Tag Archives: man hunt

Heart Attack 2/2

There’s a saying in paramedicine: trauma is trauma. Basically that just means that it is what it is. Unlike a complex medical emergency with co-morbid factors on a patient with chronic conditions who takes ten medications, treatment for trauma is actually pretty simple. If it bleeds, plug it. If it’s floppy, splint it. Then go find a trauma surgeon quickly. Yet the real nuance to effective trauma care is staying ahead of injuries by anticipating problems before they happen and caring for the injuries that you can’t see.

All of Maria’s vitals are recovering nicely and she’s answering my questions well enough, although she’s understandably in a lot of distress and on the verge of freaking out on me. I made sure to apply the occlusive Asherman dressing to the chest wound. In a perfect world that will reduce the risk of a collapsed lung. In the imperfect world that I live in I’m not certain I could do a needle decompression to re-inflate a lung on Maria because she’s just too fat. But for now she’s breathing effectively in all lung fields.

I call my vitals up to Kevin as all of my assessments and treatments are pretty much done. I just need to start a couple IVs before we get to the ED. I take the oxygen mask off of Maria, as her saturation is at 100%, and put on a nasal cannula that tracks her expelled CO2 and gives me a visual waveform of each breath. I’ll be able to see a change in respiratory effort if she develops any complications.

She’s still a little scared and crying now and then. I cover her up with a blanket and tuck it around her shoulders. On one hand I want to stay ahead of the impending shock symptoms by keeping her warm yet on the other hand the simple act of tucking a blanket around someone tends to calm them. Despite the constant bouncing of the rig and melodic whine of the siren Maria seems a little more relaxed.

“Maria, you’re doing really well. I’m just going to start a couple IVs in your arm. You can help me out by talking to this nice officer over here. She has a few questions for you.”

The officer has been waiting patiently for me to finish my initial assessment and treatment. Hearing my prompt she stands up so Maria can see her and begins the question process.

“Maria, who stabbed you?”

With tears rolling down her cheeks she answers. “My boyfriend…”

I’m in my own little world as I preform the rote task of starting IVs and reassessing vitals. It’s strangely calming to have a single task in front of me as I’m a fly on the wall listening to the back and forth between the officer and Maria, as she tearfully describes the melodrama of an argument that escalated to attempted murder.

As Kevin and I push the gurney into the brightly lit trauma room we’re met by a room full of hospital staff. Fresh baby docs are pacing nervously wondering who gets to do the chest tube today, seasoned nurses are leaning against the wall, thinking about the twenty other things they should be doing while they are interrupted by this trauma, and the stoic teaching docs are standing in the background to observe everything and be ready to jump in the second before someone makes a mistake.

“Good morning, this is Maria…”

The officer was able to get suspect information before we even reached the ED. His name, vehicle description, address, and associates were relayed to police dispatch during the trip. By the time we rolled into the ED police were already on the man hunt. I heard the police dispatch tell them that he has prior warrants for violent crime and to consider him armed and dangerous. I stood in the corner of the trauma room with the officer who rode with me and explained what the doctors were finding as they did their assessment.

A quick sonogram showed that Maria had plural effusion – excessive fluid pouring into the lungs. And then a second pass showed that the knife tore open the pericardium – the sac that surrounds the heart. The fact that Maria was a large girl actually saved her life. Had she been any smaller the knife would have punctured the heart. She was up in the operating room before I even finished my paperwork. By the end of my shift she was recovering in the ICU and the (now ex) boyfriend was in custody. Had the officer not come with me the suspect information would have been delayed until after the anesthesia wore off and that would have given him a 6 hour head start.

 

 

Heart Attack 1/2

heart

1 : a hollow muscular organ that pumps the blood through the circulatory system by rhythmic contraction and dilation

2 : regarded as the center of a person’s thoughts and emotions, especially love or passion

at·tack

1 : to set upon with violent force

2 : the act or an instance of attacking; an assault

Passion is the enemy of precision. Forget the misnomer ‘crime of passion’. All crime is passionate. It’s passion that moves the criminal to act, to disrupt the static inertia of morality.

Daryl Zero; The Zero Effect 1998

Kevin angles the rig behind the BRT in the parking lot of the apartment complex and puts it in park with the strobes still flashing. I can see the firefighters grouped around some shrubs and by their actions I can see it’s a serious call. All scenes that we go to have a vibe and once you get used to reading body language you can usually tell how serious a call is before even getting to the patient. Bags are open, oxygen is about to be administered, clothes are being cut away, officers are asking questions of bystanders, the police dog is barking from the back seat of the K9 unit… this is a serious call.

Kevin looks over at me, “Just go, I’ll grab everything.” It’s my tech and Kevin knows I want to get to the patient and start my assessment and treatment quickly.

