I worked at the baked-bean supper for the fire department tonight. rabidkitten and the kids didn’t go. We’re apparently the only vegetarian family in town and I’m trying to break in the FD easily; in the meantime, there isn’t much for the family to eat at the FD suppers.
I had suggested doing something special for Valentine’s Day at the last business meeting and was appointed cruise director for my troubles. I picked up bags of conversation hearts and M&Ms, plus some red doilies and tablecloths. It was swellish. The kids dug it.
We had a huge turnout; about 200 people; almost twice as many as usual.
As I was wiping down tables, one of my pagers went off, not the FD pager, but the one from the town to the north. I told the chief I was heading out. I listened to the tone on my way out the door; woman fell and hit woodstove, bleeding profusely, unconscious.
I got in my car and started to call in; my radio battery was dead. I hopped out and went inside and asked the kitchen full of brother and sister firefighters to call and say I was on my way. Mrs. Turquois, who happens to also serve on three of the same services I do, offered me her portable radio.
Off I went. On the way, an ex-member of the rescue squad in the town where I was heading signed on. Weird; I’d never met her, but welcome.
I thought the circumstances related in the call sounded odd, so I asked dispatch if law enforcement was on its way. Dispatch replied that LE knew about the situation and was not planning to come unless I requested them from on scene.
Fine. Crossed fingers it’s not a domestic.
I briefly considered stopping for the rescue truck, but finally decided against it. There could be burns; I might wish I had a burn sheet. The rescue barn was on the way, but it would have added a minute or two to my response time. Bleeding profusely and unconscious sounded like symptoms that might need timely assistance, though, so I decided to go for it with the tools I carry in the car.
Dispatch called and said that ETOH was involved; alcohol.
I got to the house, pulled into the door yard. I left the strobes on to aid the other rescue person and the ambulance, grabbed my bags, and went to the house. There was a woman on the porch. I asked her what was going on; she said her mother had been sitting on a stool, her eyes had rolled back in her head, she had pitched off the stool onto the woodstove. The stove was not lit.
Good and bad. Good; no domestic, no threat to me. No burns. Bad, some underlying issue before hitting the woodstove. Unconscious.
I went inside.
An elderly woman was on the floor in a puddle of blood. A man was holding a dishcloth to her head. Her eyes were fluttering.
I spoke to the patient; no response. Bad. I asked how big the cut was. Big, they said. I didn’t care to look for several reasons; primarily, I didn’t want to disturb any clotting action by peeling the dishcloth off her head. Too bad; the guy holding her head wasn’t too articulate.
So I peeled. There was a big gash, but not huge. Inch and a half to two inches, maybe. It was deep, though, and lots of blood was coming out. I had the guy start to apply direct pressure again and took a pulse. It was high and irregular. Real high. I started to take it again just as the other rescue person came in with her boyfriend. They got right to work. She took over the head while he started getting my O2 rig put together. I took the pulse again; still high. We put a collar on the patient; it didn’t fit. I picked a second size and put that one on.
Meanwhile the guy that had been holding the head was yelling, “Name, open your eyes!” I say ‘Name’, not just for HIPAA reasons, but because even though I heard the name yelled over and over, I was preoccupied and I just can’t recall.
Her level of consciousness was diminishing. She was no longer fluttering. I checked her pupils and they were fixed and constricted. Better than fixed and dilated, but still way not good.
The ambulance got there and we put the woman on a board. The other rescue person’s boyfriend, while able to set up oxygen, turned out to not be an EMT. I thought he was, so I had him grab the torso to roll onto the board. The other rescue person had the head, so she called the roll. Boyfriend didn’t know what to do and the woman’s spine ended up being pulled out of anatomical position; not necessarily bad in this case. Spinal precautions were just that; a precaution. I would tend to think that she would not have a spinal injury from the mechanism of injury; still, I thought the roll sucked. I had to lean over and pull up on the woman to get the board under her. We used so-called parallel parking to get her into the right position on the board, threw on the straps and blocks, loaded her onto the cot, got her out of there. Threw her into the ambulance, slammed the doors, off they went.
The other rescue person and boyfriend left to take the daughter to the hospital. I put my gear back in order.
