Ugh. The text glowed white on a black background, eliciting inward consternation and outward groans for my partner and myself.

As Medic 19 lumbered up Georgia Avenue, I clicked "enroute" on the computer and flipped it closed. We had been fitfully trying to get back for lunch, but no such luck today. Any day on an ambulance, really. Far out of our response area, we headed north to find what awaited us on Shepherd Street.

Jay (as we'll call him) was seated completely naked on the floor of the basement he lived in, surrounded by the sparsity of a man whose sole obsession is certainly not furnishing his living quarters. Instead, Jay's room accessories consisted of a TV, a high-backed rolling office chair parked in front of it, and six or eight of the 50-count DVD towers full of porn.

(Oh, and there was a small coffee table; the one square foot of it what was not covered in porn had amassed a collection of chinese food containers, stacked twenty or thirty high.)

There was porn on the walls, there was porn kicked under the bed, there was porn still in unmarked brown mailing boxes, waiting to be unwrapped. Porn playing cards had apparently fallen over quite some time ago and were left to lie about; the few of them that remained visible offered a stark and explicit punctuation to the collection of dirty towels and clothes on the floor.

Taking a history and obtaining vitals was a surreal sort of moment, surrounded by every manner of pornographic material. Apparently the southwest corner of the room was the blacks-on-blondes fodder; yet another DVD tower specialized only in group social functions of staggering proportions.

Side note: I wasn't aware that they even made Innocent Until Proven Filthy 13, much less the first twelve that were neatly organized above it in the rack. Others were far more blunt (and thus unprintable here).

—————

According to Jay, he had come home from lunch and needed to go to the bathroom; shortly thereafter, he sat down on his chair, became dizzy, and slid to the floor.

Sir, at what point between sitting in this chair and sitting on the floor did your clothes spontaneously fly off?

(I couldn't bring myself to ask.)

Physiologically, everything checked out. He was a touch confused, but not in a stroke kind of way. More of a "uh, why did I pass out naked and who are these people in my house?" kind of way. His vitals were great, but we all agreed that he should be transported to the hospital anyways; his obesity had led him down the road to a number of chronic medical conditions, and it was impossible for us to rule out the etiology of his syncopal episode.

(If you ask me, the only chronic thing he's suffering from is a… *ahem* protein deficiency.)

The TV was blaring the entire time we were there. Surprisingly, it wasn't porn. Instead, the classic Guess Who's Coming To Dinner added to the general absurdity of the room. Sidney Poitier's soothing baritone rang out through the TV as we wheeled Jay out the door and into the ambulance.

—————

"Did you see my movies?"

"Hmm?" I looked up distractedly from the tablet computer where I was entering his most recent set of vital signs.

"Did you see all of my movies?"

There was a hint of pride in his voice, and I was only half-surprised that his first cogent sentence was about his pile 'o porn.

"Uh, yeah. That's… quite a collection you have there."

"Aw, that's not that much. It's pretty small right there, but I have more somewhere else."

My mind reeled at the thought of Jay's U-Stor-It unit somewhere nearby. He would fling the rolling door up with a great flourish to reveal another collection of unimaginable quantity; and like Scrooge McDuck, he would jump in and laugh as he swam amongst the DVDs piled inside his vault.

I snapped back to reality as I realized he was listing off names, seeking my approval for various titles and actresses.

"Gianna Michaels, she's pretty good… The Lesbian Truth or Dare series? I like Alexis Texas, too…"

He drifted off into his own thoughts, and I left it at that.

Personally, I’m partial to the first one.

(Which you can find here, if you missed it.)

Ronald Reagan International Airport, late morning. A 747 approaches runway 33 for a landing from the southeast. At the last second, an engine cuts out and a bad gust torques the left wing upward. The plane tumbled off-balance as the wheels touched down at an awkward angle. Smoking for the briefest of seconds, they snapped and disappeared under the body as the nose began its arcing path towards the ground. Just before the faded gray of the runway destroyed the windshield, the pilot glimpsed what lay not far ahead in a lush green enclave: the river.

Now in two sections, the fuselage tore through the airport’s chain-link fence like tissue paper. A net of twisted metal dragged across the GW Parkway, startling the lucky motorists and dragging the unlucky into the water. The remainder of the plane slid to a stop amidst stunned onlookers, burning neatly in the middle of the six-lane highway.

