“That’s juvenile, cruel and a perfect example of inappropriate horseplay in the workplace…so by all means, take my video camera.”

You just have to love a boss that gives you marching orders like that.

For those of you who are unfamiliar with the workings of small town Mom and Pop ambulance services, they constantly struggle to find ways to buy supplies and equipment and pay the employees to the degree of poverty at which they are accustomed. Often, there just aren’t enough real ambulance calls to pay the bills. So, Mom and Pop are often forced to do unpleasant things…

…like take body calls.

They’ll contract with the coroner’s office or the local funeral homes to transport bodies to the funeral home or to the medical examiner’s office if an autopsy is ordered. For a modest stipend, Podunk Ambulance would send their Highly Trained Lifesavers to your house or nursing home to provide transport of your loved one’s earthly remains to the charnel house for preservation and burial.

If it sounds a bit macabre and ghoulish, that’s because it is. But hey, it pays the bills when quite often our real mission does not. And though it sounds odd, there is a certain honor in the service provided. A little respect, compassion and gentle handling of a loved one’s remains can often temper the sadness of the event for the grieving family.

Such solicitude however, does not extend to the EMTs performing the task. Away from the eyes of the family, body calls are an excellent opportunity to scare the bejeebers out of your fellow Lifesavers – particularly the squeamish ones. For some reason, there are quite a few medics who will aggressively work a cardiac arrest and perform all manner of procedures on a body in an effort to resuscitate someone…and then be absolutely unwilling to stay in the same room with that same body once it has been declared Officially Dead. A fellow crew – a husband and wife team – was just the type of which I speak.

I had heard the dispatcher send Ernie Keebler and The Troll way over to Quaint Little Hamlet on a body call. Knowing they’d take at least an hour and a half for the trip, Pardner and I hustled over to the Boss’ house to retrieve my moulage kit. The Boss was a tad curious as to why I’d want theatrical makeup at oh-dark-thirty on a slow night.

A wise man would concoct a lie. A creative fellow would contrive a plausible story. A careful man would consider his words before delivering an answer.

I blurted out the truth.

“Boss, I’m going to make up my feet with a little death pallor, strip down to my skivvies and lay under a sheet on the embalming table at Stiffs R Us funeral home. When Ernie and The Troll arrive with that body they’re transporting, I’m going to scare the living shit out of them.”

To which Boss had replied with the aforementioned marching orders, and provided the means to record the event. I suppose enlisting the Boss as a co-conspirator in a dastardly workplace prank could be considered unprofessional, but hey – the only time the words professional and Podunk Ambulance could hope to meet in the same sentence was when we were rendering patient care.

So, off we sped to Stiffs R Us to set up. After hiding our rig around the corner, we slipped the Hide-A-Key from its hiding place and let ourselves into the embalming room. Picture a cramped 10×10 room with a counter top along one wall and cabinets that extended almost to the ceiling, a big porcelain sink, an embalming pump mounted on a rolling stand, cans for medical waste and soiled linens and patient clothing, assorted other detritus, and one of these babies sitting smack dab in the middle of the room:

Pardner grabbed a sheet from the rig while I hurriedly stripped and applied some death pallor makeup to my legs from the calves down. I even added a little tinge of cyanosis and mottling to the underside of my legs to simulate lividity. Hey, I’m a detail-oriented prankster.

“Okay,” Pardner tells me breathlessly, “we’re all set. Hop on the table and let me spread the sheet over you. They’ll be here in ten minutes.”

“Did you disinfect the table first?”

“Uh, no.”

“Then respectfully, fuck you. I know what’s been on that table. I put some of ‘em on there myself. Find some Clorox or something.”

“C’mon, c’mon! We haven’t got time for this,” he urges, flapping the sheet impatiently. “They’re almost here!”

“Ahem. Three weeks ago. Hundred degree heat, big fella found in his house trailer after no one had heard from him for six days. We used an entire jar of Vick’s salve between the two of us.”

“Oh. Yeah, that guy. Maybe I can find some wipes or something around here…”

I watch with a critical eye as he thoroughly wiped down the table with some disinfectant wipes he found in a cabinet, then I climbed aboard the cold porcelain and let Pardner spread the sheet over my considerable carcass, leaving just my artfully decorated feet sticking out.

Pardner wedged the video camera on top of the cabinetry, pointed the lens down toward the table, pressed the RECORD button, and beat a hasty exit. I lay on the table as still as possible and tried not to think about what had been there before me.

Presently, I heard the growl of a Powerstroke diesel engine outside. Vehicle doors slam, followed soon thereafter by the sound of a key in the lock. The door opened and through my eyelids I became aware of the dim glow cast by the street light in the back parking lot of Stiffs R Us.

“Shit,” sighs Ernie Keebler, “they’ve already got one on the table.”

“Uh uh!” grunts The Troll dubiously. “I ain’t going in there.”

“Okay, okay, OKAY,” Ernie groans placatingly. The Troll is a hard woman to please. “Let me go inside and I’ll see if we can find somewhere to put this one.”

The lights flick on and I am bathed in brilliant fluorescent light. I try to remain absolutely still. I sense Ernie somewhere to my right, just out of reach. He’s muttering to himself, moving around linen and biohazard cans…

“Damn creepy body calls…don’t know why I ever married that heifer…I’m a damned paramedic, not some professional ghoul…not my job anyway…Jeez, that’s a big sumbitch on that table. How the hell am I supposed to move him?”

I hold my breath. Then I hear the inner door open – the one leading inside
the funeral home. More banging around and fumbling for light switches. Ernie’s voice fades as he walks further into the funeral home, sounding all the while like a kid whistling his way through the graveyard…

“Jeez, why don’t these damn people even keep a stretcher handy…can’t be the first time they’ve had two stiffs at once…not my damned job anyway…the Lord is my shepherd…”

I let out the breath I’ve been holding, trying not to make a sound. I smell cigarette smoke from outside. I hear Ernie coming back, accompanied by the squeak of stretcher wheels in need of lubricant.

Okay, here it comes…

Ernie, still grumbling, can’t negotiate the space with the stretcher.

“You’d think they could throw some of this crap out…I shall fear no Evil…now where can I put these containers?”

I suppress the urge to smile. The only place to stow them out of the way is right next to my table. I hold my breath once again.

Grunting, Ernie drags first one can and then the other next to my table. I hear him cursing and breathing heavily, not two feet to my right. Those cans are heavy when they’re full.

“WHAT THE HELL DO YOU THINK YOU’RE DOING???” I bellow as I sit bolt upright, reaching out with my right hand and grabbing Ernie’s wrist in the process.

Heh.

Go back to those halcyon days of your childhood when you watched cartoons all Saturday morning. Remember how the characters, when frightened, could levitate into the air while their legs pedaled madly, and the body would turn 180 degrees and zip away…but leave the head just hanging in space for a split second, mouth open and eyes bugged out?

Well, now you have a mental picture of what Ernie Keebler looked like when the chunky corpse reached out and grabbed his hand. His eyes stayed fixed on me, and his mouth tried to form words, but no sound came out. Meanwhile, his torso and legs were already out the door, leaving his head to catch up as if it were on a rubber band.

The Troll let loose with a bloodcurdling scream as her hubby blew past, still two feet off the ground and gaining speed and altitude. Ernie didn’t stop until he was in the back lot of the funeral home, curled up in a fetal position on the grass, moaning “Oh God, you got me…Jesus but you got me good…you bastard, you nearly killed me…“

Ernie appreciated a good joke as much as the rest of us, and he was rolling with laughter as soon as his mind reported that it was me rather than a reanimated corpse. The Troll however, well let’s just say she bore a grudge. Might have something to do with her momentary lapse in bladder control, but then again, she never liked me much anyway. Teasing her about it for the past eight years hasn’t helped the situation much, either:

Pardner: “Hey, you seen the new MasterCard ad?”

AD: “Nope. How does it go?”

Pardner: “Death gray makeup – $16″
“Sneaking into the embalming room – N/C”
“Making The Troll soil her bloomers – PRICELESS”

The Troll still doesn’t talk to me, but Ernie Keebler still chuckles about that night…

But not while his wife is around.

A retread because I’m suffering Blogger’s Block today

It’s hot. I mean hot, like it only gets in Louisiana or equatorial Africa, which, come to think of it, share more similarities than the weather. It’s late July, and the temperature has been hovering near 100 for the past six days, with 93% humidity. There’s nothing like working outside while stewing in your own juices.

We’ve just worked a wreck on North Main Street, a bullshit fender-bender with three victims suffering from acute “Allstate-itis.” There were no apparent injuries, but everyone in one car had a severe case of “The Other Guy Was At Fault” syndrome, as well. It’s a common malady around here.

I’m sitting in the cab of the rig, wondering idly if that smell is coming from me or my partner, when dispatch calls us over the radio.

“Unit One, Dispatch?”

“Unit One, corner of Ben Franklin East and North Main, go ahead.”

Yes, Satan?

“Respond to Consolidated Foods on a Priority One.”

“Unit One rolling.”

BOHICA – Bend Over, Here It Comes Again.

We’ve gone about a half-mile, where North Main turns into State Highway 25 when the radio crackles again. “Unit One, Dispatch. You’re responding to a fall at Consolidated Foods. The patient will be at… stand by…”

Please God, not the rendering plant…

“…at the rendering plant in the back. The gate guard will guide you in.”

Thank you very effin‘ much, Dispatch.

Consolidated Foods is the local poultry processing plant. I worked there for an interminable six months as the plant EMT – endless eight hour shifts of ergonomics lectures, urine drug screens, and dispensing Ben Gay and Motrin to an endless stream of poorly educated, minimum wage workers convinced that they have “Coppertone Syndrome.”

They employ a sizable number of Hispanic workers, so I had to take a crash course in Spanish to work there. Despite all the classes, I still only habla un poco Espanol. Thanks to the ubiquitous signs posted around, I can now say “Caution: Wet Floor” in Redneck Spanish.

Cuidado! Piso mojado!

I have also uttered such knee-slappers as “Does my chest hurt when you breathe?”

*sigh*

The rendering plant is the section where all of the waste products go for processing. You’d be surprised at what they can use from a chicken, besides the meat. The beaks, feet, feathers, and fat are all packaged and processed for sale for one purpose or another. What’s left is then sluiced through a series of drains that all lead to the rendering plant, where they separate it into what can be turned into dog food and what cannot.

What cannot be rendered into dog food is then pumped into tanker trucks and hauled to the incinerator every day. The point is, what makes it into the tankers is well and truly waste. It is the foulest, most Godawful sludge you can possibly imagine, literally not fit for a dog to eat. It is to this section of the plant that the guard directs us.

When we pull around the corner, the smell hits us like a solid wall of funk. The rig immediately starts losing traction, fishtailing a little as Pardner gives it gas. Just ahead is a tanker with the top hatch opened. For a hundred feet in every direction, every surface is covered with an inch of rotten chicken slime. The plant nurse is on the scene, waving us closer. He already has our patient packaged and immobilized.

The nurse, Arrogant Bastard, gives us a report as I unsuccessfully try not to gag. In EMT school, we were taught that puking on your patient is not considered professional. AB attended the same class, but seems to be better at not retching than I am.

“Some asshole left a full tanker here over the weekend. He climbed up on top to make sure the hatch was secure, and it blew. Knocked him about ten feet out into the parking lot. Apparently some gases built up and vented when he broke the seal.”

No shit, really? It’s only been simmering in a metal tank in 100-degree heat for three days. Hope nobody lights a match.

“Thanks,” I croak. “We’ll get it from here.” AB smirks as we load the patient in the rig, gagging the entire time. I always knew he was an asshole. Apparently, his nose doesn’t work either. I’d like some more information from him, but right now a full handoff report takes a distant second to my avoiding doing the Technicolor yawn all over the back of the ambulance.

As soon as we hit the highway, I holler at Pardner to phone in a report. The handset of the phone is in the cab, and under the circumstances, it would take the threat of violence to make him open the divider window and hand the phone to me. Not that the threat would work – Pardner could kick my ass without trying.

I check my patient’s pulse and ask him to move his arms and legs. Everything moves fine.

“You okay, man? Anything hurting?” It’s the best patient interview I can manage between gags.

“How the hell do you think I’m doing, man? I’m covered in rotten chicken shit!”

Okay, dumb question.

“I meant, does anything hurt more than the rest? Any difficulty breathing? Numbness or tingling?” By now, I’ve edged over to the curbside door well, and I’ve got my face pressed to the screen of the sliding window. I’ve got the air filtration system running, and it ain’t helping.

“No, nothing hurts but my head, Goddamnit! Oohh, I think I’m gonna’ puke.”

Join the crowd, buddy. Why didn’t we hose this guy off before we put him in the rig?

I roll him onto his side as he retches. Nothing comes up though, and as the spell passes, I roll him back. Between the smell and the sympathy retch, I can’t hold it any longer. I manage to toss most of my Sonic burger and tater tots into the biohazard bag, but some of it hits the floor. Craving some kind, any kind of relief, I poke my head through the screen on the curbside door and gasp for fresh air. I spend the next minute hanging my head out the window like a poodle, painting the side of the ambulance with the remains of my lunch.

As we pull into the hospital, Pardner is cursing. Nobody is waiting outside for us, despite the fact that he asked for someone to meet us outside with a hose. Podunk General Hospital, Nail Salon and Crawfish Hut doesn’t have a decontamination shower – at least not one that can be set up outside.

Oh well, they’ll regret that mistake in just a minute.

As we roll into the Emergency Department, the nurse’s questions are cut off by her gag. “Okay, what’s the… Jesus Christ! What is that smell?”

She doesn’t wait for an answer, but instead flees into Room One.

Well, can’t say we didn’t warn you, sweetheart.

We follow her into the room and unload the patient. The patient report we give is wasted. Our patient’s nurse is currently heaving in the sink, not paying much attention to us.

Does it constitute abandonment if the nurse was too busy puking to hear your report?

As we leave, we hear footsteps running down the hall. Apparently, reinforcements are on the way.

Join the party, folks! This should be fun to watch.

As we clean our rig, it becomes apparent that the nurses have worked out a system; they are assessing and treating the patient in shifts. Every few minutes, a different one will run out into the ambulance bay, rip off her surgical mask, vomit into the grass and gasp for air.

“I wonder how long it will take them to cut his clothes off and hose him down?” Pardner wonders.

“Who knows?” I shrug. “You warned ‘em. Let them figure it out. Speaking of clothes, we need to change ours.”