As I walk up to the shrubs I see an officer holding her hand on the patient’s chest. Judging by the amount of blood covering my new patient’s clothing it appears that the officer is holding direct pressure on a wound.

The fire medic is applying the oxygen mask as he looks up at me. “We just got here a second ago. Looks like a penetrating wound to the chest; maybe a stab wound. Unknown downtime; she was found a few minutes ago by a bystander.”

The bloody shirt is finally removed and I ask the officer to lift her hand briefly so I can visualize the wound. She lifts up her bloody glove and I clear off some of the blood with a dressing. I see a three centimeter horizontal stab wound just to the left of the sternum. Pushing my fingers into the chest for landmarks I find that the wound is directly over the 5th intercostal space and it’s likely the knife slipped between the ribs. Judging by the length of the wound the knife likely traveled pretty deep. Crap! That’s a bad place to miss the ribs!

I look over to the rig just as Kevin rolls the gurney next to the shrubs. “I need an Asherman and C-spine.” Kevin nods and rushes to get the supplies, returning in just a few seconds. Kevin and I tend to truncate our communication to the bare minimum on stat calls. More often than not we’re thinking the same thing and we really don’t need to verbalize most things during treatment. It makes things flow so much better when partners are on the same page and have worked together for a while.

As we cut off the rest of my patient’s bloody clothing and look for any additional wounds, I try to get a baseline on her mentation. She’s not tracking with eyes or answering questions yet she has spontaneous, erratic movement of all extremities. Actually a little too much movement – she’s slowing down our attempts to strap her to a board. I look forward to the day that we adopt a protocol that allows us to forego spinal immobilization when a patient presents with no neurological deficits. But for now we have to do it based on an abundance of precaution.

With my patient strapped down and the occlusive Asherman dressing applied, we’re ready to start transporting. It takes four of us to lift the gurney as my new patient is a bit on the obese side. I’m at the head as I push her towards the ambulance. She yells out as we lift the gurney and her big round eyes look up at me with a terrified gaze as she locks onto my eyes.

I smile down at her. “Hi, I’m KC, what’s your name?”

“Maria.”

“Maria, we’re going to the hospital because you got stabbed. I’ll ask you some more questions in a minute.” We load the gurney into the rig and I turn to Kevin before jumping in. “Code-3 trauma to Big City Trauma Center, I’ll get you vitals on the way.” Kevin nods and goes up front to drive.

I turn to the officer that was holding pressure on the wound. “She started talking just a second ago. Do you want to come with us?”

The officer gives me a big smile as she pulls off bloody gloves and tells her sergeant that she’s going to ride with us to the ED. There are usually only two reasons to take an officer with me: to get suspect information, or to witness a dying declaration. As we pull away from the apartment complex I’m hoping it’s the former. I’d really rather Maria didn’t die on me.


Candy Man 2/2

The dispatcher comes up giving us a call back in the “Flowers.” We call it that because all of the streets are named for different flowers. It’s also on the list of spots to avoid today. “Medic-40, respond to 1055 Rose St. for the 242, unknown assault. Please stage, your scene is not secure.” Fabulous!

Louis punches the address into his GPS and starts driving. I reach back into my bag and pull out my body armor. We’ve been partners for a few weeks but he hasn’t seen me pull this out yet.

“Oh that’s just great dude, where’s mine?”

“Sorry man, I think yours is at the store waiting for you to buy it.” We have a fun banter throughout the day — our way of releasing some stress. Maybe it sounds twisted but everyone I’ve worked with is like this; we make snide comments, totally inappropriate observations, and have some pretty dark humor before and after a call. Once we’re on scene and in the public’s eye we are 100% business. It’s a coping mechanism that seems to work.

Before entering the Flowers our dispatcher tells us that the scene is secure and we’re clear to enter. That didn’t take long; probably because the whole police force is mobilized right now.

Covering the last few blocks to the call I can see people standing in front of houses for maybe four blocks. The whole neighborhood is outside to see if this is the guy from the manhunt. I’m sure everyone in the city knows what’s going on right now.

As we pull up I can see firefighters on the corner treating a person with blood on his head. Louis and I have already talked about how we’re going to handle this one. Despite what the dispatcher says, there is nothing secure about the city today. So we’re going to hold our scene time to a minimum and treat every call as a “load and go.”

Walking up I see a small pool of blood on the sidewalk, an eight foot pole with cotton candy bags tied to it, and a man in his twenties getting put on a back board. The fire medic tells me that this is one of the street vendors that walk around selling stuff (usually ice cream or candy) in the urban neighborhoods. He has a bicycle horn tied to his pants with a string — he honks it as he goes up and down the streets to let the kids know he’s around. Two guys jumped him for his cash — a totally random act of violence, and particularly low considering that this guy probably only makes $50 or $60 per day. Looking at the pole with the candy on it I’m even more disgusted — the pole is still half full, so they couldn’t have gotten more than twenty or thirty dollars.

