in place.

I patched my report to the hospital and soon enough, the back-up alarm was sounding as we came into the ER bay. We unloaded the cot, Brian still resting comfortably and the Inapsine still on the bench.

The nurses met us in the ER hallway, silently pointing to bed 6. Brian had tried scratching and pulling at his IV a few times and I was glad that I’d tied it down. He’d also started to have this smoldering, angry look in his eyes and I knew he was trying to work up to something. But he transferred to the ER cot on his own and I exited the ER bay with an apologetic look to the nurses.

Just a few steps outside the room though, he started pulling at his IV line again and trying to scramble off the gurney. I turned on my heel and dashed back into the room to give the nurses a hand. Brian was getting more and more agitated and I had to use my forearm to keep his shoulder pressed into the ER cot. It took a minute or so, but an ER tech came in with a set of soft restraints that we tied Brian down with. I backed away from Brian, pulled my gloves off, apologized again to the nurses, and left the room.

Maybe I should have used the Inapsine.

Stress and a Brick Wall

Last night I tried putting together an entry about how I'm really getting unhappy at work, how my partner stresses me out, how I work over half the shifts in a month at a station 35 miles from home (while the supervisors don't work there at all), and how I feel like I'm beating my head against a brick wall about this stuff. I was complaining about how working in Little Fishing Village was giving my nothing in the way of calls, how working in a station the supervisors didn't have to be at was bullshit, and how I was tired of getting up a 5:30 in the morning to make it to work on time. Then I deleted it because it was too negative, too whiny.

I put the laptop away, then rolled over to go to bed. Thirty minutes later, I was being dispatched to a baby just born, not breathing. I had never worked an infant code by myself before, and it was not a call that I was looking forward to.

The Fire guys were there ahead of us, upstairs in the second floor, rat-hole apartment. There was a definite air of calm as my partner and I lugged our gear up the stairs in into the apartment. The Fire Medic was right inside the door as we walked in and told me right away, "this is Sylvia and she's miscarrying."

Right then, I had a guilty surge of relief. I wasn't going to be working a newborn arrest, but I still had a very difficult call ahead of me. I'll say it right now though, thank God that the Fire Medic was there--he kept his newer EMTs calm as well as the cops, and I leaned on him an awful lot during this call. He's been a Medic for over 20 years and I have a lot of respect for the guy.

The Fire Medic gave me a few more notes about Sylvia before I entered the bathroom to talk with her. She was young, sitting on the toilet, anxious and upset. She was hispanic and her husband was next to me, kneeling on the bathroom floor mat, and holding a small basin between Sylvia's legs. She was 16 weeks, had a number of miscarriages in the past, and seemed to be holding herself together fairly well. She had a lost a lot of blood, though. The husband reported she had been bleeding for about two hours prior to the 911 call, at least a litre had been lost.

I tried to talk with Sylvia, using the husband and one of the police officers as translators. My partner was brining up the stair chair and I just wanted to get her out of that apartment and into my ambulance before I did anything. I had questions to ask, and after everyone I felt this sick, empty pause. Normally, I can small talk with patients and be comfortable with them, with the scene. This was different though. I knew that Sylvia and her husband felt helpless, and I admit I felt a little helpless as well.

We had to walk Sylvia to the stair chair, then carry her down the stairs. All the while, we did everything we could to keep her covered and comfortable. I called the radio report in the phone, no need to give out too many details be radio, I thought. She was tachycardic and pale, and little hypertensive. I started a line and gave her fluids, then we transported the short mile to the hospital.

For a few minutes, Sylvia and I were in the back of the ambulance alone. She was wimpering now, partly becuase of the pain, but more I suspect becuase of her loss. I felt horrible that I couldn't say anything to her, or do anything to comfort her. And I felt terrible for Sylvia, this incredible sense of sympathy.

My partner and I turned her over to the ER staff, who went to work on Sylvia right away. I spoke with the husband briefly before leaving, who thanked me for helping. We then returned to quarters and I wrote my chart.

When I was working so much time in Little Fishing Village, this was definatley not what I was looking for in the way of calls. I told my supervisor about the call this morning when he relieved me. He's a medic with 15 years experiencing, a very calm level headed person who doesn't let anything phase him. What he said summed it up for me: disturbing.

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.

My Alzheimers

Of all the patient's I see, I can't tolerate drunks. I'm not talking about the happy drunk or the quiet drunk who doesn't bother anyone or gets themselves in trouble. I' talking about the angry or belligerent drunk who's behavior and actions have required my services. I have a zero tolerance policy for drunks--if you mouth off once you get a warning, again and it's chemical sedation. You threaten violence or come into physical contact with me or my partner, you've just bought yourself a tube and a very unpleasant experience. Woe be upon the drunk that finds themselves in the back of my bus.

Next to drunks, I have a hard time with Alzheimer's patients. I understand that they have a legitimate medical condition that has reverted them to an earlier point in their life, or causes them confusion, or severe dementia. However, just as often, I see family and care staff use Alzheimer's to defend a patient's behavior and actions during the patient's most lucid periods.