The air filtration system has done an admirable job of clearing the smell from the rig, but our clothes still reek. Three hours later, when we bring in a nursing home transfer, the fire department is there with ventilation fans set up in the Emergency Department hallways. It still smells like rotten chicken shit.

Read about the idea here.

Hat tip to Daz’d and Confuzed.

You know folks, Rocky Mountain Medic is a pretty darned good storyteller. If you haven’t visited his blog, drop by and see what you’re missing.

Maybe if we show him enough love, he’ll post more often. *grin*

Med School Professor: “Okay, if it looks like a duck, walks like a duck and quacks like a duck, what is it?”

Medical Student #1: (with absolute certainty) “Duck-billed platypus.”

Medical Student #2: (with a smug, intellectually superior air) “One might be tempted to call it a duck, but my experience tells me it’s most likely an Andean condor with aberrant conduction.”

Med School Professor: “You boys are going to be good cardiologists one day.”

It was a beautiful Saturday at Bushwood Country Club, but unseasonably hot. The temperature had soared past eighty degrees, making a mid-April afternoon feel more like May. Birds chirped, and a warm Gulf breeze blew gently across the fairway…

“Thwack!” A golf ball flew down the fairway true, with just a little fade. Eminent Cardiologist bent over to pick up his tee and felt a little dizzy.

“Nice shot, Bob,” said Orthopedic Surgeon as he teed up his ball. “Retirement seems to have improved your swing. Your game doesn’t suck nearly as bad as it did when you were still practicing. “

Eminent Cardiologist took a swig from his beer and sat heavily on the golf cart seat. He gave Orthopedic Surgeon the finger, handed his empty to Eldest Son and motioned for another. Damn, it was hot.

Eldest Son was a second year medical student, planning to be a cardiologist just like his old man. Rounding out the foursome was Tax Lawyer, a genial enough sort who was allowed into the group by virtue of his specialty. A personal injury attorney would have been as welcome at Bushwood Country Club as say, this guy:

As it was, Tax Lawyer was only a guest, not a member, and the bastard had even had the poor taste to win a $50 Nassau off him on the front nine.

Asshole probably plays every week, and it’s not like I don’t already pay him enough already. I think I’ll drop an anonymous blackball when he applies for membership.

Eminent Cardiologist waited for Tax Lawyer to take his shot, and the foursome all piled into their carts and took off down the cart path running alongside the fairway. Eldest Son’s driving made his dad feel slightly queasy.

Eminent Cardiologist stepped out of the cart and walked to his ball, his legs slightly rubbery. He addressed his ball, swung, and hit a sweet 2-iron to the right front edge of the green, soft as butter. The swing felt good, despite the feeling of vertigo he experienced with his follow through. He surreptitiously checked his radial pulse as he stood with his back to the others.

“Eighty beats a minute. Right where I should be. So why am I so damned woozy? I only had a few beers. Maybe it’s the heat.”

Eminent Cardiologist bent over to replace his divot, things went kind of gray…

…and he did a face plant, right there in the middle of the fairway. He awoke several minutes later, surrounded by the rest of his foursome and a concerned and rather obsequious course steward.

“Sir? Sir?? Are you unwell?” The steward, an exquisitely groomed young man named Randy, asked from nearby. He held a cell phone clutched in one trembling hand, the other fluttering over his chest like he’d just gotten a case of the vaypahs.

“I’m all right,” groaned Eminent Cardiologist. “Don’t nobody worry about me.” He struggled to sit up, and nearly passed out again. He rolled to his right and vomited in the grass. Randy, his blemish-free nose wrinkled in disgust, barely stifled a sympathy spew.

“Stay where you are, Bob,” Orthopedic Surgeon said gravely. “I’ve called for an ambulance. You were out for a couple of minutes.”

“Yeah Dad, don’t push it,” urged Eldest Son worriedly, as Orthopedic Surgeon checked his father’s pulse. Eminent Cardiologist would have none of it, however.

“Goddamnit Don, help me up!” he growled in an “I Will Be Obeyed” tone to Orthopedic Surgeon, who grudgingly complied. “And I’m not going anywhere in a Goddamned ambulance. I’m fine, I tell you!” His statement was belied by the pallor of his skin and the fact that he leaned far too heavily on Orthopedic Surgeon as he walked him back to his cart. He could barely stand upright.

“Don’t be a horse’s ass,” Orthopedic Surgeon retorted. “You had a syncopal episode, and you have a cardiac history. You can’t ignore that.”

“Dad, are you having chest pain?” Eldest Son pressed. “Palpitations? Any difficulty breathing or…” his voice trailed off as Eminent Cardiologist fixed him with a withering stare.

“Perhaps you should actually see a real patient in school before you try taking a history from me,” he suggested, his voice dripping with sarcasm. He turned to Orthopedic Surgeon. “Really, I’m fine, Don,” he reassured him. “I just got a little overheated, that’s all.”

“The ambulance is just a minute away,” Randy informed them breathlessly, cell phone pressed to his ear. Tax Lawyer fetched another beer from the cooler and enjoyed the show. As if on cue, an ambulance siren wailed, drawing ever closer.

“Oh my goodness!” Randy cried, mortified. “That ambulance person is going to drive that monstrous vehicle right out onto the fairway!” With that, he ran toward our ambulance, frantically gesticulating and waving his arms.

“Check this guy out,” Farting Partner grunts in amusement. “He looks like he’s gonna have a conniption fit.”

“I think he wants us to stay on the cart path,” I chuckle. “Perhaps we should do as he says. If he gets any more excited, we’ll be reviving him with smelling salts and Evian.”

“Is he doing the YMCA, or is he waving directions? I can’t tell,” FP wondered. Shaking his head, he pulled down the cart path as directed.

“Either he’s Vogueing, or he wants us to park it right here,” I guess. “This guy could be a flight deck crew chief on the USS Androgyny.” The wheels of the rig had straddled the cart path perfectly, leaving deep ruts in the grass on either side.

No charge for the new hazard, folks. Bushwood Country Club’s course will now play one stroke tougher, courtesy of Podunk Ambulance.

We got out of the rig and strolled up to the foursome. “The ambulance drivers are here,” Tax Lawyer announced, stating the obvious.

I wonder how he knew my name?

“Howdy folks,” I greeted them cheerfully. “My name is Ambulance Driver, and this fellow is my partner, FP. What seems to be the problem?” I address the last question to the elderly fellow in the really ugly Madras plaid pants and a wet towel over his head.

“He experienced a syncopal episode about five minutes ago, lasting roughly two minutes,” Orthopedic Surgeon stated authoritatively. “His pulse was thready a
nd weak, about eighty beats a minute. You need to load him right away and take him directly to – “

“Directly to the Goddamned green and let me putt out,” interrupted Eminent Cardiologist. “I told you I’m fine!” Tax Lawyer tried to stifle his look of relief. He stood to win another $100 if Eminent Cardiologist finished the round.

“Why don’t you tell me what happened,” I suggest gently as FP wrapped a blood pressure cuff around the man’s arm. I look closer at the man. “Have we met before? You look familiar.”

“I’m a retired physician. I used to be Chief of Staff at Big City Memorial Medical Center.”

“Aahhhh, so that’s where I’ve seen you. I recognize you from your portrait in the lobby.”

“Then you know I’ve been a practicing physician for over thirty years, and I’m telling you this is unnecessary.”

“So why don’t you just humor me by answering a few questions while my partner gets your vital signs, and we’ll let you get back to the serious business of whacking a little white ball with a weighted stick all afternoon. After all, it’s not like we’re talking about anything serious, like your health,” I say innocently.

His head snaps up and he glares at me. Eldest Son and Orthopedic Surgeon chuckle. I wink.

“Fine,” he sighs, holding out his arm. “Do what you need to do. My blood pressure will be 134/70. My heart rate will be eighty. I’m allergic to penicillin. I have an implanted pacemaker, placed by one of the many cardiologists I’ve recruited and brought to this city. The procedure was done in the chest pain center I founded at Big City Memorial, the center I ran until just four years ago, back when you were learning CPR for the first time and learning how to drive that ambu – “

“I’m sorry,” I interrupt. “Could you spell ‘CPR’ for me one more time? You’re talking kind of fast and I’m trying to write all this down. Try to use small words, please.” He glared at me for a moment, then chuckled.

“I’m being patronizing, aren’t I?”

“Horse’s ass is more like it,” opined Orthopedic Surgeon. “Let the kid do his job, Bob.” Eldest Son and Tax Lawyer nodded in agreement.

“He’s the best man around if you need a new hip or knee, but he has no people skills,” Eminent Cardiologist nods toward Orthopedic Surgeon. “He’s a Harvard man, and you can always tell a Harvard man…”

“…but you can’t tell him much.” I finish, with an evil grin. Tax Lawyer and Eldest Son laugh appreciatively. “Well, let’s get some orthostatic vital signs and we’ll be done,” I suggest. “Just take my hand and I’ll ease you to your feet…”

…and Eminent Cardiologist’s knees buckle almost immediately. I catch him and ease him back to a sitting position and give FP The Look. He immediately drops the BP cuff and heads to the rig for the stretcher.

“Well, that answers that question,” I say wryly. “Look, you may be dehydrated and suffering heat exhaustion, or it may be something more serious. Either way, I’m not going to get into a pissing contest with you. You will get on that stretcher, and you will go to the hospital and be a good patient,” I tell him in my own “I Will Be Obeyed” tone. To his credit, he caves.

FP and I bodily place him on the stretcher and wheel him to the rig. Eldest Son walks alongside the stretcher. “Dad, I’ll be right behind you, okay? And I’ll call Mom to – “

“You will not call your mother!” Eminent Cardiologist snaps, “and don’t follow right behind the ambulance. Just meet us there, understand?”

“Hey, that’s my line!” Farting Partner says in mock protest. Everyone chuckles as we load the stretcher in the rig and I climb in behind it. FP turns the rig around and eases back towards the clubhouse, and I busy myself applying oxygen, turning up the air conditioning and setting up an IV line. Eminent Cardiologist grimaces in irritation as I place the nasal prongs in his nostrils.

“And another thing,” he announces defiantly, “I’m going straight home from the ER. I will not be admitted to the damned hospital.” He looks at me as if I’m going to challenge him.

“Are you sure you didn’t go to Harvard?” I ask, choosing not to reply directly. He chuckles and relaxes visibly. I notice a squarish lump below his left collarbone as I attach the cardiac monitor leads.

“Pacemaker,” he grunts, “so that’s all your gonna see on your little monitor there, son. Don’t even waste your time.”

“Single chamber, dual chamber or biventricular?” I ask with a grin. He cocks one eyebrow and looks at me appraisingly.

“Single chamber ventricular pacemaker,” he tells me. “Technology has come a long way since I got this one. I’m getting a new rate-responsive, dual chamber pacer soon.” I look at the monitor screen to see the characteristic wide complex beats of a ventricular pacemaker, rock steady at eighty beats a minute.

“Soooo, where did you go to paramedic school?” he asks curiously. “And how long have you been a paramedic?”

“I went to the Close Cover Before Striking Paramedic School at the local technical college, just over three years ago. I drew a stethoscope on a matchbook cover, and they said ‘You too can become a paramedic!’ so I gave it a shot. It pays the bills.”

“Not well enough,” he snorts. “Ever thought about becoming a doctor? You seem pretty intelligent, for a paramedic.”

“And you seem pretty humble, for a cardiologist,” I retort as I wrap a tourniquet around his arm. “I was in pre-med in college. Biology major, actually. I fought many a hard round with calculus and physics. They won by split decision. So, I decided to continue dragging my knuckles on the carpet until I could afford to go back to school.”

“Look, I didn’t mean to sound condescending,” he says apologetically. “I was just trying to say -”

“No offense taken,” I brush it off. “It is kind of dumb to piss off the paramedic when he has a big needle in his hand, though. How did you make it through med school?”

He laughs nervously as I hunt for a suitable vein. “Hard work and a lot of sweat. I wasn’t a gifted student, that’s for sure. I was too stubborn to quit.” He looks a little apprehensive, eyes fixed on the IV catheter I’m holding. “Uh, look…my veins are really tough to hit. Why don’t we just wait until I get to the ER?”

“Relax, Doc. People can’t find veins because they just try too hard. You have to relax… feel the flow…feel the vein…be the vein…” I look up at him with an evil grin, close my eyes, and make the stick.

“Nn…nnn…na na na na naaaa…”

Doc was laughing too hard to even notice that I had gotten the line on the first stick. I taped the line down and opened up the fluids, and we giggled like two kids the rest of the way to the ER.

You gotta love a Doc who appreciates Caddyshack…

Fact #1: Jim Zumbo, a hunting writer of high repute and mediocre skill, stepped on his wang the other day and labeled ARs, AKs and their like “terrorist rifles,” and by extension labeled the folks who shoot them as terrorists.

Fact #2: The gun rights blogosphere swarmed like a school of piranhas, and within 48 hours, Zumbo had lost much of his readership, the biggest of his sponsors, perhaps his job, and certainly the respect of many shooters. And rightfully so. Say something stupid and piss off a sizable portion of your employer’s customer base, expect to get fired.

Fact #3: His apology, such as it was, left a little to be desired. Most gun owners were not mollified. Me among them.

Fact #4: There is a healthy debate on the gun blogs I frequent, particularly the lovely Tamara’s about the debacle, and 99% of the comments are anti-Zumbo, off-with-his-head, yay we slew the dragon in our midst stuff. 1% of the comments point out, and rightfully so, that perhaps we might have done better with a more reasoned and circumspect approach. Act not in anger, but with a clear head. Educate, reason, bring the brother back into the fold. Reasonable advice, that.

Fact #5: That 1% of commenters is being pilloried by the other 99% for writing “PC, liberal drivel” and emphatically lumps the dissenters into the “them” crowd, as in “us” the gun owners and RTKBA advocates, versus “them” the gun grabbing zealots.

Fact #6: Now who is being divisive, folks? Righteous anger is one thing. Bug-eyed, fanatical vitriol is another. It does not help our cause. It makes us look like, well…gun nuts, and I mean that in the Brady connotation, not the good one.

And while I’m on the subject of free speech and the right to make stupid comments, when the Dixie Chicks excoriated George Bush at a London concert a few years back, I vowed to quit listening to them, quit buying their records and became a bigger Toby Keith fan than I already was. Pretty much all of America did the same. Virtually their entire fan base labeled them as unpatriotic. They disappeared from the airwaves virtually overnight.