As we’re strapping him to the board I just can’t help myself; I honk the horn. Well, I guess I’m not always appropriate on scene. That seemed to lighten the tension a little with the other firefighters and PD that are standing around us. I get questions about the vest and nods of approval; today it’s very appropriate.

We load him in the rig, I jump in after him, and I tell Louis to take off. Eight minute scene time — not bad! It’s not a trauma activation but we don’t want to hang out in the hood any more than we have to today.

We’re driving out of the Flowers without lights or siren; it’s a Code-2 trip to the closest hospital. I do my secondary assessment which reveals nothing new — just the minor bleeding from a laceration to the left orbit and some swelling to the cheeks. I’m doing my assessment and talking to Jose, my new patient, in my pigeon medical Spanish. I learned to do a pretty good Spanish assessment when working in the rural county where I interned, which had a large migrant field worker population.

I give Jose an ice pack and he’s able to hold it to his cheek as I put a sterile dressing on the laceration. As I’m reassuring him that everything is fine and this is all just precautionary he starts to cry; he’s getting very emotional and scared. I think I see what’s going on here.

“Señor, soy un paramédico no un policía, todo es bueno.” I look out the window to see that we’re out of the Flowers so I pull the Velcro straps on my vest and take it off. It says Paramedic in big letters on the front and back but even still I look like a cop to him. I want to take it off to make him feel a little better.

I still remember being in the rural county with my preceptor on Halloween. We thought it would be fun to hide in the ambulance, parked in front of our quarters, and wait for the trick-or-treaters to ring the bell. Then I hit all of the lights on the rig and my preceptor jumped out and scared the kids. It had an unexpected result as the children of the migrant farm workers ran off screaming, “AAAHHH policía, policía!” Poor kids, I really felt bad about that — we forgot about the badges that we wore in that county. No way in hell I’d wear a badge in this county — it’s already too dangerous.

¿Medicamento para el dolor, la morfina?

He declines the Morphine. No candy for the candy man today. He’s still pretty emotional but at least it hasn’t gotten worse. I suspect I know what’s going on. I’m going to assume he has a questionable immigration status. Most of the people that work this type of job do — not all, but it’s a high probability. These are the kind of people who want to fade into the background and not be seen by the authorities. The new laws in Arizona have made a lot of people in my state very nervous. Then, through a random act of violence, this hard working man is all of a sudden looking up at three flavors of uniforms from the light bar fraternity — pretty much his worst nightmare. Possibly that’s why he declined the Morphine — he wants to keep his wits about him as he’ll be answering a lot of questions for the next few hours.

He was also evasive when I asked his address. I need it for my paperwork as we picked him up from a random corner. I was thinking my pigeon Spanish wasn’t working so I typed the question into my iPad and it spoke it to him in a very suave Spanish voice. It practically scared him to death. I don’t think this guy has much contact with technology. And to have an iPad ask him where he lives was too much.

We roll him into the same trauma hospital where the officer is still in surgery upstairs. Sitting in the triage room I get the attention of the triage nurse by squeezing the horn which is still attached to Jose’s pants. She gives me the coldest stare possible. Crap, I’ll be blackballed on the nurse network by the time I clear the hospital.

As we roll him into the room we are met by his nurse. She’s a traveler that I haven’t seen here before. We have a nursing shortage in the state so many temp workers from other states — and even out of country — are paid a premium to relocate and work in our hospitals for six months at a time. She’s probably brand new to the city, and she has a thick English accent. She greets him and he shakes his head.

“He doesn’t speak English.”

“Well what language does he speak?”

“Welsh…” I can pull off a deadpan delivery pretty well.

She stares at me with a confused look for a while until I tell her it’s Spanish. If she sticks around she’ll eventually get my humor and she’ll be speaking pigeon medical Spanish. I tell her what happened and finish by telling her that he’s very scared right now and what I suspect the cause may be. She calls for a translator to reassure him that his immigration status has no bearing on our treatment and we do not share records with INS.

On the way out I get an update from the underground nurse network that the officer is in critical yet stable condition. The news from dispatch is that the shooter is still at large. Back at the rig there are a few clean cut guys in casual clothes standing by the ER entrance.

One of them asks me how to get in to the ED. I ask if he’s with East Side PD; he nods. My heart goes out to these guys. It was just like this last year when the four officers were shot. All of the off-duty guys showed up at the ED. You need a uniform to get past security to the ED so I escort them through the hospital to the area where they usually set up a room for these guys.

What does it say about the city that they actually have a protocol in the hospital to accommodate this kind of tragedy?   