My partner and I were sent to Auburn a few shifts ago, which after doing the transfer math, I realized was a 6 hour round trip. Irritated by this, but resigned to the fact that I'm doing my job, I awaited the page for the assignment. Upon receiving said page, my irritation went into full blown contempt as I read it: COMBATIVE ALZHEIMERS PATIENT. A 3 hour trip with a combative psych patient did not seem like fun to me. Begrudgingly, I did my job and we placed ourselves in route and a few minutes later, on scene. The hospital, known for sending a high percentage of psych patients, is also home to some of the most irritating and burnt out nurses I've ever had the displeasure of working with. The nurse at the desk points to an ER room and says "she's in there, here's her paperwork." Without a further word, he turns is back and continues his crossword (or whatever it was he was doing).

I fling a disbelieving look at my partner before I ask the nurse, "so what's the deal with this patient?"

The nurse gives me a heavy sigh, "family tried checking her into a care facility earlier today, she became anxious and didn't want to be checked in. So family brought her here for a psych eval."

As if on cue, the family approaches me (smelling of alcohol, to top things off) and asks me "you're going to put her on that?" indicating my gurney. "She's gonna get combative. You're gonna have to give her something."

I stop the conversation at this point and turn to the nurse. "I'm hearing two things here, that's she's anxious or combative. Which is it?" I ask the question as I glance over at a very sweet looking short, elderly woman in a flowered sweater and blue wind breaker.

ETOH smelling son answers, "well, she can get combative."

"So she's actually been physically violent before?" I clarify.

"Well no, but your gonna to have a heck of a time with her if you don't give her something to settle her down."

Again I turn to the nurse as the ER doc walks up. "I carry Versed, Ativan, or Inapsine and she's going to get something before we leave."

This settles the issue as the doc writes a quick order for Inapsine. The patient gets her shot, we load her on the cot, and then we get going. For the first hour, everything goes smoothly. The patient is in a happy place, even though I'm ready to upchuck due to the winding road we're on, and I'm writing my chart. The patient and I make small talk, and once she says to me "you're cute."

"Thanks. My wife likes to think so," I answer. The patient quiets then and I move to the airway seat to check in with my partner. I then hear the patient's seatbelt unclick itself and fall to the ambulance floor. I remind the patient that the seat belts have to stay on for her safety, I secure her again, then return to the airway seat. A few minutes later, this happens again. I go through the routine again. This repeats twice more before I move to the bench next to the patient, then the mysteriously unfastening seatbelt settles down.

Shortly after, the patient tells me again "you're cute" and her hand finds its way to my left knee. Now, I should say at this point that the patient knows exactly what she is doing--I had watched her twice unfasten her seatbelt purposely, she was aware of her surroundings, and knew where she was going and why. In short, she was lucid. So casually I readjusted her arm to take a blood pressure, then placed her arm back at her side. I return to me chart and a few minutes later I hear it again "you're cute." The hand returns to my left leg, a little higher up this time. This time I readjust my position on the bench seat out of arms length of the patient.

We're about an hour from our destination at this time and I decide its time for more sedation. A little more inapsine and the patient was docile and hands-to-herself for the remainder of the trip. At the hospital, we turn the patient over and I get an "I love you" from patient, then my partner and I pack up the ambulance for the return 3 hour trip, thankful this is now behind me.

The point I'm trying to make is that I've been in EMS for 6 years, not a career by any stretch of the imagination, but long enough to understand when a patient is operating under their own free will. My problem with Alzheimer's patients are those that act and behave inappropriately under their own free will. And what happened with this patient? Chemical sedation. Inappropriate behavior is the same no matter what the age group and I shouldn't be at the receiving end of it no matter the circumstances.

My Care Home Frustration

My partner and I took a call today at one of our assisted living facilities. We have 6 in our county, 8 in our total response area, and multiple adult foster care homes which are outside of the normal assisted living community. We were sent for low blood pressure, which happens quite frequently and is most often attributed to the med-aids' inability to take an accurate blood pressure. The staff tells me that they found the resident in his bathroom pale, sweaty, weak, and with a very low blood pressure.

My first impression of the patient as he's sitting in his wheelchair is that he has great skin signs and is alert and competent. My partner gets a quick set of vitals, after which I ask the staff "so what's his pressure normally?" I don't know was the immediate answer. I then ask the staff "what's his history?" I don't know, he's only been here four days and we don't know anything about him. Now, I should mention the patient is extremely hard of hearing and I have to communicate by pen and paper. He keeps saying he's been sick, but is non specific and the staff has no idea what he's referring to. His medical paperwork has no information regarding a previous history. At this point I realize I won't be getting anything from the staff or the facility, even though there are three med-aids in the room at this point all with the same blank I don't know expression.

So I take Mr. So-and-so to the hospital and turn him over to the ER nurse who asks me a multitude of questions that I wasn't able to answer because I couldn't get answers from the care staff. It should also be said that I'm on great terms with the ER nurses and they understand my frustrations and don't hold this against me.

It occurs to me that it's these care takers' jobs to know what their patient's conditions are. It's there job to know a medical history and their recent activities. It's there job to be able to give me an answer other than I don't know. Granted the resident was new to the facility... by 4 days. I might be able to forgive this after his first day, but after 4 days I would assume the staff had a clue regarding the patient's medical conditions and history. Given this, I know I wouldn't want my grandmother taken care of by these people.

This is just one more irritating example of the incompetence inherent in the assisted living system.