Category Archives: Trauma

Burning Questions 3/5

As we clear from EPS we are sent further from the big city and the chaos that has already started to get ugly. Our first deployment of tac-medic units are already at the staging area near downtown. They are getting pared up with their counterparts in PD and FD to create mobile task forces for civil unrest response.

I’m scheduled for the second deployment which should be in maybe ten hours, only two hours after finishing this shift. This could be a very long day.

As we drive away from the city we are monitoring four radio frequencies: our regular EMS station, EMS tac-channel, PD tac-channel, and local news reports on an AM station.

The crowds have grown to over 500 with smaller groups smashing store fronts, looting businesses, and setting garbage dumpsters on fire. PD is maneuvering skirmish lines of police in riot gear to contain the worst of them. On the PD tac-channel we hear the yelling from the crowd, the bottles smashing as they are throne at the officers, the M-1000s exploding near the skirmish line (very large firecrackers throne by the rioters.) Three armed men are maneuvering in the crowd; they have paper masks with the depiction of the face of the man killed by an officer just 18 months ago. The officers give the order to don gas masks, they ignite smoke grenades at their position to cover a strategic redeployment (retreat).

The dispatcher comes up giving us a call. We’re in the city furthest from the chaos so it will be unrelated to the craziness going on thirty miles away. With all of the radio traffic going on at once we couldn’t hear the nature of our call. I turn down the extra frequencies and ask our dispatcher to repeat our call information.

“You’re responding to a male patient, victim of a shooting, your scene is not secure, please stage out.” Seriously? In this city, what the hell!

Before we get to the neighborhood our dispatcher comes up again. “You’re scene is now secure, PD is on scene, you’re clear to enter.” Fabulous…

As shootings go this was about as basic as they come; a man in his twenties, wearing the wrong color shirt in the wrong neighborhood, shot by three men in a moving car that sped away. It’s your classic drive by shooting. Strange how I take comfort in the familiar at times like this. It’s a small caliber GSW (gun shot wound), apparently through and through, to the calf. It may or may not have grazed the bone but everything distal to the wound is moving and perfusing. Bleeding is controlled with just a few pieces of gauze and a wrap of kurlex. I would give him some morphine for the pain but he came pre-medicated with alcohol and weed. I just need to monitor him for changes while transporting him to the ED.

I load him up and take him code-2 to the nearest hospital. Perspective is an amazing thing. This county has so many GSWs (3 in the last two hours) that we don’t even trauma activate the patient if the wound is below the elbow or knee. These patients get a slow ride to any basic ED. Once I arrive and give a quick report to the charge nurse she orders a lock down of the ED. All visitors are told to leave; more security guards are positioned at the closed entrances which are secured. They are protecting the victim, and staff, from any potential follow-up violence.

It’s happened before; gang-bangers returning to the scene of a shooting when they realize they didn’t quite kill the guy, or walking into the ED to finish the job. Another paramedic in county was holding c-spine (hands on either side of the patient’s head to prevent spinal injury) when a shooter returned and shot his patient point blank in the head, the bullet passing within inches of both of the paramedic’s hands.

Sitting at the EMS desk in the ER I’m working on my paperwork for this call while listening to the PD tac-channel on my portable radio. The riots are getting worse; more arrests, more fires, more looting. The tension in the officers voice is high as I’m listening to them redeploy platoons to box in the most violent of the rioters. Nurses and doctors walk over to stand close enough to listen to the traffic on my portable radio exchanging worried looks between themselves and texting love ones to let them know they are okay.

Clearing the hospital we are told to report to our main deployment on the edge of the big city. It’s near the end of this shift and they are switching me to another unit to head into the city. Katie is relieved as she’ll be going home soon. I’m not sure what I’m feeling as I prepare my equipment on the drive back towards the chaos.

Burning Questions 2/5

My neighbor’s college age son and his friend take over the grill. The first round of food is done so it’s a little slower. I sit in a chair next to Darren who’s holding his infant son in his arms as he sleeps.

We talk in quiet voices about the chaos of the last few days. We share a bond from all of the calls that we’ve handled together. We take comfort in having a sympathetic comrade living just three doors away. The rest of our neighbors on our street are completely ignorant of the street life that we frequent in our working hours. They watched the news and saw the watered down version of what happened. Darren and I know the real story yet we keep it to ourselves as most people are uncomfortable with reality.

This suburban neighborhood is sheltered from the poverty and desperation of the inner city. With our manicured lawns, home owners association, community pool, and golf course weaving throughout the neighborhood we are a microcosm of self imposed delusion.