24 hours later the shooter was taken into custody without incident as he attempted to cross the Mexican border. It appears that the officer may recover.

 

 

Candy Man 1/2

can·dy

1 – a rich sweet confection made with sugar and often flavored or combined with fruits or nuts

2 – cotton candy; a large soft ball of white or pink sugar in the form of thin threads, which is usually sold on a stick and eaten at fairs and amusement parks – UK see candy floss

3 – verb; to sweeten – make pleasant

 

man

1 – an individual human; especially : an adult male human

2 – one of the distinctive objects moved by each player in various board games

3 – verb; to supply with people – as for service – man all stations

4 – a male pursued or sought by another, especially in connection with a crime: Inspector Bull was sure they would find their man

“Hey, look out the back window at the other side of the freeway!” Louis yells to me from the front of the rig.

Looking across the freeway I see at least 10 police cars, lights blazing, speeding back to the neighborhood we just left. I have a patient in the back of the rig with me but he’s stable so it’s just a routine call. He threw his back out when he attempted to move the dresser, chasing a mouse. It’s a flair-up of an old injury. After some Morphine for pain and Versed for anxiety he’s resting more comfortably and I’m working on the laptop. Considering he was curled into a fetal position and resisting any effort at movement when I met him this is quite an improvement.

Louis and I have been partners for a few weeks now and he’s pretty much the best EMT partner I’ve ever had. We get along great and have a lot of fun at work. He jokingly calls me The Candy Man because I use so much Morphine in my treatments. He says that he’s watched more Morphine use in the last two weeks than in his previous two years on the job. He seems to think that I’m single handedly responsible for the nationwide Morphine shortage.

Hey may have a point, but it was burned into me by my FTO (field training officer) when I switched to working in this county. “In this county we treat pain!” Okay, copy that. The protocols are flexible enough to allow it and I honestly feel better being able to help someone. It’s not uncommon to spend an hour waiting to see a nurse — even when transported by ambulance — so I can at least make that wait a little more comfortable.

Louis yells back over his shoulder again. “Officer involved shooting, turn your radio on.” I always keep my radio on my belt with the mic clipped to the front of my shirt. Usually when I have a patient in the back I have it turned off as Louis can monitor the radio for anything that may pertain to us.

I hear the tail end of the dispatch. “Medic-20, Medic-44, respond to 1059 Tulip Street for the GSW, possible officer involved, multiple vics. Please stage out, your scene is not secure.”

We listen to the trauma drama play out on the radio as we drive to the hospital on the other side of town. The Highway Patrol is setting up observation posts at the bridges and major freeway connections. The County Sheriff is crossing jurisdiction to back fill the Big City with officers as everyone is on a man hunt for the shooter who is still at large. His description — including some very distinguishing tattoos — as well as the license plate number of the car he stole at gunpoint (car-jacked) are paged to all of the EMS staff.

By the time I finish my paperwork at the hospital we have a little more information as the underground nurse network has been mobilized. Many of the ED nurses work in more than one hospital in the city so they have cell numbers to people all over the city. In less time than a teenage girl can text her BFF, a network of texts spreads information across the city. I think it’s actually a little more reliable than my dispatcher sometimes.

Apparently, two detectives from a neighboring city in the county were attempting to serve a warrant on a known gang member in our Big City. He shot one of the officers and tried to car-jack a car. When that person attempted to speed away he shot at the car and then successfully car-jacked a different one. The injured detective’s partner threw him in the cruiser and took him directly to the trauma center without EMS. Gutsy move, but considering we would have been staging at least 10 blocks away until they could secure the scene for us, it was probably the right move. It’s hard to have a secure scene when the shooter is at large. Two of our units treated and transported the two car-jack victims. We were only 20 blocks away, ten minutes prior to the incident, helping out my last patient with the hurt back.

This city is starting to get even worse with the summer heat and the bad economy — there’s a feeling of desperation. Not too long ago we had a series of riots because of an officer involved shooting of a suspect. We had a sniper shooting at officers maybe a month ago; they never caught him. The Highway Patrol had a prolonged gun battle with a suspect on the freeway a few weeks ago where the shooter was wearing body armor. And no one can forget the four officers that were gunned down last year. My old partner, Brent, actually pronounced the shooter on scene. Brent couldn’t even count the holes the guy had in him. If City PD catches up with this guy I suspect one of us will be pronouncing him later today.

We have multiple SWAT teams running searches throughout the afternoon with their EMS standby teams. Our pager keeps us up to date on which areas to avoid although that’s not much help when the dispatcher sends us to those same areas for a call.

Through the underground nurse network we keep tabs on the officer throughout the day; he’s been in surgery for the last four hours, one GSW to the thigh, one to the pelvis, lacerated femoral artery — it’s critical.