I still don’t buy their records or listen to their music. I stood by my principles. They stood by theirs. They didn’t back down from their statement, in the face of virtual career suicide.

Now several years later, they’re winning awards again. Good for ‘em. I disagree with their politics in just about every single way. They made an unpopular statement, but they had the courage of their convictions, and held to them in the face of overwhelming opposition. They did what they thought was right. They lost my support, but they earned my respect.

You may not agree with them, and neither did I. But it takes balls to do that. One might even say it’s a quintessentially American thing to do so.

Next post, I’ll tell you about the Caddychack Call.

Until next time…

Please indulge me while I pad my hit count before I move on to a boring subject…

Iraq war, naked webcam, big tits, Anna Nicole Smith, Hillary Clinton, Barak Obama, yada yada yada…

There now. Those should help keep the sitemeter happy while I induce general anesthesia among my non-EMT readers. This post is generally intended for the medical folks, but by all means, stick around if you have an inquisitive nature.

Mechanism of Injury is the dry medical prose that we EMS folks use to describe how someone sustained their injury.

And no, “Acute Gravity Attack” does not count.

EMTs have the concept of MOI drilled into their heads from the first day of the trauma module when we are introduced to the concept that being struck by a cement mixer at seventy miles an hour might…gasp…break bones. Truly, what a revelation.

Now, I will admit that understanding mechanism of injury does make one a more discerning evaluator of woochies and whoomp knots than your average rubbernecker. Someone without a working knowledge of the kinematics of trauma is far more easy to impress than a seasoned medic.

Bystander Boy: “Holy crap! I heard this real loud BOOM, and saw all this smoke coming from under the hood, and the car was just demolished! I drug him from the car because I was afraid it was going to burst into flames! He’s lucky to be alive!”

Medic: Hmmm, excellent example of the wonders of crumple zone technology. No axle displacement that I can see. And the windshield is broken, but appears to be bulged inward, probably from the crumpled hood. No dash intrusion that I can see, either. Seat belt appears to be locked and un-retracted, so he was probably wearing it at the time. Both airbags deployed, but the steering wheel doesn’t appear to be deformed underneath that deflated bag. That fellow standing over there calmly talking to the police officer must be the driver. He certainly looks uninjured.

“Thank you for your heroic efforts, Bystander Boy. If it weren’t for concerned citizens like yourself, my job would be much less…interesting.”

Note the last part of the medic’s mental scene assessment: He certainly looks uninjured.

Never underestimate the diagnostic value of a good Look Test, my EMS brethren.

Somewhere along the way, we have gone from using MOI as an element of a thorough patient assessment to the ridiculous extreme of using the MOI as the assessment. Even worse, we often treat people based solely on MOI, despite the fact that mechanism alone is a piss-poor predictor of actual injuries.

It’s a clue, people. It’s not the investigation itself. And quite often, those clues lead to dead ends. If we’re lucky, the dead end doesn’t negatively impact patient care. More often, the dead end leads us to performing treatments and diagnostic tests that are unnecessary, expensive and in some cases, harmful.

Case in point: A roofer comes in to the ER the other afternoon after falling maybe ten feet to the pavement. He caught himself on his hands and managed to fracture both wrists in the process. He didn’t lose consciousness and he didn’t hurt anywhere besides his wrists. He wasn’t intoxicated (which makes him a pretty unusual roofer, in my opinion). No neck pain with palpation or movement. No numbness or tingling in his extremities. Aside from the deformity and crepitus in both wrists, the physical exam was unremarkable. Unremarkable.

So, a little diagnostic radiation to both wrists would seem to be in order. A simple set of x-rays, maybe some pain relief, splint him up with a soft cast or pre-formed splint and ship him to the orthopedist at Big City Hospital. All very reasonable and prudent.

What wasn’t reasonable and prudent was the order for the skull and cervical spine CT scans, the rigid cervical collar, head immobilizer and spine board – all ordered because the physician trusted MOI more than his own assessment.

For those of you unfamiliar with NEXUS criteria, I’ll give a brief history. The National Emergency X-radiography Utilization Study was designed to develop a set of assessment criteria that accurately identified cervical spine trauma. The assessment criteria in that study have been proven more accurate at identifying and ruling out cervical spine fractures than doing an X-ray. Let me say that again:

The assessment criteria in that study have been proven more accurate at identifying and ruling out cervical spine fractures than doing an X-ray.

The whole purpose of the study was to develop an assessment criteria that helped reduce the number of unnecessary x-rays taken in the Emergency Department.

Didn’t save this fellow a couple of grand in unnecessary tests, though.

We live in the age of diagnostic imaging, and that’s a good thing. But that gee-whiz technical wizardry has its limitations, and it has dulled the assessment skills of a generation of medical providers – from EMTs to neurosurgeons. It’s getting to the point that some people can’t make a damned clinical decision without first worshiping before an altar of digital displays and computer generated images. And I’m not just talking about x-rays and spinal immobilization. Strong clinical assessment skills and a good education trump technology every time, and nowhere is that more true than the austere environment in which EMTs practice.

Right about now, a few of you are thinking, “Well AD, what about significant distracting injuries? This guy had two broken wrists. That’s a significant distraction, right?”

Wrong. A distracting injury is one that distracts the patient from participating in the exam, or distracts you from performing a thorough exam.

Put another way:

Calm young man self-splinting his broken wrists and answering questions = not distracting.

Hysterical man screaming in agony, “Oh my God, my broken leg!!” = just a wee bit distracted.

Just keep in mind that MOI is just one brush stroke. It ain’t t
he whole damned picture.

Here endeth the sermon.

A quote from a favorite ER Doc this evening:

“Personal responsibility? What the hell is that? Nobody is responsible for anything any more. Our entire society has degraded into a bunch of big children, unsupervised and home alone, playing with matches. It’s a perverted Peanuts comic strip – lots of children, and not a damned adult anywhere to be seen.”

Can you tell what kind of night we were having?

I’m going to start my own worker exchange program. I’ve got six malingering, whining, healthcare system abusing, hypochondriac, chemically dependent, Professional Victims of Life that I’ll willingly trade for three hardworking illegal Mexicans who want a shot at the American dream. They can have the jobs that these hunnert percent, by-God Murkins can’t seem to find or hold.

Supplies are limited (but not limited enough). These babies are American made, the finest products of the U.S. welfare system. They’re labor-ready, with nary a dent, ding or callous. You might even call ‘em showroom new. I’ll throw in a cattle prod to motivate ‘em and provide transportation to your city.*

And if you act right now, I’ll throw in six more at no extra cost!

*All trades non-returnable. You buy, you feed. Not for use as breeding stock – all models have been forcibly sterilized. Serious inquiries only. Contact Ambulance Driver at Podunk General Hospital, Nail Salon and Tire Repair. Dissatisfaction guaranteed.

For those of you who don’t know Bryan Bledsoe, he’s an emergency physician from Midlothian, Texas. Aside from being the 800 pound gorilla in the EMS textbook industry, he’s also a former paramedic, internationally known speaker, humorist and creator of the most toxic chili in the known world. He’s also a friend and mentor. He posted this to a discussion list today:

ALBANY, NY-Albany Memorial Hospital cardiologist Dr. Richard Grafton appealed to the Board of Trustees during its monthly meeting Monday to give his unemployed friend, Doug Ferris, a newly available position in the hospital’s internal medicine wing, calling Ferris “a good guy, deep down” and a “hard worker when he wants to be.”

Grafton called his friend, a “fast learner, eager to help out.”

“Doug’s been through some tough times, but I know if the hospital took a chance on him, he’d do great,” said Grafton, 35, shortly after emerging from the meeting. “He’s good with his hands and takes direction real well. If I told him to put a stint in a patient’s clogged artery, he’d do it. No questions asked.”

“He’d be fine, I swear,” Grafton repeated.

Ferris, 34, who attended Syracuse University with Grafton in the early 1990s and graduated with a bachelor’s degree in communications in 1999, was reportedly laid off two weeks ago from his job as a TelePrompTer operator at the local CBS affiliate, WRGB-TV 6. Grafton said that attempting to get Ferris “doctor work” was “the least [he] could do” for his longtime friend.

According to Grafton, when he learned that Dr. Ron Clarke, a general practitioner with 25 years experience, would be vacating the position to chair the SUNY-Albany medical school, he immediately thought of the newly jobless Ferris.

“He’d be doing very basic medical procedures,” Grafton said. “Like asking patients if they smoke, and if they do, telling them to quit. Eighty percent of being a doctor is knowing where the lymph nodes are anyhow.”

Although Ferris’ experience is limited to first-aid and CPR training received when he worked as a lifeguard 18 years ago, he said he would gladly accept any job that gives him the ability to pay his bills. And, he added, the chance to reunite with an old friend was “a definite plus.”

“It’s gonna be great to work with Graffy again,” said Ferris, who, if he gets the position, would earn just over $250,000, approximately $220,000 more than he made previously. “It’ll be just like the summer of ’93 when we barbacked at Bullfrog’s [Bar & Grill].”

While Ferris said he planned to skim through borrowed copies of Gray’s Anatomy and the Physicians’ Desk Reference if hired, he believes direct, hands-on experience with such doctor activities as prescribing drugs and performing Caesarean sections would ultimately be the best teaching tool.

“I’ve always been one of those learning-by-doing types,” Ferris said. “Graffy told me that if you can put together a sound system without a manual like I can, you can pick up bone-setting. And if I ever get confused, I’ll just go get one of the nurses.”

Despite concerns about Ferris’ lack of qualifications, most notably from Senior Administrator Theresa Bove and Chief Resident Dr. Alfred Jacobs, Grafton insisted Albany Memorial had “nothing to lose” by hiring Ferris. He assured the board that he would take full responsibility in the “highly unlikely event” that something goes wrong,

“What’s the worst that can happen?” Grafton said. “I’m not trying to get him a job doing complicated thoracic surgery-just normal, everyday doctor stuff. Doug’s not here to ruffle any feathers. The man just wants a job.”

“Plus, Doug could be a real breath of fresh air around here,” Grafton continued. “We already have plenty of doctor types on staff, and frankly, it can get a little stuffy. He’s really funny once you get his sense of humor.”Should the board deny his request to hire Ferris, Grafton said he will contact their mutual friend, US Airways pilot Capt. Joshua Weldon, who might be able to connect Ferris with a “sweet gig” operating commuter flights between New York and Washington, D.C.

Did I mention Bledsoe is just a little twisted?

Update: As Rory pointed out, that story turned out to be something Dr. Bledsoe forwarded from The Onion. Give me a few days, and I’ll post some gen-yoo-wine Bledsoe and you can see why I figured that was his original work.

Hammer has a meme on his blog discussing cars we once owned and wished we had never parted with.

Since he was kind enough not to tag anyone, and since there is a funny story that goes with this truck, I shall voluntarily regale you with said story.

Back in the early nineties, I was training retrievers for a living and drove a 1984 Ford Ranger 4×4. I bought it used from a fellow pro trainer when he upgraded his truck. The rig was a two-tone, tan and brown flatbed Ranger with a ten hole, aluminum dog box bolted on the back.

The rig had been built for shipment to upstate New Yawk, where apparently air-conditioning was still an option and not standard. Driving it in Louisiana was an extended exercise of stewing in your own juices. After a long summer drive I’d emerge from the rig with meat falling off the bone.

But it was rugged, and it was dependable. I put a hundred thousand miles on it before I even added an air conditioner. It had over two hundred thousand on the original engine when I closed my kennels for good, and still it ran like a top.

So when I embarked upon my career of Saving Lives and Stamping Out Disease, I sold the dog box and kept the rig. When I parted company for the first time with Podunk Ambulance, I moved to south Louisiana with all my worldly possessions strapped to the flatbed, ala the Beverly Hillbillies.

I had my clothes in Hefty bags, a few milk crates full of books, some pots and pans, a full-sized bed left to me by a former patient, a rickety entertainment center, and an old leather recliner with matching ottoman.

And strapped in that recliner was this fellow, sans clothing and accessories:
He was part of my severance package with Podunk Ambulance. I thought I was owed one figure in back pay, and they countered with another, much lower figure. So, amidst heated negotiations and threats to call lawyers, we arrived at an amicable cash settlement with the manikin thrown in for good measure.

So it’s 1:00 am and I’m driving through central Louisiana with this naked, lifelike manikin tied to a chair, in the middle of a driving rainstorm, when I notice that a corner of the tarp covering my belongings has worked its way loose.

So I slow down, hoping vainly that the rest of the thing wouldn’t come undone, and start looking for some place to pull over. Before I could do that, I pick up a tailgater.

He’s close enough that I can only pick out the glow of his headlights in my side mirrors, and I can’t see him in my rearview because of the huge mound of junk in the back. Immediately, I had him pegged for a cop.

What in Hades is this? I’m not speeding, I’m not weaving, everything on the truck is legal. So why is he following me?

After a few miles, I start having my doubts that it actually is a cop.

A cop would have pulled me over by now. A cop wouldn’t be so reckless as to follow me this close.

So I speed up, taking care to stay below the limit. I slow down. I tap the brakes. And still this guy rides my bumper. Finally, I notice another car approaching from the opposite direction. As he gets closer, I see that he’s a Sheriff’s Deputy from that particular parish. After he passes me, he lights up his cruiser and whips it around.

Finally! Now he’ll get this asshole off my tail. Thank God for the Po-leece when you need ‘em.

So he pulls up behind me and my tailgater and follows us for a bit, and then he whips out and goes around me…

and then pulls abreast of me, crowding in until I give up and stop in the emergency lane. About this time the cruiser behind me (yep, it was a cop after all) lights up and gets on the PA speaker.

“Out of the truck NOW!”

*sigh*

Thus begins my introduction to that quaint euphemism, the “felony traffic stop.”

Do you know how difficult it is to open your door and exit a vehicle while keeping your hands in sight? It requires rolling down the damned window and opening the thing from the outside, which only served to soak me to the bone before I even got out of the truck. Even better, the seat was soaked, so I didn’t even have the promise of driving in dry comfort once I had changed clothes.

That is of course, presuming I stayed out of jail or successfully avoided being perforated at my first sudden move. Add to this the fact that I was performing this door-opening exercise with my eyes screwed shut against the glare of the spotlight on my windshield, helpfully pointed by the Nice Deputy in front of me.

So, I assume a prone position on the pavement at the rear of the truck at the direction of the officer behind me. I believe his exact words were, “On the ground, asshole! Face on the ground and arms spread out!”