Darren and I are interlopers in both worlds; chameleons that quietly navigate between two realities. Blue collar workers living in a white collar neighborhood; our names stenciled on our uniforms, on a first name basis with the homeless, addicts, gang-bangers, and prostitutes of the city. Yet also the friendly neighbor who offers to take the garbage cans in from the curb, picks up the newspaper, and dog sit when others are on vacation.

Darren quietly voices concern for his children; wondering how he will impart the realities of life to them while protecting them from the very same realities. I don’t have a good answer for him, it’s a dichotomy that parents first struggled with shortly after the first city was settled and supported by the produce of the surrounding farms. Sitting in the shade watching the smoke from the BBQ, happy children playing, friendly neighbors talking, infant son asleep on Darren’s chest, we share a comfortable silence and a beer.

Burning Questions 1/5

burn·ing

1 :  marked by flames or intense heat: a burning fire

2 :  characterized by intense emotion; passionate: a burning desire for justice

3 :  of fundamental importance : urgent <one of the burning issues of our time>

 

ques·tion

1 : an interrogative expression often used to test knowledge.

2 : to express uncertainty about: doubt

3 : to dispute; a challenge

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The wind changes direction, smoke and flames blow towards my outstretched arm. I pull it back just in time to save what little arm hair I have. I don my flame resistant glove, pick up my flat metal tool and dive back into flames from an upwind direction. One minute later my perilous task is complete; all of the hamburgers have been flipped and repositioned to avoid the sudden flair up. Didn’t even spill my beer, nice!
Darren comes over, attracted by flames as most firefighters are, and helps to offload some of the finished burgers. Darren’s wife organized the block party and my wife is helping by setting up the tables and taking food orders on her iPhone.

Most of the families on our street are here in the cul-de-sac on a Sunday with perfect weather. Cones block the street from traffic; kids are playing soccer and drawing on the street with giant pieces of chalk.

A few days ago Darren and I were watching flames throughout the big city where we both work. Darren’s a lieutenant on a fire engine with quarters next to the elevated commuter train station where this whole mess started. As a paramedic on an ambulance in the 911 system I run into Darren a few times a month when we get called to the same job. A few days ago I was posted at the same commuter train station when the page came out to the whole county. The jury is expected to read their verdict in one hour. Darren got the same page while enjoying a day off by playing with his young daughter and newborn son. He grabbed his jump bag and made the 40 minute drive into the city.

I’m looking at the train station through the windshield; all of the windows covered with plywood to protect against the potential for civil unrest. As this is expected to be ground zero; my partner and I decide we need to be somewhere else. Anywhere but here!

Just then the dispatcher comes up on the radio and we get a call; a car backed into a young woman, pinning her to another car in a parking lot. The car took off; hit and run. The young woman has minor injuries and PD was called but I don’t expect to see them any time today. I know they’re currently mobilizing to full deployment. She’ll have to file a report at the hospital.

On scene we exchange apprehensive comments with the fire fighters about what the next few hours will bring. Once at the hospital the same conversations are shared with the ED staff. Out in the parking lot to the ED they are manning their MCI (mass casualty incident) tents with decontamination showers used for pepper spray and tear gas exposure.

Katie, a part time EMT, picked up my unit today as my regular partner took the day off for a class. Katie wants nothing to do with the big city today. I volunteered for the tac-medic units which are sent into the ‘warm zone’ with PD escorts. But if Katie wants out I’ll do everything I can to make it happen. I call our dispatch center on my cell to make the request. They made contingencies for this; almost half of our staff volunteered to work the riots so there’s no reason to send someone there who is uncomfortable with the impending chaos. We get cleared to head towards the quieter cities on the other side of the county.

Before leaving the ED I open my jump bag with my riot gear and don my ballistic body armor. Although it makes me feel a little better it just makes Katie more nervous. I need to get her out of here ASAP!

On the way to our post on the “safe” side of the county we get a call assigned to us based on our GPS location. We didn’t make it out fast enough; the freeways were parking-lots because most of the businesses in the city closed early to allow people to get out before the chaos.

Katie is getting pretty worked up as we drive to the urban sprawl gang infested neighborhood just outside the city. We pass the apartment building where 3 officers were killed last year and the street where two more were gunned down on a traffic stop. But this isn’t that kind of job; this is a basic call for a woman on a psych-hold by PD. Nothing medical going on here so I assign a BLS (basic life support – EMTs) unit to transport the patient to the county EPS (emergency psychiatric services), thinking that maybe we can clear the scene and continue our escape.

Dispatch has other plans; they immediately send us to another call closer to the city. This call could be a carbon copy of the last one with the only difference being that I have no BLS units available for transport. I’ll have to take this guy to EPS myself.