—————

The scenario was a grisly one, for sure. However, anything that simulates the need for DC, Arlington, Alexandria, Fairfax, and several other surrounding jurisdictions in addition to the massive crash trucks kind of has to be.

I counted myself fortunate that I was able to make it; that Saturday wasn’t a normal shift for me. I was working a trade at Engine 33, home of several pieces of Mass-Casualty-related apparatus, and so was with one of the few companies who attended the drill from DCFD.

We were joined by quite a few agencies…

…even some of the big-league players.

Several Mass-Casualty Apparatus (apparati?) were set up near the treatment area; per MC Incident guidelines, each category of patient (red/yellow/green/black) had a colored tarp onto which patients were carried.

For part of the drill, I transported a red-tagged patient (flail chest, altered level of consciousness, okay-ish vital signs) to Arlington Hospital. They were actors, of course—but many of them were quite dedicated to their patient descriptions. I see daytime soap opera roles in many of their futures!

The “wreckage.” The airport FFs were the ones extinguishing this while we all waited in the staging area.

—————

All in all, the drill took maybe five hours. If I recall correctly, there were a few dozen patients to be triaged and transported. Afterward, the organizers were nice enough to feed us Potbelly sammiches, and then we returned to DC. Eight years ago, I was at another inter-agency drill at Dulles Airport. Both were pretty cool—I don’t get much exposure to airport firefighting stuff unless I see one of the trucks as I taxi down the runway when flying. Pretty cool to hang out in one of the stations—much thanks to MWAA, Reagan National/DCA, and all the other agencies that made this a well-put together drill!

]]> http://raisingladders.com/2010/10/apex-2010/feed/ 2 http://raisingladders.com/2010/09/washdown/ http://raisingladders.com/2010/09/washdown/#comments Wed, 01 Sep 2010 18:26:31 +0000 raisingladders http://raisingladders.com/?p=763 The frantic, comical waving stopped as soon as I was within a few feet of him. “She just stopped breathing before you got here… and I think she used to have a pulse, too!”

That’s probably a safe assumption.

As soon as MPD’s latest hero stepped from between the cars, I could see the full extent of her injuries. No, she wasn’t breathing. No, I couldn’t find a pulse. Oh, and she had so many holes in her that I didn’t have time to count them all right now. Stomach, torso, arms… she looked like an extra in a B-level slasher movie.

The wounds that concerned me the most were currently making a faint whistling sound. Two new openings to her trachea had been made, and both were leaking air as fast as we could force it in with the bag.

Someone started chest compressions. The sirens in the distance told us that we had a minute or two until the ambulance arrived, so I glanced behind me and grabbed my tube kit; as I turned around and opened the laryngoscope with a neat snap, I saw the ramifications of our first round of CPR.

With every mushy compression, more of her insides became outsides. Her abdomen had been opened with such force and depth that various parts of her which were never meant to see daylight now became available for full visual inspection.

Dammit. Well, let’s see if this works.

The tube passed through her vocal cords. I withdrew the stylet and squeezed the bag; hopefully the cuff was placed far enough beyond the wounds to make it to the lungs. Her chest rose and fell, rose and fell.

After a few more breaths, I slid my hands under her shoulders and helped lift her to a backboard. She was slick with blood, and surprisingly heavy in the way that only a dead weight can be.

Straps, bloody sheets, the thunk of the stretcher lock slamming home.

We slapped big defibrillator pads and occlusive dressings on her torso with equal speed. Behind me, I heard a radio squawk out our destination hospital as I looked at the monitor. There was electrical activity present, but it wasn’t actually making her heart move. Keep pumping.

I listened with a stethoscope to make sure the tube was in her lungs. It was properly placed, but each breath sounded like a dishrag being wrung out. Her chest was filling with blood, and the pressure increased every minute as we bumped down the road.

Our verbal report felt futile. 31-year-old female, multiple stabbing. Trachea, chest; abdominal evisceration. Pulseless and apneic on our arrival. Still no pulse, got a tube for ya.

The ER only worked her for a minute or two. A nurse approached the bed with a chest tube tray, but was waved off by a tired-looking doctor.

No, no need for any of that… time of death, 1759 hours.