Rather than looking around for the asshole, I correctly assumed that Barney was addressing me, so I promptly complied with the request.

*sigh* Someone has seen too many episodes of Cops.

While making kissy faces to the pavement, a pair of Rocky tactical boots appeared in my peripheral vision, just ahead of me and to the right. I felt the other guy grab my wrists and handcuff me. Where their weapons were pointed at the time, my vision couldn’t tell, but I’d hazard a guess that they were trained somewhere in the middle of my sizeable thorax.

Once cuffed, I figured they’d let me stand up or at least kneel. But nooooo, they left me prone on the pavement, rapidly assuming ambient temperature in the driving rain. But hey, the urine warmed me considerably. The Rocky boots in front of me moved over between me and the truck bed and I heard the tarp being thrown back…

“Sheeeeeeit,” muttered the Rocky boots in utter disgust. “You dumbass. ‘Dead body’ you said. ‘Need backup’ you said. In the middle of an effin’ monsoon, no less. Do me a favor – don’t call me again tonight.” The boots stomped back to the cruiser from whence they came and drove away. I never even got to see what the deputy looked like.

The local cop who had initiated the stop hauled me to my feet and briefly interrogated me before removing the cuffs and sending me on my way. I don’t know whether the interview was so short because of his embarassment or the frigid rain pelting us, but I was back in the truck five minutes later. He even apologized for the misunderstanding and helped me tie the tarp back down.

Last year, the same cop pulled me over for speeding. He had me cold at 10 mph over the limit. He didn’t recognize me at first, but when I reminded him of that night nearly ten years a
go, he looked at me blankly, started to chuckle and handed me back my license.

“I suppose I owe you this one, son. Now git.”

And git I did, you can believe that.

“Freedom is never more than one generation away from extinction. We didn’t pass it to our children in the bloodstream. It must be fought for, protected and handed on for them to do the same, or one day we will spend our sunset years telling our children and our children’s children what it was once like in the United States when men were free.” – Ronald Reagan

They didn’t call him The Great Communicator for nothing.

I could only wish that one day my prose could attain such elegance and resonance, but it’ll never happen. I’ll have to settle for whimsy leavened with smartass.

For other examples of how great men seem to be able to distill lofty ideas into a few eloquent words, visit Steve’s Nude Memphis Blog.

One of my Dear Readers (I call ‘em Dear Readers in an effort not to sound too derivative of the LawDog) has asked for my help in an essay she is writing.

It seems that Melissa is aiming for the Public Safety Career Trifecta – she is already an EMT and firefighter, and now she wants to be a cop. Here’s wishing her luck in that endeavor. You could do worse than follow the same career path as the LawDog.

Now normally I’d refuse to do her research for her, but being as how her request is more in the nature of an interview than a request for plagiarism by proxy, so I decided the least I could do is answer her question, which is the main topic of her essay:

“What similarities do you see in EMS and law enforcement? What commonalities do they share as far as duties, public perception, pay and the like?”

I was going to reply to my Dear Reader in a private e-mail, but then I thought that the rest of my readers may have some salient comments to add. A number of the folks who drop by the blog have experience as both EMT and LEO. Mr Fixit is a Dallas firefighter and paramedic. Matt G. has done his share of first response in his capacity as a LEO. The LawDog has already completed the career trifecta. DW knows how to put wet stuff on hot stuff, dry stuff on red sticky stuff, plus he’s a glow worm too. A good friend from Boston is a long-time paramedic and reserve police officer, and hopefully he will weigh in with his comments. All of them, and others, may have some valuable perspective to add.

Remember, if you steal ideas from one person, they call it plagiarism. If you steal from many, it’s called research.

Making a comparison between law enforcement and EMS requires that first EMS needs to be defined, and that is a thorny task indeed. Those of us in EMS cannot often agree on exactly what we are. The best definition I can provide is that EMS is a unique blend of public safety and health care. It is neither fish nor fowl nor good red meat. And the taste varies from city to city.

As for my answer to your question, I see a number of similarities between law enforcement and EMS. In fact EMS may share more commonalities with law enforcement than with firefighting, despite the fact that a great many fire departments provide EMS.

In EMS systems that practice Systems Status Management (or as I like to call it, Systemic SadoMasochism), the medic unit is not tied to a fixed location. Rather they tend to be fluidly deployed, in areas of anticipated high call volumes. In this way, we are far more like cops than firefighters, who typically spend their time between calls at a fixed location like a fire station. EMTs and cops may spend the vast majority of their shift sitting in their units on a street corner somewhere, or driving back and forth.

In many systems, EMS uniforms are very similar to what cops wear. I am uncomfortable wearing such. I prefer to be distinct from the police in manner and dress, no matter how closely I may identify with them in general attitude and worldview. Being distinct from cops affords me the opportunity to portray myself as a neutral. Many of the patients I have to deal with distrust the police, either from good reason (because they are thugs, and the enemy of a thug is the man who would stop the thuggery), or because they have been societally conditioned to do so. Many of the law abiding distrust the police as well, for reasons mostly imagined but magnified by the actions of a tiny fraction of cops. One bad apple can waft its stench over the entire barrel. I want to look different from cops. Hell, at some places I’ve worked, I wanted to look different from my own co-workers.

One way I see a kinship between cops and EMTs is in their dealing with the public. In many cases, we would not willingly associate with the vast majority of people we see in our shifts, yet we must gain their trust and extract some good information from them. Cops already work at a disadvantage because often their relationship with their interview subject is adversarial by its very nature. In my job as an EMT, I often use this to my advantage:

“Hey Bro, I ain’t the effin‘ po-leece. You can trust me. So tell me what I need to know.”

My friend Gary summed up our differences and our similarities rather nicely:

A good EMT or medic is a lot like a good detective. Not the dopey ones you see on TV, but real ones. Unlike TV, real interrogations are actually interviews. In both professions we are trying to get people to tell us intimate or even embarrassing things about themselves. We have a slight advantage in that we are usually not in an adversarial relationship. We truly do want the information so we can help the patient.

AD has a very easy manner and people will open up to him. Same with good detectives.

As important as a medic or EMTs medical skills may be, their people skills might even be more so.

Fire departments have a very well-defined command hierarchy, as does law enforcement. EMS (as practiced outside of fire departments, anyway) typically does not have as rigid a command structure – a fact which has both advantages and disadvantages.

In the environment in which cops and EMTs practice, individual judgement, personal initiative, and creative problem solving are at a premium. Not so with fire suppression. I’m not saying firefighters aren’t capable of independent thought, but there is little place for improvisation on the fireground. On an EMS call however, improvisation is necessary more often than not. I know of a number of instances in some of the more dysfunctional fire departments where a paramedic’s treatment decision was overridden by a higher ranking firefighter with far less medical training. I don’t need to elaborate on the stupidity of such acts, nor will I paint all fire departments with the same brush. But it happens.

Now, I’m not saying that the presence of a Stuporvisor doesn’t occasionally muddle things in law enforcement and EMS, but most of the
time, they are not present at the scene, so the EMT and the cop practice with a fair degree of autonomy. Not so with firefighters. Of course, your mileage may vary.

Well Melissa, hopefully that will get you started. Not much in the way of substance here, but it should give you the germ of an idea or two. Hopefully, the rest of my readers will weigh in on the subject with their comments.

Anyone? Anyone? Bueller?

Tough IV sticks would be so much easier if you had your own cheering section and a good color commentator, don’t you think?

“What an incredible Cinderella story! This unknown, comes out of Podunk, LA, to lead the pack…at Augusta. He’s on the right arm, this dude’s got some tough veins there…He’s about four inches away, he’s gonna stick about a 14 gauge I think. [sticks, produces a world class hematoma] Oh, he got all of that! The crowd is standing on its feet here at Augusta. The normally reserved crowd is going wild… [pauses] for this young Cinderella Paramedic who’s come out of nowhere. He’s got about two veins left to shoot for, he’s going to stick about about a 16 gauge it looks like, don’t you think? He’s got a beautiful technique… [sticks, catheter won't advance] That’s- Oh, he got all of that one! He’s gotta be pleased with that! The crowd is just on its feet here. He’s a Cinderella medic. Tears in his eyes, I guess, as he lines up this last shot. He’s got about an inch left, it’s a twisty little vein, and he’s got a, looks like he’s got about an 18 gauge. This crowd has gone deadly silent… Cinderella Paramedic story, out of nowhere, former dog trainer, now, about to become the IV Access Champion. [sticks, gets flashback, catheter advances] It looks like a mirac- It’s in the vein! It’s in the vein!”

One day soon, I’ll tell you about my Caddyshack Call.

A story from back in the day…

They say that the measure of a man’s intelligence is the degree to which he agrees with you. By that standard, Medical Director and I now regard each other as certified geniuses. Not that we interact a great deal in the clinical environment; being a lowly EMT Basic, I simply drop off my patients at the hospital, bow respectfully, and back slowly out of his presence.

But today is a different story. Today the all-powerful physician and the lowly EMT are on an even footing, because when it comes to Trivial Pursuit, I bow to no man. I am the “King of Obscure and Arcane Facts.” , and Medical Director, if not my equal, is at least good enough to sit at my right hand. We have been paired off as partners in a game of Trivial Pursuit, and we are spanking some serious ass. We are humiliating people. For six games straight now, we have run the board, winning with nary a question missed. For the past two games, it’s been everybody versus us.

We’re hanging out at the ambulance station, celebrating Podunk Ambulance’s third month of business, and things are looking good. Call volume is increasing, we’ve upgraded our capabilities, and rumor has it that we’ll even be getting paychecks any day now. Life is sweet. Since I’ve been getting paid in promises, I’ve moved into the Podunk station to save money. The only drawback to living in the station is that I am perpetually on duty. Every morning, I wake up and stumble to The Boss’ office and knock on the door.

“Am I on duty today?” I’ll ask, and wait patiently as Boss becomes lost in thought, shuffling through the duty roster he keeps in his head.

“Yep,” he invariably says. “We can use you.” I will then obediently trudge to the bathroom, shower and put on a jumpsuit, but I don’t mind. This stuff is so fun, I’d do it for free.

Well actually, I am doing it for free right now.

The emergency line rings, interrupting our game and sparing the rest of the crew further humiliation from at the hands of my M.D. partner and myself.

“Cardiac arrest at 137 Owl Creek Road,” Boss calls. “Let’s go.” I am Boss’ partner today. After two months spent as the attendant on most of our calls, our upgrade to EMT-Intermediate service has seen me demoted back to driver. I don’t like it; I start paramedic school in two months, and I need the patient care experience.

“I think I’ll ride with you on this one,” Medical Director muses as we get up from the table.

Oh shit, just what I needed.

I say nothing, just sprint to the rig with Medical Director in tow. On the way to the call, I can hear him curse softly from the back as I make a few hard turns.

“Hang on, Doc!” I call unnecessarily. “Rough road ahead!” In the rearview mirror, I can see him hanging onto the overhead bar for dear life. “Why don’t you toss the suction, the jump bag and the AED on the stretcher?” I call back to him, adding, “and spike a bag of saline, too!” Boss looks over at me and grins, shaking his head.

At the house, there is a woman doing CPR on a fifty-ish man lying on the living room floor. Several other relatives are standing around sobbing quietly, and a hyperactive little Chihuahua is bouncing from the couch to the chair to the floor, yapping excitedly. The woman doing CPR is crying as she goes about doing chest compressions and ventilations. There is snot running from her nose, which she absently wipes away as Boss places the AED on the floor next to the man.
“Ma’am,” he asks gently, “what happened?” The woman doesn’t answer, just stares vacantly and cries, wiping her nose with her sleeve. There is a smear of bloody vomit on her lip. Delicately, I move her to one side and hand her off to Medical Director, who is standing around looking lost.

“Hey Doc,” I suggest, “why don’t you find out what happened, and have someone gather up his medications? Hand me the suction before you go.” Medical Director hurriedly hands me the suction unit and escorts the woman into the other room, talking quietly to her. The Chihuaha snaps at my hand as I suction the vomitus from the man’s mouth and Boss attaches the AED pads. I swat impatiently at the dog, who returns the favor by snapping at my fingers again and growling ferociously.

“Uh, can one of you corral the dog?” I ask pointedly at the group of relatives standing nearby. A young woman, perhaps the victim’s daughter, snaps out of her reverie.

“Sweetie! Stop that! Stop it this instant!” she scolds, snapping her fingers. “He’s really a sweet puppy,” she apologizes.

Sure he is, lady. Why is it that every psychotic little ankle-biter has a name like Sweetie or Sugarpuss, instead of something that fits, like Tasmanian Devil or Charles Manson?

For his part, Sweetie ignores her, jumping from the couch to his master’s chest and back. Irritated, I bat the dog off the man’s chest as I begin chest compressions. I hit him a little harder than I intended, sending him somersaulting across the rug all the way to the fireplace. Sweetie bounces back up like nothing happened, and contents himself with jumping back and forth from the couch to my back, nipping at my hair and shirt collar with each circuit.

“Sweetie!” the woman cries, anguished. “Please leave the nice man alone!” I ignore them both, moving up to the man’s head to ventilate as Boss presses the ANALYZE button on the AED.
“Shock indicated!” the AED announces.

“Everybody clear!” Boss shouts, looking at the AED and pressing the SHOCK button… …just as Sweetie completes another pinball circuit, landing squarely on his master’s chest, right between the AED pads.

“POP!” goes the AED, accompanied by an agonized yelp and the stench of burning dog hair. Sweetie ricochets across the couch and retreats for safer parts, yelping piteously all the while.

“What was that?” Boss asks, turning back to the patient with a frightened expression.

“If the dog wasn’t in v-fib, he probably is now,” I comment dryly. “Apparently, ‘clear’ is not a command in his vocabulary.”

The AED interrupts any further conversation by reminding us in its telephone-operator voice that the patient is still in v-fib, and one of us should press the SHOCK button. Boss just shakes his head wonderingly and, looking at the patient this time, presses the button again.

“Kachunk!” the defibrillator discharges, causing the man to arch his back in a prolonged spasm. Within a few moments,
the man coughs and starts breathing raggedly. Boss and I share a triumphant look.

“No shock advised,” the AED tells us unnecessarily. “It is safe to touch the patient. Check breathing. Check pulse. If no pulse…”

There is no need to check breathing or pulse, or begin CPR as the AED politely suggests. Dead people do not vomit and roll their eyes wildly. I quickly stick the suction catheter in his mouth to clear his airway. Soon, the man is breathing better, but still coughing and retching. I switch the oxygen tank to a non-rebreather mask and place it over his face.