As I’m walking the patient to the ambulance with two officers I hear a shooting go out on the police radio. Katie’s eyes get big and round. The location of the shooting is only 4 blocks from our last call. We were driving past that street just a few minutes ago. The officers’ jump in their cars and take off; lights on and siren wailing.

I transport immediately; the city is becoming increasingly chaotic, Katie is getting worked up, and EPS is further in the right direction to get us out of the city.

Blunt Force Trauma

blunt

1: having an edge or point that is not sharp

3: slow in perception or understanding; obtuse

2: Slang: a cigar stuffed with marijuana.

 

force

1: cause of motion or change

2: an agency or influence that if applied to a free body results chiefly in an acceleration of the body and sometimes in elastic deformation

 

trauma

1: an injury (as a wound) to living tissue caused by an extrinsic agent

2: an agent, force, or mechanism that causes trauma

“Okay Ronald, you need to calm down and listen to me for a minute. Things are going to start happening very fast and I need you to focus. I know you can feel your heart beating way too fast and it hurts.” My cardiac monitor, sitting on the captain’s chair over Ronald’s shoulder, spits out a second 12-lead strip. Same interpretation as the first one: ***ACUTE MI SUSPECTED***
“I need you to chew up these aspirin while I explain what’s going on here. Whatever was in that blunt you smoked, maybe crack or meth, is making your heart beat too fast.”

He’s scared, staring at me with big, round, bloodshot eyes with that “doom” look that I’ve seen often with cardiac etiology. His heart is racing at 166 beats per minute, irregular, and his blood pressure is through the roof at 210 over 120. He smoked 20 minutes ago with some people he didn’t know and the weed came from an unknown source, so he has no idea what it was laced with.

When he told them he needed an ambulance they told him to “get the fuck out!” He called 911 from his cell phone a few blocks away.

Given the fact that he’s only 32 with no cardiac history it’s likely that his heart just can’t handle the fast rate and it’s causing some localized ischemia. Regardless of the etiology – whether it’s just the drugs or the unlikely occlusion of the coronary artery – I’ll activate him to the cardiac receiving center. They’ll have a cardiologist standing by when I get there to decide if he gets a trip to the cath lab or just monitoring until he calms down.

The siren starts to wail as we pull out of the parking lot where he sat waiting for us. I figure I’ve got maybe six minutes until we get there, just enough time to do what I can for him.

I hit transmit on the cardiac monitor and dial in the cardiac hospital. Bouncing down the road I place his hand on my knee and lift my heel up off the floor, making my leg an extra shock absorber so I can match the bouncing of the rig. As the needle finds a vein and gets a good blood flash I hear the monitor doing a modem handshake with the hospital to transmit my 12 lead.

Nitroglycerin and morphine are contra-indicated for his heart rate. It took a while to get used to that footnote in the protocols when I switched to working in this county because in my previous county it was part of our protocol. But so be it, I’ll play by the rules.

Fortunately we have decent sedation protocols for extreme anxiety, and I have just enough time to get two rounds of Versed on board before I get to the ED. Admittedly, I feel a bit strange treating a possible MI with a sedative but that’s what he needs right now. Ronald is really worked up, half from the unknown drug and half from the reality of the situation.

Versed is a decent drug – it’s used for procedural sedation in the hospital, like doing a reduction on a dislocated shoulder – give enough of it and you can put someone completely out, give just a little and it reduces anxiety. If you can titrate just right and walk the line between the two you can put someone in a very relaxed state yet they can still interact. It also has amnesia properties so people may not remember the pain they experience. That’s what I’m shooting for with Ronald but he’s a heavy guy so I don’t think I have enough time to get him there.

Backing into the ED another crew who heard us coming in code-3 opens the back doors and helps me unload the gurney. Walking into the critical care room the cardiologist comes in holding my transmitted 12 lead. I hand him the two follow up prints while I give a quick run down of the treatment I did and how Ronald responded.

They do a full cardiac work-up on him, and run their own 12 lead which comes out with the same interpretation. I always feel a little better when their machine and mine say the same thing.

They draw blood and send it to the lab to look for elevated troponin levels, the byproduct of distressed cardiac tissue. They’ll also run a tox screen to see what was in the blunt. Walking out, after giving a report to the staff I hear the cardiologist make an order for Ativan, another sedative. The ED has better drugs than I do but at least I got Ronald to the right place and started him in the right direction.

Off to the next call – my pager is buzzing on my belt and my dispatcher is chasing me out of the hospital for the calls that are stacking up.