—————

The smell of blood mixed with stale tank water overcomes your nostrils quickly, almost overwhelmingly. A funny thing about being a paramedic on an engine company: sometimes our versatility confounds my impersonality. Usually, it’s not an issue for me to remain clinical and detached. As providers, we’re asked to treat young and old, grateful and ungrateful all the same. Dead, living, whatever the call is; do your job and go on the next run. But even before we heard the story of who did it and why, we could tell that this was a very hateful—and very personal—attack. It turned out to be petty shit; and although I wasn’t thinking about it at the time, there’s a bit of retroactive anger and disgust when the engine is called back to wash someone’s handiwork off the asphalt. Handiwork that we lifted not eight hours ago, dripping and glassy-eyed, into an ambulance for the first of her last trips. The hearse will come soon after; the final ride may depend on what you believe in.

The ancient Greeks called for a coin in the mouth of their dead to cover the cost of the ferry to the underworld.

I hear Charon is quite particular about paying up front.

I present to you: Super Sexy CPR (also coming in June, Super Sexy Abdominal Thrusts! Main link here, slightly NSFW). If they could have made a year-long paramedic course as riveting as the following video, I’m certain I would have entered academia to study this sort of thing instead of being a street-level provider.

Maybe EMS isn’t so bad, after all.

/RL

Click on the photos below for the larger, more-readable version!

Thank you to the entire G.E.R.M.S administrative and training staff, with a special thank-you to Brendan Maggiore (VP of Operations), without whom this endeavor would never have come together. If anyone would like to see additional pictures from that day, all of them are available in this gallery on Raising Ladders Photography.

Keep up the great work, G.E.R.M.S.!

/RL

P.S. – an interesting bit of lore: on a shelf above the staff mailboxes, there is an old frame holding a conundrum of a photograph. It is, quite clearly, a glamour shot of actor Danny Glover. However, upon closer inspection, it says “To Germs, continue your great work. Danny Glover.” The strangest part? Nobody has any idea how it ended up there. Despite the photo’s prominent location for “quite some time now” (i.e. longer than anyone whom I asked remembers), there are no records, memories, or even legends of its origin. One G.E.R.M.S. member took it upon himself to look back more than a decade into the service’s employment records, interviewing and calling prior staffers about the photo—nevertheless, the search proved once again fruitless.

Any ideas?

“Ugh… you have got to be kidding me.”

On average, I say that about five times per tour. In this particular instance, I was (quite comfortably) slouched down in the passenger seat of Ambulance 12—returning from my fourth switch-out that night—when a woman ran out into the street, frantically waving one of her arms. The other, unsurprisingly, had her cell phone sandwiched to the side of her head.

I blinked twice, hard, as if to clear both the sleep from my eyes and the woman from my view. As I climbed out and grabbed a pair of gloves, I convinced myself that rolling my eyes was an Ancient Chinese Secret used to increase alertness—at least, that’s my story if anyone saw me do it.

Flaggings usually don’t amount to much. Granted, there’s the occasional “this guy was just shot,” or “she clutched her chest and fell down and now she’s not breathing,” but for the most part, being flagged down is akin to hailing a taxi on a day when it might rain: “…So, should we? Eh, maybe not, we can make it… oh, here comes one! Let’s get it anyways, since it’s here!”

Let’s not assume anything, though. I mean, she was quite the Samaritan: She ran out into the street, laughing at something on her cell phone (trust me, she was not speaking to a 911 operator); flagged us down; then barged past us into the storefront as we tried to find the patient, saying “Ooh, I gotta finish gettin’ my nails done!” Of course, she stepped over the unmoving supine figure on the ground, nearly skewering his skull with a stiletto in the process.

Quite the Good Samaritan, indeed.

Bystanders said he walked in and laid on the ground with no explanation. Okay, well he’s breathing. That’s good. Strong pulse, also good. Outwardly, there doesn’t seem to be anything physically wrong with him. Blood sugar? Well within normal limits. Maybe a heroin overdose? It’s fairly common, so let’s just take a look at his eyes…

Cue the Microsoft Word Paperclip Assistant. If you were to click “yes,” you would see a small list:

1. Do not roll your eyes in the back of your head when I lifts your eyelids. It’s a dead giveaway.
2. If I lift your hand up and then drop it, let it fall to the floor. Lowering it in a controlled manner is another silly move.
3. Please do not let me catch you opening one eye to look around at what’s going on. I will tell you to stop wasting my time, as well as the time of the other ambulance, EMS supervisor, and the entire damned engine company who you woke from a nice deep sleep.