“What happened to the dog?” Medical Director asks as he escorts the patient’s wife back into the room. “He came through here like his tail was on fire or something…” he trails off as he sees our patient.

“Ma’am?” he nudges the woman, who looks up, startled. He just smiles, gesturing toward her husband. She gasps and kneels at his side, sobbing again, but in a different way than before. The man says nothing, just closes his eyes and squeezes her hand as he coughs and sucks deep, shuddering breaths of pure oxygen. I take a little time gathering up our equipment. The woman continues holding her husband’s hand all the way to the ambulance, disengaging only briefly as we load him on the stretcher.

Since Medical Director is with us, Boss lets me ride in the back on the way to the hospital. MD has a bit of trouble getting an IV. “Goddamn! Can you ask Boss to take it easy for the next couple of minutes?” he asks, frustrated. There is sweat dripping from his nose as he makes his second stick at a vein.

“He is taking it easy,” I tell him. The ambulance is barely moving forty miles an hour, and I can see Boss’ eyes in the rearview mirror, watching Medical Director as he makes his second, successful attempt. “Besides, we’ll be at the hospital in two minutes.”

Medical Director has his eyes closed, concentrating as he auscultates heart and breath sounds. “Shit,” he mutters disgustedly. “I can barely hear. Lungs sound clear, I guess. He may have a systolic murmur.”

“They call it ‘diesel engine,’ Doc,” I tell him wryly. “Now you know why we palpate so many blood pressures.”

“This machine doesn’t even have a printer or a screen!” MD mutters in frustration. “We need a real cardiac monitor, and some lidocaine, and maybe some dopamine…” he looks around in frustration for a drug box that isn’t there.

“We’re not a paramedic service yet,” I remind him. “But the AED does have some interesting features. For instance, it has a voice recorder that activates when you turn the unit on. Where do you think we get the tapes you review?”

“You mean that…” Medical Director asks, looking suspiciously at the AED. “Yep,” I confirm with an evil grin, “everything is recorded for posterity, including Sweetie’s electrocution.”

“Good Lord,” he breathes. “Well, at least no one will hear it but me.”

“Well, we could make copies of the tapes before you get them,” I muse. “Purely for record keeping purposes of course.”

“You do that,” he threatens with a grin, “and I’ll withdraw my recommendation for paramedic school.”

Until next time…

A little Chicken Soup for Holly the Goddess‘ mood…

The highway between Podunk and Hooterville can be a lonely stretch of road, and a dangerous one. The steep shoulders there have already claimed the life of one Podunk Ambulance EMT, and I’d rather not become number two. The road here is in a perpetual state of construction, the work progressing at a glacial pace. One day they will invent a way to make a shovel stand up by itself, and half of every Louisiana Highway Department road crew will become obsolete.

“You know those guys make eighteen dollars an hour?” Rookie Partner asks, pointing at the flagman as we pass a long line of stalled traffic. “All they have to do is talk on a radio and turn that sign around every few minutes.” She shakes her head.

“Who makes eighteen dollars an hour?” Paramedic Student wants to know, hollering from the captain’s chair in the back.

“I do!” I shout back at him. “Why do you think I come to work every day to baby sit paramedic students and rookie EMTs?” PS just grins and shakes his head. He only has a few shifts left to do to complete his paramedic clinical time, and he has elected to spend a week in Podunk, riding with me. The Missus and I have decided to move back up here, and I’ve spent the last week house hunting between calls.

“Who’s a rookie EMT?” RP asks indignantly. “I’m no rookie!”

“Okay, how many things do you have on your belt?” I ask, rolling my eyes. She immediately blushes a deep shade of red. “Here, let me count them for you,” I say with an evil grin, gleefully cataloguing everything she is wearing. “That’s quite an impressive display of doodads and paramedals you have there. I see a holster with a pair of trauma shears, a penlight and a window punch. You have a radio, a cell phone, a glove pouch and a pager. Here’s a stork pin, one-year service pin, CPR pin, National Registry EMT pin, and a pair of wings from Priority Air. I didn’t realize you were a flight medic! Let’s see what else…hey PS! What other kind of sparky little accessories do rookies wear?”

“EMT pocket guide,” PS offers helpfully. “Maybe an oxygen cylinder wrench? And don’t forget the seatbelt cutter!”

“How about it, RP?” I tease, knowing she has exactly those items in the thigh pocket of her uniform pants. PS and I laugh in delight at her embarrassment.

“They gave us the wings at the ground crew in-service,” RP says defensively, much to her regret as Paramedic Student and I collapse in peals of laughter.

“Unit Two, Dispatch,” the radio interrupts.

“Go ahead,” RP answers, still blushing furiously.

“Motor vehicle accident, just south of Hooterville on Highway 31. We have a report of a truck in the ditch, unknown injuries.”

“Unit Two en route,” RP confirms as she engages the lights and siren. “That’s just up the road,” she remarks to no one in particular. We pass the roadside cross that marks the spot where JoAnn died. The flowers look faded.

Just south of the Hooterville city limits, we spot the debris trail first. A pair of tire tracks crosses the road, cutting twin swaths though the roadside weeds on the opposite shoulder. Gas cans, trimmers, and assorted lawn care tools are scattered in a narrow swath leading to a Ford Ranger pickup lying overturned in the weeds. A spool of monofilament trimmer line has unrolled, pointing a neon-yellow, gnarled path to the wreck. A teenaged boy is standing outside his car on the shoulder of the road, his cellular phone pressed to his ear. He points frantically to the truck.

Thank you so much, Bystander Boy. We were wondering where the wreck was.

Paramedic Student is the first one out of the rig, barely waiting for the truck to come to a complete stop before he hops out carrying the medic bag. Rookie Partner isn’t far behind. I shake my head, walking around the rig to set the parking brake before I start unloading our gear. PS has reached the point that he’s capable of running calls without my guidance. I want to see if he can function independently.

I grab a spine board, a cervical collar and immobilizer and scramble down the steep bank. PS meets me at the bottom, looking a bit lost. “What have we got?” I ask him. He shakes his head grimly.

“The driver is pinned in the truck,” he tells me, “and she’d probably weigh about three hundred pounds on the hoof. Somehow she’s gotten twisted around, and she’s lying on her stomach with her feet pointing out the passenger window. Her face is all mashed against the roof, and her right arm is pinned between the dash and the ground.”

“Can she say where she’s hurt?” I ask. The roof of the truck is crushed in nearly to the top of the seats. I can see the woman’s legs sticking out of the passenger window, and RP worming her way into the driver’s window.

“She says her arm hurts, and she’s having problems breathing,” he answers. “So what do you want to do?”

“What do you want to do?” I shoot back. He grins.

“I already had RP call the Hooterville Fire Department for extrication. She’s in there trying to assess her now – I’m too big to fit. I figure we get some oxygen and a collar on her right now, and as soon as we can, extricate her out the passenger door.”

“Sounds like a plan,” I agree, “except Hooterville VFD can’t lift the truck. Podunk VFD has high-lift airbags. I’ll call them.”

PS scrambles around to the driver’s side of the truck to speak to RP. I kneel down next to the passenger window and peer inside. I can see nothing but two thick legs leading to a mass of pale flesh protruding from under a uniform shirt of some type. Near the driver’s window, I can see the top of RP’s head as she attempts to place a cervical collar on the woman’s neck.

That ain’t gonna work. This woman is built like a snowman. You’ll never get a collar to fasten around her neck.

The woman’s legs and abdomen, what little I can see of them, look reasonably intact. I reach in as far as I can and palpate as high as her knees.

“What the fuck was that?” the woman screams. Rookie Partner, startled by the woman’s scream, bangs her head against the steering wheel and curses.

“What was what?” RP asks, concerned. Her flashlight beam plays crazily around the cab of the truck.

“Relax, it’s just me,” I call reassuringly. “You need anything over there, RP? There’s no way I can reach her.”

“Some oxygen would be nice,” she calls, “and some 4×4 gauze. She’s got a nasty cut on her head.”
/>“You got it. I’ll have ‘em for you in a second,” I reply as another thought occurs to me. “Hey, how are you reaching her? How far in there can you get?”

“I crawled in on my stomach,” she says matter-of-factly. “I can get my head and shoulders in here, but not much else. Did PS tell you that her arm is -…”

“Yeah, he did,” I answer, cutting her off. “We’ve got Podunk VFD on the way with some high-lift airbags. You get out of there before they start lifting this truck, understand? It’s not safe for you to be wedged in here. Drop whatever you’re doing and get out of the way.” Before she can reply, another flashlight beam appears from the bed of the truck. PS, scuffed and dirty, pokes his head through the rear window.

“Somebody asked for oxygen and bandages?” he asks, grinning.

“How did you fit in there?” I ask incredulously as he passes the oxygen mask across to RP’s outstretched hand.

“There’s a gap right under the side of the bed about two feet to your left. I crawled under.” I shake my head in wonder and resignation.

Both of you are a little too sparky for your own good. But I was just as foolish once.

“Okay, do what you can,” I tell him, “but the same thing goes for you. When they start lifting, you get out.”

“Why?” he asks reasonably, pointing his flashlight beam around the bed of the truck. “The truck can’t get any lower than it is.”

He’s right. As long as he’s in the bed and not the cab, he’s not in any danger if the cab collapses any more. There’s no fuel leaking, and we’re on level ground. He can stay.

“Be careful,” I warn him as I scoot back out of the ruined cab. A Podunk volunteer firefighter scrambles down the steep bank. “Whatcha got?” he wants to know.

“Big woman in an overturned Ford Ranger,” I answer. “We can’t tell how bad she’s hurt, but she’s complaining of difficulty breathing. She’s lying on the roof of the truck with her feet sticking out the passenger window,” I continue, pointing. “My partner says her arm is sticking through what’s left of the windshield, pinned between the dash and the ground.”

“Doors first, then lift the truck?” he muses.

“Yeah, that’s what I figured,” I agree, “but you’re the expert. If you can get the doors off, we can at least reach her a little better. But you’re probably gonna need your airbags and some cribbing to lift the truck a little. Oh, and one of my guys is underneath the bed of the truck, trying to work on her. Watch out for him, would you?”

“Sure,” he grunts, waving his crew down the bank. “Must be a little sumbitch to fit in there,” he says, shaking his head.

Not all that little, my man. Just totally ate up with Sparky EMT Syndrome is more like it.

The fire captain starts barking orders, pointing here and there, and his crew fires up the generator and the Hurst extrication tool and gets to work. In short order, two mangled doors are on the ground, and several cribbing blocks are wedged under the hood and bed rails of the truck. These guys may be volunteers, but they’re good.

With the doors off, I can see much more of the woman. She’s scraped up a bit, but she’s still moving, carrying on a conversation with RP that I can’t make out over the roar of the generator. PS crawls out from under the truck, then reaches back into the truck and drags out the medic bag.

“She ain’t breathing good,” he tells me grimly. “RP’s got oxygen on her, but she’s struggling. She just can’t breathe lying flat like that.”

“Well, they’re lifting the truck now,” I tell him. “RP should be able to get her arm loose, and hopefully we’ll get her out in a bit.” We both walk around to the driver’s side of the truck to where RP has wormed up to her waist into the cab. The firefighters have wedged a pair of airbags under the hood and are slowly inflating them.

“Hey RP,” I shout, prodding her leg with my toe, “back out of there.” When she doesn’t respond, I grab her by the belt and slowly drag her backwards out of the truck. She looks up at me angrily. “I said to get out of the truck,” I tell her curtly.

She has ground dirt and weeds into the front of her uniform shirt, and her forearms are bleeding from the bits of broken glass embedded there. I soften. “Look, get back up to the truck and clean some of that glass out of your arms. We’ll be ready to move her by the time you get back.”

Looking heartbroken, RP climbs up the bank. “She was doing a great job,” Paramedic Student says quietly. “The lady was scared, and RP was reassuring her. She promised the lady she wouldn’t leave.” I sigh and look back up the bank. Rookie Partner is standing outside the truck, rinsing the blood from her arms with sterile saline. Her eyes are red.

“Okay fellas, you might be able to get to her now,” the fire captain tells us, nodding toward the truck. PS and I get on our knees and peer into the driver’s side of the truck The woman is lying with her face pressed against the roof, eyes closed and gasping painfully through the non-rebreather mask. She is wearing a cervical collar that lacks a good bit from fitting around her neck, although RP has attempted to secure it with several wraps of tape. The collar is even more-or-less straight. Paramedic Student and I trade a look.

“Straight out headfirst, and then log roll her onto a board,” PS says decisively.

“And the quicker the better,” I agree. Before we can ask for one, a spine board slides into view on the ground between us. RP is on the other end of it, both arms wrapped with roller gauze.

“Let’s go!” she says to me defiantly. She looks like she’s been crying. “What are we waiting for?”

I say nothing, just gesture for her to stabilize the woman’s head as I kneel down and gently tug the woman’s arm free. From the elbow down, it has an ugly white color, but amazingly it doesn’t seem to be broken. The woman doesn’t make a sound as I move it into line with her body.

“Okay RP, on your count,” I say as Paramedic Student and I each grip the woman’s shoulders and upper arms. At RP’s direction, we pull the woman out of the ruined truck as gently as possible. It is not what I would call a graceful or pretty move. We quickly log roll the woman onto the board and strap her down. Several firefighters grab handholds on the board, and we pass her up a human chain of hands to our stretcher, sitting lowered at the rear doors of our rig. The woman is only making occasional agonal breaths as we load the stretcher. RP is crying openly now, tears trickling down her face as she slams the rear doors. I grab a bag mask resuscitator and hand it to PS as he positions himself in the captain’s chair at the head of the cot.

He starts ventilating the woman as I cut her shirt off. There is an embroidered patch that says “Mike” on the left pocket of the uniform shirt.

She doesn’t look like a Mike. Her husband maybe?

I listen to breath sounds as PS ventilates, and hear nothing but diesel engine and road noise. I do manage to hear a pulse, though. She’s still alive.

“I can’t get a seal here,” PS says, frustrated. He’s trying to keep his seat and ventilate at the same time, unsuccessfully trying to keep a mask seal with one hand. I g
rab the mask with both hands, keeping a seal with a jaw thrust as PS bags, and after a couple of minutes the woman’s color is better.