Some drunk dude came by a couple of times and asked me if I had seen 'Guffman' (obviously, not his real name). I hadn’t. I had no idea who the guy was. I said that maybe he had gone with the rescue person and the daughter. At that time, I thought maybe the boyfriend drove the ambulance; I knew someone other than the ambulance crew had driven to allow the second EMT to work in back. It was chaotic.
I put my stuff back in the trunk, called off scene, and started to back out. The dude came back up to the car and asked if there was any way I could find out if Guffman was in the car with the other rescue person.
Sure, I can do that.
I called her up on the radio and asked. Nope, no Guffman, just the daughter and boyfriend.
Sorry, pal. Good luck.
Then, glancing up, I saw a body slumped behind a pickup truck, lit by my headlights. I had a pretty good idea this was Guffman. I pointed him out to the dude. The dude went on over.
I called back on scene, then grabbed my bags and went over. Guffman had had an unwitnessed collapse and had been out for several minutes. I took a look at comatose Guffman and called for a second unit; another ambulance.
Guffman started to come around. Dispatch called and said Guffman had an undiagnosed cardiac condition; garsh only knows where that info came from. Guffman started to huff; you could see an anxiety attack building like watching a train come from across the way.
Dude explained that Guffman was having a bad few weeks; a parent died last week, the second, and last, in a year’s time. The patient we had just worked was his mom-in-law with whom he had a very close relationship. He was the guy holding direct pressure when I came in, and the yeller after we took over.
I started getting my o2 out and ready. Dude was trying to calm Guffman. Guffman was fixing to blow.
Finally he did; he started thrashing and swinging at both me and dude. I called dispatch for help; the guy was out of control. Help, of course, was at least ten minutes away.
After a fashion, the attack subsided. Dude and I convinced Guffman to breathe some oxygen.
And that was the best I could do. Guffman didn't want me to touch him; I didn't want to further upset him. I insisted on the occasional pulse check. My oxygen cylinder ran out.
A few minutes later, Mrs. Turquois arrived, then the ambulance. Mrs. Turquois had left the supper when she heard me call for help.
Guffman decided he was okay and refused transport despite the urging of the dude, other friends, Guffman’s son, and four EMTs.
I could tell Guffman felt really uncomfortable about losing it. After Mrs. Turquois got on scene, I made myself scarce to minimize his discomfort. I stayed in the background while she and then the ambulance squad spoke with him. He was having a hard time with the events of the past two weeks and kept having to stop and sob. I felt really bad for him. It’s really difficult to deal with other people’s grief; I doubt I’ll ever get used to that.
After signing the refusal, he thanked the ambulance guys for coming. He came over to me and shook my hand and thanked me.
I was exhausted. The first patient was the fastest transport I had ever worked, then the Guffman thing… The Guffman deal was from left field.
I had blood all over me from the first patient; my sweatshirt, my pants. On my tools. Inside my trauma bag.
I felt good about the first patient, but I’m not happy about the Guffman scene. I’m not quite sure why, yet.
I felt weird for asking for the ambulance and having the guy refuse transport. I apologized to the ambulance crew for making them come out; they said it was the right thing to do.
I think it was; if the guy had coded, it would have been good to have the ambulance on the way. I still have no idea of how long the guy was passed out in the snow but it must have been at least five or ten minutes.
I feel worse about being stressed on the radio, actually. I was most assuredly not calm when the guy became combative; everyone within radio range knows that.
UPDATE: Today I had a phone call from the woman who, along with her husband, runs that particular squad (not the woman I refer to as the ambulance lady; she's the head of my primary squad; the fire department, though located in my own town, is my second squad, and this squad is my third squad). The daughter of the first patient, who is also the wife of the second patient, had called the ex-member to thank us and, apparently, to praise my skills. The daughter was sober last night, as it turns out. She specifically commented on my politeness, professionalism, and manner while dealing with the crowd of people in various degrees of intoxication... Very nice, considering that this woman has her mom and husband to worry about today. The ex-member called the third-squad lady to pass along the compliments and to add some of her own; she, too, thought I handled things well. The third-squad lady immediately called me, since, as she said, we rarely get compliments and she wanted to make sure I got mine fast. It really made my day.