So into the ambulance we went. As expected, the patient miraculously “woke up” moments later and said he was fine. Now grinning from ear to ear and looking at the swarm of people gathered around, he kept saying that he didn’t want or need any medical treatment. No history, no complaints, no physiological problems, and not a care in the world.

“What happened? I fell down? I must’ve just passed out… long day, you know? Ha-HA!”

“Yes, sir, I do know. (sigh) Please just sign this.”

—————

Hey, it could be worse. About a month ago, a man in Australia flagged down an ambulance (expecting just a ride, no treatment) and then attacked the crew when they wouldn’t take him where he wanted to go.

Damn. In America, the public is at least able to come up with some reason why they need to go to the hospital–whether it’s toe pain or a cough for two weeks, at least it’s a reason.

I first encountered “free taxi” syndrome when I worked in Pittsburgh. Let’s say you wanted to go visit your friend, but you don’t have a car or any money and he’s waaaay across town. So, call 911! Tell us you have something like elbow pain, and that you want to go to Allegheny General because your doctor’s there, or something. (Really, anything. As the patient, legally you’ve got plenty of leeway.) As soon as you get to ER triage, though, you can just sign out AMA* and walk to your friend’s house!

Wonderful, isn’t it?

]]> http://raisingladders.com/2009/10/fakers-flaggers-and-fighters/feed/ 3 http://raisingladders.com/2009/10/we-run-our-strips-we-go-home/ http://raisingladders.com/2009/10/we-run-our-strips-we-go-home/#comments Mon, 19 Oct 2009 19:16:11 +0000 raisingladders http://raisingladders.com/?p=151

Damn, I was just about to go to bed.

Halfway to the bunkroom to wake up the next guy on watch, the tones went off. I shook the sleep out of my head as I spun in place and headed to the desk. I didn’t catch the dispatch, so I grabbed the printout and read it as I grabbed the intercom mic.

“Engine, engine. Medical local, for the…”

I paused as my eyes finished the page a split second before my voice did. Dammit.

“…cardiac arrest.”

—————

A hysterical wail cut through the air to my left, now audible only because we had turned our sirens off. I grabbed the medical bags and started in that direction (it’s usually not a good sign, but it ain’t a bad locator beacon, either).

As I had pretty much expected, there were three things present inside the apartment:

1. some bored-looking cops;
2. a hysterical family member;
3. a motionless body.

As I passed the first, deftly avoided the second, and approached the third, one of my hands found a place near the side of her head and tried to position her airway—the other snaked up beside her neck and felt for a pulse.

I recoiled slightly; she was as cold as the sidewalk outside, and about as flexible. Rigor was setting in, so I turned to my crew (who, wonderfully, had grabbed a BVM, oxygen, and a tube kit out of my stuff) and gave them the curt headshake reserved for TV characters who have to stoically answer the female lead’s tearful rendition of “Did he make it, doctor?”

“Just the monitor, guys.”

I still feel strange running EKG strips on obviously dead folks. I mean, in certain DOA situations, our patient is exhibiting obvious “signs incompatible with life” (decapitation, dependent lividity, rigor mortis), and yet… we must prove it.

So, we put EKG stickers on cold limbs, palpate depressurized arteries, and take pink and red pictures of motionless hearts.

I folded the paper up and turned to leave. By this time, the screaming daughter had left, replaced by a much calmer son with a thousand-yard-stare.

“Excuse me.” It was barely a whisper.

“Yes?”

“So, what’s the situation?”

“Well, she’s been down for too long, so… there’s unfortunately nothing we can do for her.”

I kept it simple. I’ve tried the other route, and it doesn’t usually work out so well in these situations. So, I swallowed all the typical, feel-better phrases that I’ve heard used countless times before. They sound like bullshit, and they feel acidic in your throat.

“So, she’s gone?”

I stared for a second.

“Yes, I’m sorry.”

“Oh, okay.” His thousand-yard stare turned from me, scanned the room, and stopped on Mom.

I left without a word, seeing his back still turned on me and his head slowly nodding.

We run our strips, and we go home.