“One of us is going to have to let go at some point,” I tell him, pointing out the obvious. “How about you try to do it solo while I set up your intubation gear?” He nods seriously, focusing on maintaining a good seal. He’s gotten into a bit of a groove. Maybe every other ventilation goes in. I quickly set up the laryngoscope and a tube, and hand it to PS. He inserts the laryngoscope blade and peers around, looking for the vocal cords and finding nothing. He raises his eyes to meet mine.

“I can’t see a thing,” he says uncertainly. “You want to try?” I shake my head.

“Why can’t you see a thing?” I ask him. “Does she need suctioning?”

“She’s real anterior,” he says, squinting and moving his head back and forth. The frustration is evident in his voice. “All I see is the base of her freakin‘ tongue!” I reach forward and press firmly on her cricoid cartilage, just below her Adam’s Apple.

“How about now?” I ask. Paramedic Student’s face lights up like a little boy at Christmas, and he smoothly passes the tube between the woman’s vocal cords.

“Got it!” he says triumphantly as he inflates the cuff. A few squeezes of the bag later, and I can tell he’s right. Her breath sounds are equal on both sides. Winking at PS, I hand him a tube restraint. “Now strap it down while I get an IV, Supermedic,” I tell him as I wrap a tourniquet around the lady’s arm. Two minutes later, I’m seriously considering asking Supermedic to switch places with me, because it’s starting to look as if I’m not going to find a vein.

Come on, AD! Your reputation as the all-seeing, all-knowing Paramedic God of All You Survey is at stake. Don’t miss this stick!

Luckily, even a blind squirrel finds an acorn now and then, and somehow the 18-gauge catheter I’m holding finds a vein in her left forearm. I suppress a triumphant grin as I hook up the line.

Yes! The blind squirrel can eat for another day!

Fifteen minutes later, we’re pulling up to the ambulance bay at Big City Regional Medical Center. Our patient is still unconscious, and I can’t quite figure out why. Her pressure is a bit on the low side for a big lady like her, but it’s good enough at 104/64. Her heart rate is ninety, and she’s only making an occasional effort to breathe. Her lungs sound good though, and I can find no injuries more serious than the scrapes and cuts on her face and right arm. There’s even a good pulse in her arm.

“Reckon she’s got a head injury?” PS wants to know.

“Could be,” I shrug, “but her pupils are equal and reactive. She withdraws from pain. If she were in shock, I’d expect it to look worse than this. I just don’t know,” I conclude helplessly.

“Maybe she just got tired out from laying on her chest like that,” PS muses. “She must weigh three-fifty. Kinda like a CHF patient can’t breathe when they’re lying flat?”

“Might be something like that,” I grunt in agreement as Rookie Partner opens the rear doors. “We might never know what it was.” RP’s eyes are red and puffy, but she’s no longer crying. I say nothing to her as we roll the lady inside, and she immediately takes the stretcher back to the rig as soon as we move the lady to the hospital’s bed.

“She’s still upset,” PS observes quietly. I nod, saying nothing as I watch her leave. Outside, I find RP sitting quietly on the low retaining wall bordering the ambulance bay. She is taking deep drags on a cigarette, and her hands are trembling. I sit down next to her and hand her a Coke.

“Thanks,” she says shakily. “Is she gonna be okay?”

“I don’t know,” I answer honestly. “Her vital signs are good, and I can’t find all that much wrong with her. Maybe she’ll come around. My question is, are you going to be okay?” I ask gently.
“I promised I wouldn’t leave her, and I left her,” she says almost inaudibly, her lower lip trembling. “She was scared, and I promised I’d stay with her. But you made me leave. Was it because I’m a girl?”

Was it? Maybe a little. But I was looking out for a rookie EMT who wasn’t looking out for herself. If PS had refused to get out of the truck, I’d have drug his ass out of there, too.

“You made a promise you couldn’t keep. But you also put oxygen on her. She might not have made it this far if it wasn’t for that,” I point out. RP says nothing, just takes a shaky drag on her cigarette. “Look, you’re a good EMT,” I tell her. “But you can’t take chances with your safety. I know you were taught never to enter an unsafe scene, right?”

“Yes, but sometimes -”

“Sometimes you enter anyway, even when you know it isn’t entirely safe,” I finish. “You take a calculated risk. In this case, the risk to you wasn’t worth the benefit to her. It was my call.”

She still doesn’t respond, and I gently nudge her with my elbow. “Look RP, we don’t save all that many lives, even when we do everything right. We reassure people, and sometimes we ease their pain a little bit. I guarantee you one thing, though…”

“What’s that?” she asks, looking up at me.

“When that lady wakes up,” I continue, looking pointedly at her, “She’s not going to remember the man who strapped her to a board, or the one who stuck a tube down her throat. But she will remember the girl who held her hand and reassured her while she was trapped in her truck, and she’ll be grateful. That’s something, whether you think so or not.” RP nods, taking another drag on her cigarette. A state trooper pulls up, double-parking behind a Mercedes in the doctors’ parking lot. Seeing us sitting in the ambulance bay, he saunters over just as PS walks outside.

“You guys bring in the wreck from Podunk Parish?” he wants to know.

“Yeah, the lady was in pretty bad shape,” I tell him, “but she’ll probably make it.”

“Did you guys pick up her purse or identification?” he asks, flipping open a small spiral notebook. “There wasn’t anything in the truck, not even an insurance card. You get her name?” Jeff and I exchange clueless looks and shrug our shoulders.

“The nametag on her shirt said ‘Mike,’ but I don’t think it’s her shirt,” I offer. “I didn’t even think to look for identification.”

“Martha,” RP furnishes, sighing as she crushes out her cigarette butt. “Her name is Martha. She told me while I was in the truck with her.”

Postscript: Martha did indeed recover from her injuries, and when she dropped by Podunk Ambulance’s station in Hooterville a couple of weeks later, she brought Rookie Partner some cookies and a card to show her gratitude. Hugged her neck, too. Paramedic Student and I were not mentioned.

Found this over at Mauser Medic’s site. Culture of hate seems a pretty apt description.

Found this while scrolling through egometer…er, I meant sitemeter…and I could just feel this poor child’s pain.

Actually, I couldn’t feel their pain, because I never had the problem for which this person is seeking help. When I was a new EMT, I was too cocky to question myself, even when I should have.

But introspection is a healthy thing, New EMT, and I hope that if you ever wander back to this blog, this post will help you in some way.

You’re new. It is natural to be scared at this point in your career. There is no shame in it. Learning to master your fear is what you need.

First you have to remind yourself of the stakes, and I’ll clue you in to something you may not have learned in EMT school. We don’t often say it aloud, because it isn’t sexy and it isn’t what new EMTs want to hear.

The stakes aren’t Life and Death. The stakes are pain and suffering. The stakes are fear and anguish. The stakes are warmth and compassion. Only rarely will you run the call where a life is at stake, and the outcome of that call usually depends more upon luck and timing than your skills.

You have entered a profession in which the reality of what you do is very different than the public perception, yet important nonetheless. The skills that will serve you best are the ones you probably already have, otherwise you wouldn’t be Googling the net searching for tips on how to calm your nerves. If you didn’t have those fears, then I’d be worried. You’d be like me, and it may take killing someone to make you realize you aren’t up to the task. The fact that you aren’t calm indicates that you care. People who really care aren’t ever satisfied with knowing enough or doing enough. Those traits will make you a good EMT.

To many people mistake indifference for calmness. Don’t be one of those.

Now that I’ve indulged in my Deepak Chopra-esque healing of your psyche, I’ll address your main question – “How does a new EMT remain calm under pressure?”

Simple. The answer is muscle memory. First you build strong EMT skills, then you practice them to the point that they become reflex. Managing an airway shouldn’t require conscious thought. The same goes for controlling bleeding, splinting, doing CPR, using your AED, whatever.

You want to practice those things so that your body takes over when your brain locks up. Actually, your brain doesn’t lock up in those situations. It simply favors the neural pathways that you have set by constant practice and repetition.

These pathways are the same ones you use when you drive. Aside from paying attention to what the other drivers are doing, you don’t consciously think about the physical act of steering a car, applying brakes, smooth acceleration and all that, do you?

I didn’t think so. You can probably ride a bike, even if you haven’t been on a bicycle in years. You didn’t ingrain those lessons in bike riding by watching a slide presentation in class. You learned them by riding. Falling, skinning your knees, getting your pants leg stuck in the chain…the lessons learned from those things become ingrained after a while, and they are still there even if you haven’t swung your leg over a bicycle seat in ten years.

Why do cops (the prepared ones, at least) routinely practice with their weapons? Because they understand that, should they ever need to actually fire that weapon in the line of duty, that the situation will not allow them to consciously think about sight picture, trigger squeeze and all that. It has to be reflex. It may never happen, or it may happen tomorrow. But that’s why they practice. Complacency is something they cannot afford.

But weapons proficiency is not the only thing that makes a good cop, and familiarity with all your toys isn’t what will make you a good EMT.

The other thing you need to cultivate is good instincts. Now how does one develop something that is instinctual, you ask? Aren’t instincts like, innate things you were born with?

They are, but they can be cultivated. I’d posit that good instincts are simply Thinking at Light Speed. It’s the ability to process information from a variety of sources simultaneously and use that information to form a coherent picture in your mind.

The first requirement is knowledge. Never stop learning. The more you know, the more likely that what is meaningless information to everyone else becomes a significant piece of the puzzle for you. And the old EMTs who say, “Why does an EMT need to know all that?” are too short-sighted and lazy to understand that fact.

The second requirement is cataloguing that knowledge. It’s all about organizing your thought processes, and the bad news is I can’t help you do that. I don’t know how your brain works. But you have to find a method of sorting out the information you’re receiving. What is relevant? What’s not? Experience will teach you the difference.

And you will make mistakes. Count on it. A wise man once said, “Good judgment comes from experience, and experience comes from bad judgment.”

Some people form a sort of mental pegboard on which to hang pieces of information. They have some broad categories that they file things under, and when necessary they can go back and retrieve that information. Others use word association or some such. Do whatever works best for you.

But there is no substitute for constant practice. Every call is an opportunity to do those mental exercises. Practice the art of situational awareness, and the boring, routine calls are a perfect opportunity to do that.

When you drive up to a scene, start looking and thinking. Think about ingress and egress. Where can I turn my unit around? How can I position my rig where it’s safest to load the patient? Environmental hazards? Is crowd or traffic control needed?

If you approach a building, scan the house and yard. What’s the best way in and out? Is there a fence around the yard? Kid’s toys lying around? Maybe a dog house? Is the house and lawn unkempt? What is the lighting like? All important questions.

When you go inside, what’s the best way to get your patient in and out? Plan your moves before you make them. Any odd smells? How clean is the house? What’s the ambient temperature? Where is the patient? If you’re unsure of the situation, it’s best to stay out of kitchens and bedrooms. Lots of weapons, real and potential, in those rooms.

When you see the patient, do they respond to your presence? How? How many pillows on the bed? Pill bottles on the bedside table? What kind? How is the patient positioned? Body language? Hygiene? Fingers, feet and ankles? Medic Alert bracelets or pendants? Never underestimate the diagnostic value of The Look Test.

I could go on ad infinitum, but the point is, once you train your
self to actively look for clues, it becomes reflex, something you do subconsciously. Then you can turn your conscious attention to processing all those clues. Keep at it, and it will come.

Once you’ve learned how to process those clues, those disjointed puzzle pieces become more of a mental photo album, one you can flip through until you find a photo that resembles the one you’re seeing now.

The last thing I’ll stress is communication. Talk to your partner. Ask questions, discuss, review. Before, during and after the call. Once you learn how each other thinks, then you have two brains working on the problem instead of one. Until then, talk, talk, talk to each other until you develop that level of understanding.

When in crisis mode, slow down, make eye contact with people and give specific instructions. Things get chaotic because of lack of communication. Even an untrained bystander can be useful if you give them something specific to do.

So, muscle memory and situational awareness are the two biggest pieces of advice I can offer. Develop those, and keeping your wits about you becomes much easier.

Until next time…

I was reading Matt G’s post on gun stuff and hog hunting, and it got me to reminiscing, so I figured I’d post a little gun porn of my own.

Of course, this isn’t real gun porn. Real gun porn scares the hell out of liberal democrats like real pornography scares right wing religious fanatics. You know, the firearms equivalent of fishnet stockings and a leather corset. Think suppressors and high capacity magazines. Accessory rails. M203 grenade launchers. That sort of thing. All very sexy and desirable, but not the sort of gun you’d bring home to mother.

You know, like this one here. Now that’s a tattooed biker chick of a weapon right there. With big breasts and a pierced tongue. And she’d probably be more fun than nitrous oxide, but you’d feel kind of dirty afterward. This is not the kind of gun you’d marry. This one, you’d keep for a mistress.

Nope, my gun porn is much tamer. If they were women, they’d be the wholesome gals you’d find in Good Housekeeping or Redbook. I’m talking checkered walnut. Clean lines. Deep, rich bluing. They’re the guns you can bring home to meet your Mama. Guns you’d marry.

I learned to shoot this baby when I was just a little sprout.

It’s a Winchester Model 74 in .22LR. My uncle had the original version that came out in 1939 in .22 Short, and my Dad liked his so much that he bought a .22 LR version when they came out in 1940.

If you’re of a certain age, you’re probably familiar with this one, as they were a very common shooting gallery gun in fairs and carnivals back in the day. I don’t know if Winchester made this thing with such a superb trigger right out of the box, or if the sear had worn in by the time it was handed down to me, but it shot like a dream. Birds, tin cans and small critters were not safe within 100 yards. And aside from an annoying tendency to stovepipe when it was tilted to the left, I rarely had feed problems with it. Once I discovered at about age 12 that I was left eye dominant and learned to shoot all my weapons shotgun-style, with both eyes open, I quit subconsciously tilting it and haven’t had a stovepipe since.

My friends and I have a long standing tradition of taking the rimfires out on opening day of squirrel season. I love squirrel hunting with a .22 rimfire. It just seems so much more…pure. Plus, it also gave us a means to take any wild hogs that we encountered. Centerfire rifles were only allowed on the refuge during deer season, so a .22 was our best option.

So several years back, my buddy and I had found a little stand of pin oaks near where we usually duck hunted. Our medical director had killed a hog with his bow in the same place the year before, so it seemed the perfect place to set up. So, my buddy and I beach my boat on this little oak chenier and take up positions on opposite sides of the island.

By 10:00 am, I had five squirrels in the bag with five shots fired, and buddy hadn’t fired a shot. It was getting hot and the mosquitoes were becoming intolerable, so I decided to walk over to his side of the chenier and rouse him from his slumber.

So I’m slipping down a dim trail, most of my attention focused upwards on the treetops, when my peripheral vision catches a flash of black in the palmettos off the trail. I freeze, and catch a glimpse of two young hogs feeding on palmetto shoots about fifty yards out into the woods. Both of them are young hogs, but not shoats, either – maybe 125-150 pounds each.

“Suh-weet!” thinks I, easing over to a small sapling at the trail’s edge. “I’ll stick a hollow-point in his ear, and we’ll be eating The Other White Meat for supper…”

So I find a rest, take a careful aim and squeeze off a round.

“Pop!”

Dropped him like a stone. The other hog just gives his brother a glance as if to say, “Hmmm, wonder what’s wrong with Wilbur?” and then goes back to his rooting.

“Oh, this just keeps getting better,” I exult as I center the crosshairs on the ear of Hog #2. I’ve got enough tension on the trigger that the break is just a hard wish away, when the little porker’s olfactory glands finally decided to give him A Clue. He snorts and raises his head right as I fire…

“Pop – squuueeeeeelllll!” Dammit, wounded him!

He takes off through the palmettos at a right angle to me, and my wingshooter’s instinct took over…

“Pop! Pop!” – two rounds, right behind the shoulder… and down he goes, ass over teakettle.

I’m busy congratulating myself on my marksmanship and mentally composing my Epic Hog Shooting Story to share with my buddies when I notice another, much larger flash of black, back where Hog #1 had dropped. The third hog, that I hadn’t seen. Oh, but he had seen me, and was rapidly making his way over to Say Hello. So I shoulder my trusty tack driver and pick him up in the scope to see…

nothing but black hair. Rapidly approaching, pissed-off black hair. And somewhere around the front end of all that back hair, somewhere I can’t seem to find in my scope, is a pair of tusks that should catch me somewhere above the knees, or if he’s really evil and ambitious, in the Nether Regions. It is in such situations that shot placement takes a distant second to the sheer volume of lead you are prepared to throw toward the enraged critter. So I proceeded to do exactly that – throw lead in a decidedly indiscriminate manner, all the while moving laterally toward any tree big enough to support my frame.

“Pop-pop-pop-pop-pop-pop-pop-click…” culminated by a toreador move with the gun barrel that managed to turn him literally at my feet -”Ole!”

The porcine assassin ran off into the palmettos, leaving me to sink slowly to a sitting position, leaning against a pathetically slender sapling. I had just about gotten over the adrenaline shakes when my buddy came puffing up at a quick trot (Not a run. Remember when I said paramedics do not run?)

“Hogs?” he asks expectantly.

“What makes you think I got into some hogs?” I grin.

“Well, it was either hogs, or you started a firefight with somebody. Either way, I figured you could use some help.”

After a little good-natured ribbing, buddy and I set out to trail the wounded hog. We spent maybe an hour
poking around before the blood trail petered out, so we reluctantly went back to drag the two dead ones back to the boat. We went after Hog #2 first, because I didn’t have that much faith that two .22 hollow points in the chest would anchor a decent sized hog. Imagine my surprise to find that both rounds had completely transited his chest cavity, one breaking a rib on the way in and another breaking a rib on the way out. The hog was dead as John Kerry’s presidential hopes.

But we were flabbergasted to find Hog #1 on his feet. Granted, he wasn’t in the best shape, but he was alive, a condition remedied by a coup de grace at the base of the skull.

It was on that day that I decided if I was going to hunt hogs with a rimfire rifle, I was going to pack something with a little more kinetic energy than a .22 LR.

So, the Missus bought me a Ruger 77 in .17 HMR for Christmas that year. God I love this rifle. Clean lines, well balanced and of a similar weight to my deer rifles, and it literally drives tacks. Plus, it sends a nifty little 17 grain Nosler ballistic tip bullet out the muzzle at around 2000 fps. Not quite as much muzzle energy as a .22 WMR, but the bullet construction more than makes up for it. They fragment rather than ricochet, and a head shot is lethal on anything from small critters to big hogs.

PS. We did wind up finding Hog #3 a week later. Of the seven rounds I fired at him, I hit him in the chest cavity or shoulders with four, and clipped him with another one. Missed him clean with two rounds at less than 25 yards, which shamed me no end. But hey, I was in a hurry!

Until next time…

Back in the days when Anna Nicole Smith first appeared in Playboy, I was quite smitten with her. I even wrote her letters, which can be summarized something like this:

AD: Dear Anna Nicole Smith, I am your biggest and bestest fan (pant, pant). Howzabout you and me hooking up, hot stuff?

Your friend, Ambulance Driver.

ANS: Get a life, creep. You’ll sleep with me over my dead body.

I’m filing a restraining order,
Anna Nicole Smith

Soooooo… now I’m thinking I’ve got a shot.

Okay, even I’ll admit that was just wrong.

Hey there, Salt Lake City, Utah! You were visitor #10,000! I started this blog on Docember 23, 2006, and it is humbling to know that I have had ten thousand visitors to my humble blog in such a short time. While I may never attain the rock star status of LawDog and Tamara, or be the Renaissance Man that is Matt G., I am truly thankful for my readership, and the many (okay, seven) discerning bloggers that have linked me.

Of course, if you really loved me, you’d buy the book, people. The double-wide fund needs an infusion. *grin*

And Salt Lake City? You get to choose the topic of my next blog post, and of course the cement bicycle that Land O Lakes, Florida still hasn’t claimed.

Pick your topic, my friend. I’ll try to make it an epic one.

Until next time…

That one was just for you, Rusty.

I have a confession to make. I routinely break the law.

I am a speeder. There, I said it.

They say admitting your problem is the first step on the road to recovery, so perhaps there is hope for me yet. Mind you, I’m not one of those menace-to-society speed demons, and I’m far from an aggressive driver. Heck, I drive my ambulance more cautiously than I drive my truck, and at higher speeds. I simply have two basic speeds – stop, and ten miles an hour over the posted limit. Or maybe fifteen. All right, maybe twenty miles over the limit on a couple of occasions.

I’ve gotten more speeding tickets over the years that I can count, and I’ve taken them all like a man. I didn’t beg, I didn’t offer excuses, and I paid my fines on time. As I got older, and after I became an EMT , I discovered that often I could plead a speeding offense to a non-moving violation, or pay well before the court date and keep it off my MVR.

I rarely even use my misdemeanor credit card. That is, I never invoke the public safety brotherhood to get out of a ticket. A number of reasonable officers have let me go once they found out, through their own questioning, that I was a paramedic. Usually, with nothing more than a verbal warning and on a couple of occasions, a world-class ass chewing that would have done a Parris Island DI proud.

Cops have a job to do, and I respect that. And most of the cops I know hate working traffic detail. It sucks for them almost as bad as it does for us. Aside from nabbing drunk drivers and the occasional narcotics bust, traffic detail isn’t very rewarding. So I admit to my speeding, sign the ticket, wish the officer a nice day in return, and drive away well below the posted limit. For at least a couple of miles.

But there is doing your job as a peace officer, and then there is being a chickenshit bastard.

(Insert standard anti-prejudice disclaimer here: I have nothing against cops. I love cops. Some of my best friends are cops.)

And aside from the badge-wearing, gun-toting, legally sanctioned extortionists that work for the Woodworth, LA Police Department, I get along with just about every cop I’ve met…

Except for the bane of my youthful existence. Back in the day, I used to train retrievers for a living. It was a great job for a redneck in his late teens and early twenties – good money, make your own schedule, and unlimited duck hunting opportunities.

I hunted in a little rice field town just south of the Arkansas state line, and I had to drive through the little hamlet of Booger Holler every time I went duck hunting. Now, I drove through there nearly every day, and I knew the town’s reputation as a local speed trap. I kept my guard up, and my speed down.

But invariably, I’d slip up one time, and he’d have me. The assistant police chief would park his cruiser right on the other side of the speed limit sign, hidden behind some semi trailers. And if you passed that sign at faster than 35.1 miles an hour, buddy you were written. The man wrote me at least one ticket a year for five years. The last ticket he wrote me, I was driving a new truck. My Nemesis pulled me over, sauntered up to the truck and flashed his Maglite in my face, and grinned.

“Well, howdy there STBAD (Soon To Be Ambulance Driver)! I didn’t recognize you in the new ride! Does the speedometer work in that thang?”

*sigh*

I supported this town. They should have erected a billboard thanking me. In addition to the pothole repairs, basketball courts and bulletproof vests I personally subsidized, I kept my insurance carrier fat and happy. They never had to pay a claim, but I paid them a monthly premium slightly larger than the gross national product of Uruguay.

But hey, what’s an unmarried male under age 25 with 3 speeding tickets on his record to do but grin and bear it?

Well, that and plot revenge. Sweet, sweet revenge.

Fast forward about eight years. I’m working a part-time gig at an EMS service in that same parish, and I get called as the backup unit on a wreck north of town. I arrive to find my patient already packaged by the first-in ambulance, so we load my guy in the rig and proceed forthwith to the Bandaid Station.

As I’m standing over the guy, fishing IV supplies out of the cabinet, I ask him his name.

“Floyd XXXX,” he replies through gritted teeth. I pause and look down at him.

“Assistant Police Chief Floyd XXXX of the Booger Holler Police Department?”

“I used to be a cop in Booger Holler,” he says. “Why, have we met?”

I swear I heard a Heavenly choir. The back of the ambulance was suffused with a warm, ethereal light.

Thank you, Lord, for this opportunity to smite mine enemy hip and thigh. And hopefully a few other places as well.

“Floyd,” I smile beatifically at him, as I put back the 18-gauge I’ve selected and choose a much larger needle, “I want you to know I have dreamed of this day.”

“So, where do I know you from, kid? Are you from there? Who are your – ouch! Hey, that hurt like hell!” Floyd says as I hook up the line to the huge IV catheter I’ve just inserted.

How do you like them apples, Floyd?

“No sir, your name just rang a bell, that’s all. I went to college with a guy from Booger Holler.”

Don’t recognize me, Floyd? I’m crushed. Then again, I didn’t recognize you, either. You’ve really let yourself go, Floyd.

“Floyd, I need to check out your hip and leg, so I need to get these clothes out of the way, okay?” I pull out my trauma shears and start ripping the seams of his trousers. On further consideration, I decide it’s easier to just go straight down the middle.

“Hey, is that really necessary? I mean – hey! Not my boots, too!”

I’m so sorry, Floyd. And they looked expensive, too. Was that full-quill ostrich skin?

“Floyd, I need you to tell me if any of this hurts,” I tell him as I bolster his pelvis and palpate his legs.

“Aaaaahhhhh! Goddamn right, that hurts! Holy shit!”

Okay, note to self: Floyd’s left hip and knee are extremely tender to palpation, although no crepitus is noted. I’d think a big man like you would be a little more stoical about the pain, Floyd.

“Hurts where, exactly?” I want to know. “Does it hurt here…”

“Aahhh!”

…or here?”

“Ouch! Goddamn, it hurts everywhere you touch, okay? Just don’t do that any more, please!”

“Floyd, can you feel me touching your feet?” I ask him as I rake the soles of his feet with my pen. />
“Aahhhh, shit! What was that?” Floyd hollers as his toes curl and he desperately tries to pull his feet out of the straps.

Okay, Floyd obviously has distal sensory and motor function. Maybe I should have put the cap back on my pen before I did that, though.

“Relax, Floyd. I’m just doing my job.”

“Look kid, is all this really necessary?”

“It’s okay, Floyd. We’re done. I just need to get a little information from you. How old are you?”

“I’m 51.”

Well, that’s about $200 less than my monthly insurance payments in those days. Do you have any idea what an unmarried male under 25, with three speeding tickets, pays for car insurance?

“How much do you weigh?”

“About 260, I guess.”

That’s about what I had to pay my lawyer to have my driving record expunged, so Podunk Ambulance’s underwriters would agree to insure me. Do you know how unemployable an EMT who can’t drive is, Floyd?

“Hey, can we loosen this collar a little bit? It’s digging into my neck.”

“Sorry Floyd, but I can’t do it. We can’t take it off until the doctor clears you. Usually they’ll do at least an x-ray of your neck before they clear you.”

Suffer, Floyd, suffer.

“How long do you think that will take? I kinda have to piss.”

That’s because I’ve given you half a liter of fluid, Floyd, with another half-liter yet to go. With any luck, they’ll be totally swamped and I’ll have the singular pleasure of watching you piss your pants right on my spine board.

“I have no idea, Floyd,” I say, standing up and surreptitiously squeezing the bag. “Hopefully, it won’t take long to – hey, we’re here.” We roll Floyd into the ER and give the nurse a handoff report.

A few minutes later, I hold my clipboard over Floyd’s head and hand him a pen. “I need your signature right here, Floyd.”

He scribbles his signature and returns my pen. I tear off a copy of my run ticket with a flourish and hand it to the nurse. I turn to leave, and then pause in the doorway. I turn around and walk back to the bed and lean over him.

“Hey, Floyd?”

“Yeah, what?”

“Have a nice day,” I tell him cheerfully. “Drive safely.”

Until next time…

It’s 3:17 am. This is our witching hour, when the weekend drunks have left the bars and headed home. Everyone else’s Circadian rhythms are at their lowest ebb, including mine. Around here, the cops catch the drunkest ones in town, as soon as they weave out of the parking lots. The ones we see are those who’ve slipped the net, or those driving home from Big City, 30 minutes away.

The strobes are hurting my eyes. I reach over and turn off the siren, earning a quizzical look from my partner. I snap at him, “Why do you have to run that fucking thing in the middle of nowhere on an empty road?” He says nothing, and I immediately feel like an ass. He’s just following company policy, and green enough to still worry about breaking the rules – even the ones that make no sense. But, he fears my disapproval even more, so he shuts his mouth and keeps driving.

Junior Partner is a good kid, just 25 going on 17. He still acts like a carefree high school senior, despite the fact that he’s got two kids. He’s been a First Responder for about eight months, just long enough to be excited rather than petrified about calls like this.

We’ve been slammed running transfers all day, and only got to bed just two hours ago. My eyes are sticky, and I’ve got a serious case of bed-head under my cap. My mouth feels like a cat shit in it. JP, on the other hand, looks fresh.

Fucking kid.

We’re heading to a “Signal 20-I,” which is cop-speak for a motor vehicle accident with injuries. They usually turn out to be total bullshit, or at the other end of the spectrum, road pizza. Not many fall in between.

At 3:17 am on the s-curves of Highway 35 South, they’re always bad news. There are enough little white crosses on that stretch of road to fill a small cemetery. JP is not yet experienced enough to dread calls like these. I know better. I’ve cared for my share of the names on those little crosses. JP slows down as he passes the Hooterville Volunteer Fire Department. The bay doors are open, a good sign. We don’t have direct radio contact with some of the volunteer First Responders, but I’m hoping the folks from Hooterville will be at the scene. Extra help never hurts.

As if reading my mind, the radio crackles, “Unit One, Dispatch. Be advised Hooterville First Responders are 10-97.” Good. JP slows even more as we round a curve, easing over the center line. A doe and two yearlings are standing in the ditch on my side.

“You see ‘em?”

“Yep. Big buck standing just in the trees behind them.”

“Well, be careful.”

The moon is full, and the deer will be night feeding along the road shoulders and in the pastures. At least once a year, a doe zigs where she should have zagged, and wipes out the front end of a rig. JP snaps the wheel to the right, just a little jerk to get my attention. It startles me a bit and I glare at him. He’s grinning at me. At least he’s not mad at me for snapping at him earlier.

“What, you got something against eating road kill?”

“No smartass, I just don’t like wiping out at eighty miles an hour.” He snorts, unable to envision a situation where his reflexes would not be equal to the task.

See what I mean about 25 going on 17?

JP isn’t a bad driver, just still sure of his own invincibility. I keep my mouth shut. I’ve bitched at him enough, and wrecking a rig might be one of the dues he has yet to pay. He slows down anyway and starts scanning the ditches. I suppress a grin and pretend not to notice. I realize that in the past ten minutes, we haven’t met a single car coming from the opposite direction – not a good sign. My grin fades.

The scene comes as a surprise as we top a hill just south of Robichard’s Grocery. The wreck was reported as several miles further south.

“Fuck me…” JP whispers.

My sentiments exactly.

On either shoulder, cars and pickup trucks are parked for a couple of hundred yards. Quite a few of the pickups have their emergency flashers on, red gumball lights on their dashes marking them as the firefighters’ personal vehicles. The last few motorists start to ease over when I hit the siren in brief bursts, and the sea parts.

There are remains of a compact car sitting crossways in the middle of the road, a mass of mangled metal, like ugly origami folded in the hands of a clumsy giant. It’s impossible to determine the make or model now. The front end is gone, the windshield a cloudy spider web of cracks.

A cluster of volunteer firefighters notices our arrival and beckon frantically. At least two more ignore us, leaning into the shattered windows on the driver’s side. I look at JP.

“Spine board and trauma bag. Let’s go.” He nods, throws the rig into park and bails out.

I am halfway to the wreck when more volunteer firefighters and good Samaritans get my attention. A Ford pickup is in the ditch on the opposite side of the road. A girl is sitting on the ground nearby, hugging her knees and sobbing, rocking back and forth.

All the commotion centers on a spot about ten feet past the truck. I stop, and JP nearly runs me over with the stretcher. I look back at him, hesitating. In the past, I’ve triaged the patients and decided which ones needed the most urgent care. JP has never had to manage a critical patient on his own. Looks like tonight there will be plenty for both of us, and the backup unit is just coming back into the parish, at least 25 minutes away.

Shit.

I grab him by the arm and shout over the snarling of the generator and Hurst tool the extrication crew has just fired up. “Look, holler for Unit Two, and have them start easing Unit Three this way. You take the pickup; I’ll take the car. If you get anything you can’t handle, come get me. Otherwise, just put the volunteers to work.” He bobs his head nervously and heads toward the pickup.

“Wait!” I call after him. I take the spine board and trauma bag off the stretcher. “Send somebody back to the rig for any equipment you need. I’ll take these.” He nods dumbly, and starts to turn away again. He looks scared.

“JP.” I say it softly, in my ‘Calm Voice’. His eyes shift back to me from the wreckage of the truck, and eventually lock with my own. “There’s nothing I can do for ‘em that you can’t. Just assess and package ‘em on boards, and I’ll do all the paramedic stuff on the way to the hospital. You’ve got plenty of help. You can do this.”

I turn away before he can reply. He’ll have to manage on his own for the next few minutes, scared shitless or not.

The two firefighters leaning into the car are Frick and Frack, identical twins and EMTs from n class="blsp-spelling-error" id="SPELLING_ERROR_15">Hooterville. Where you see one, you will invariably see the other. In turnout gear, I can never tell them apart. One is reaching through the driver’s back window, maintaining spinal alignment while his brother is standing beside him, reaching through the front window applying a cervical collar.

The driver’s face is a wreck, blood and tangled blonde hair masking her features. I poke my head in between them, and Frick or Frack looks at me from behind the girl’s head, a grim smile on his face. “Wassup, AD?”

“You tell me, guys.”

Frick or Frack backs out of the car and gestures at the interior. I take his place and look in. In addition to the front-end damage, the passenger side of the car is caved in all the way to the center console, and looks to be folded over the girl’s right arm. I glance down at her legs, and they appear to have about four more joints than they should. About two inches of her right femur is protruding from her jeans. Her right ankle is folded under the accelerator pedal.

Her breathing is ragged and gurgling. Amazingly, the rear-view mirror is still attached to the shattered windshield. There is a graduation tassel hanging from it. Everywhere there is a fine white dust from the airbags.

“We gotta get her out now, guys. Let’s see if we can pop this door first, and someone needs to get working on the passenger side to free her arm.”

I back away as the crew moves in with the Hurst tool. I get my laryngoscope and a tube from the airway kit. I hear the groan of tortured metal behind me as the spreaders pop the door open. I don’t really relish doing a seated intubation on this girl, but if we don’t get her out right this minute, that’s what is going to happen.

I can reach most of her now with the door out of the way, and as I maneuver in front of her, my arm brushes a trim piece folded over her arm. It moves easily and I tug at it. It comes away in my hand, and I notice that her arm is not entrapped at all. The metal is just crumpled over it, but there is nothing pinning her. Her ankle is broken, the foot folded back under and pinned beneath the accelerator. I move her lower leg and foot gently to the left and cringe as I feel the crepitus in her ankle. But her foot pops free, and I worm my way back out of the car and shout for the board. I lay my laryngoscope and tube on the remains of the hood, just forward of the windshield, and my scope promptly rolls down into a crevice somewhere in the engine compartment.

Lovely. Just fucking lovely.

One of the twins is wedging the end of the board against the seat while his brother holds spinal alignment. I grab the girl by her hips and torso and rotate her onto the board. It’s not pretty and we really need more people for the move, but there is simply no room. We manage to extricate her and strap her to the board.

I feel a hand on my shoulder and look up. It is JP. He has his patient packaged and on the stretcher. He looks a lot calmer now, sure of himself.

“Driver of the truck’s dead,” he says. “This one was ejected through the windshield. He’s unconscious, but he’s breathing. I’ll load him and send someone back with the stretcher.”

I grin at him and give him a thumbs-up as he moves away. Frick or Frack is digging around under the car, and comes up triumphantly with my laryngoscope. “Lose something, AD?” He grins at me and his brother joins in. “Boy, send a guy to Paramedic school, give him cool toys to play with, and we still have to go around picking up after him…”

I roll my eyes. “If you guys were actually any good, you would have found my tube as well. I’m not impressed.” They laugh some more as we load the patient onto the stretcher.

Our girl is not doing well. She has agonal breathing, and we hustle her toward the truck. I get another blade from the airway kit to replace the oil-smeared one I have, and intubate her lying right there on the stretcher at the back of the rig. There is more room and light there.

JP is behind me in the rig, setting up IVs and cutting the clothes from his patient. The tube goes in easily, with good breath sounds all around. Before I can place the tube holder, she bites down on the tube and curls her arms up to her chest in decorticate posturing.

Not good. I have to pry her mouth open to place the bite block between her teeth. As I secure the tube, I can hear a siren approaching, and Unit Two pulls up right behind us. I load our patient as Ernie Keebler walks up to the back of our rig.

“Need some help?”

“As usual, your timing is impeccable. You got here just in time to transport, but you managed to avoid all the hard work.” I love to give Ernie a hard time.

“Yeah, we timed it just right,” he grins, then turns serious. “How many patients do we have?”

“One DOA, two critical. If you’ll take the one JP has, I’ll take this one. We’re going to Big City.”

Over my left shoulder, and twelve minutes away, is Podunk General Hospital. It’s a good hospital, as small hospitals go, but they just don’t have the resources of Big City Regional Medical Center, twenty minutes away.

JP and I hand his patient out to Ernie. His wife, The Troll, has parked Unit Two’s stretcher at the back of our rig, and they slide the spine board onto their stretcher. As I hand the head of the board to Ernie, I notice that JP has written vital signs on the tape securing the patient’s head. The patient is moaning behind the non-rebreather mask. There are several deep lacerations on his forehead, and his upper lip is split all the way to his nose. His teeth are showing through the gap. I can smell the alcohol in his blood.

JP tosses Ernie a spiked bag of saline. “Here. Don’t say I never gave you anything.” One of the twins climbs into the back of the rig as JP slips out the side door.

“Found her purse in the car,” Frick or Frack says.

“Didn’t figure it was yours,” I grin. “It doesn’t match your belt or your shoes.” Frick or Frack replies with a grin and a one-finger salute.

“Need somebody to ride in with you?”

“I never turn down free help, man. Shut the doors and let’s go.” Frick or Frack takes over bagging while I get an IV. I slip in a 14-gauge and tape the line down as JP pulls away, forced to maneuver far onto the shoulder to get around the wrecked car.

I take her vitals,
and don’t like the results. Her heart rate is only 62, and her BP low at 84/40. She stopped breathing on her own several minutes ago. Her chest and abdomen seem free of injuries, but her pelvis and legs feel like broken pottery. Both femurs and tibias are broken, as well as her right ankle, but I’m worried most about her head injury.

Aside from the brief episode of posturing when I inserted the tube, she’s been completely flaccid. Both her pupils are dilated and barely react to light. I’m still at least ten minutes away from the hospital, just passing into the outskirts of Big City, so I slip another large bore IV in her right arm and run in some Ringer’s solution. She’s had around 500 ml of saline, and I get Frick or Frack to get another set of vitals while I contact the ER.

Around here, all hospital contact is done via cellular phone, so I place the call while Frick or Frack struggles to hear a BP over the siren and engine noise. I recognize the nurse who answers the phone. My report is brief and to the point, nothing like the full patient report I was taught to deliver.

“Hey, Jeremy. This is AD with Podunk Ambulance. En-route to you with a female driver, frontal impact collision. Multiple lower extremity fractures, pelvis as well. Possible head injury. I’ve got her tubed, bilateral IVs and about 500 cc’s of fluid. GCS is 3, BP 80 palp, heart rate 60. We’re seven minutes out.”

I finish cutting her clothes off and assessing her. There’s not much in the way of outward injuries to treat, and splinting her legs at this point would be wasted effort. I feel the truck lurch, and suddenly we’re backing into the ambulance bay at Big City Regional. JP flings open the door and helps us unload. There’s a lot of shit to sort out – cardiac monitor, two IVs, oxygen tubing, and the shreds of her clothes hanging off the cot.

Jeremy meets us just inside the door. Just behind him is Doc Magoo. It’s late and she’s obviously tired. She looks haggard. She says nothing, just points to the trauma room.

As we move her over on the board, I give Doc the bullet: “Unrestrained driver, frontal impact. Airbag deployed, steering wheel deformed, windshield starred. Lots of dash intrusion. She was unconscious at the scene. Got her tubed, lines on the way, 500 cc’s of saline. Pelvis and lower extremities fractured, probably a head injury, too – her pupils are dilated and un-reactive.”

“Any posturing?” she asks, sidestepping to the left as the radiology tech maneuvers a portable x-ray machine into the room.

“She showed some decorticate posturing when I intubated her, but other than that, nothing.” I shrug my shoulders. It’s not an expression of indifference, just helplessness. Doc Magoo smiles tiredly as she turns back to the patient. She doesn’t waste her breath on words like “good job” or anything so trite – she doesn’t have to. I know if I had not done something to suit her, she’d have chewed my ass thoroughly.

I have a lot of respect for Doc Magoo. She’s a strong advocate for EMS, and always treats the crews with respect. On the other hand, she’s also quick to quietly, methodically tear off a strip of hide if you fuck up. She taught me the basics of acid-base balance in medic school – Magoo’s Acid-Base for Idiots.

I collect my paperwork and walk outside. As usual, my rig is a total mess. If trashing a patient compartment were an Olympic sport, I’d be a Gold Medalist. JP is busy cleaning up behind me, but it will be at least half an hour before we’re ready to go. I’ve managed to get blood on the cot, the grab rails on the ceiling, and on the underside of several cabinets – basically everywhere I put my hands. I help him make up the stretcher and carry the biohazard bag back inside for disposal.

Everyone is filing out of the trauma room – Doc Magoo, nurses, respiratory therapist, radiology tech, everybody. Our girl coded right after we got her there, and they’ve been working her for the past twenty minutes while we cleaned our rig. They’ve only just now called it. Just like that, a young girl is gone.

The ER staff never even knew her name. Come to think of it, neither did I. Her purse is still outside in the rig. I go back outside to retrieve it, and I find her wallet and driver’s license inside. She was eighteen years old, her birthday only a couple of weeks ago. Her name was Jennifer.

As I walk back inside with her purse, I pass a woman clutching a cell phone with a bewildered look on her face. I start to tell her that the ER waiting room entrance is around the corner, but she sees the purse in my hands and recognizes it. She looks a lot like her daughter.

She stops me and starts to ask me what, where, how her daughter is, but she can’t find the words. She just chokes back tears and looks at me pleadingly. I tell her that her daughter was badly injured, what I did for her, what the doctor and nurses did for her after we got to the hospital, but I am too much of a coward to tell her the rest. I want to be able to say something to this woman, something that will banish the horror of this night for her, but I can’t find the words either.

She asks anyway. “But, is she going to be okay?” My silence tells her enough, and she slowly collapses in on herself, sobbing but making no sounds.

“The doctor will be out to speak with you soon,” I tell her as I take her hand and lead her to a chair in the waiting room. It’s a lame response, and we both know I’m too much of a coward to tell her the news.

On the way out I tell the ER clerk that the girl’s mother is in the waiting room, and I climb into my rig to leave. JP is already behind the wheel, catnapping as he waits for me. The sun is coming up.

Some day, I’m going to get better at this. Some day I’ll know what to say.

Until next time…