Good Information

When I was but a wee little lad, well, 17 years old, I had the opportunity to take the EMT class offered in my little rural county of NJ. As part of taking my EMT, I was taught some very very important rules, one of which was the simply, and yet undeniable truth that as an EMT, it is critical that:

"You never upset the dispatcher, they get to tell you where to go, and can be your best friend, or your worst enemy. Whatever you do, never, ever, EVER, piss off the dispatcher."

I can say, from experience that dispatchers do in fact have an extremely difficult and stressful job. While working for the ambulance corporation after I graduated college, I had the opportunity to dispatch for several shifts. Probably the most stressful day I've ever had at work was the day that I sat behind the dispatching screen and had to make sure my trucks got to the right place, on time, and picked up the right people.

Unfortunately, as much as that rule may be critically important when it comes to dealing with dispatchers, I am about to break it, well, maybe just bend it. I hope that my dispatcher readers will forgive me.

August, I think 2007, although it might have been 2006, I'm not sure. The squad is in the middle of fair week, which is basically 10 days of at least 14 hour days (often longer.) The fair shut down relatively early this evening, and the ambulances returning to the station make a small convoy. Just as I reach the station parking lot, the tones sound, and send us on a run. The run was dispatched as a suicidal female, which a leg injury. (pay attention, this is going to be important later.)

Because of the scattered nature of duty crews during the fair, the crew for the evening is scattered around the four winds. (Translation: we aren't sure where they are.) One of them was in the mini-convoy of ambulances, so she's in the parking lot ready to head to the run. I offer to ride along with her, so the crew is complete. Just as we're getting ready to put the rig in service, actual crew member 2 pulls in. I offer to bail, but they decline. In service we go.

Half way to the job, we get a radio call that the 3rd actual member of the crew will meet us half-way there. Again I offer to jump out, and drive his truck back to the station, but the offer is declined. We continue onto the job, and arrive on location at the same time the first responders from the local fire department arrive on scene. The state troopers are already on location. This shouldn't be too bad.

Grab the gear, say hello to the first responders, walk to door, knock.

No answer.

Knock on door.

No answer.

Knock on door.

"Hey guys, over here," says the state trooper from the side of the house.

Walk around the back of the house to find the following scene: One trooper walking in front of us, one trooper in the back yard (flashlight in elbow, off), a middle aged couple is standing in the back yard, probably about 25 feet from the back wall.

"Hey troop, what's going on?"

"She was drinking, got emotional, and either jumped, or slipped off the deck."

"OK"

As we walk up, the crew heads towards the middle aged lady standing in the backyard. As a general rule, she seems to be alert and oriented, knows what's going on. Doesn't seem emotionally upset, etc.

As we approach, we're discussing if our patient needs to be backboarded. She fell, which calls for it, but she's up and walking around, which probably means that any damage that might have happened would have happened already. We decide that just as a precaution, looking at the deck, we're going to go ahead and backboard here for transport.

I approach the middle aged man, whom I presume is the husband of the patient, and attempt to gather information. I think the trooper overheard me start asking questions about the man's wife, and realized my mistake.

"That's not her, she's over there."

Turn around to see one of the troopers had turned his flashlight on, and is pointing it at the ground almost underneath the deck, where a young lady (late teens, early 20's) is laying on the ground.

"Oh, ok," we repond. Only, as we approach the patient, it quickly becomes evident that in fact, she is NOT ok, and the situation is NOT ok. Patient is responsive, but only to extremely loud, or painful stimuli. She smells like alcohol, won't answer questions appropriately, and is generally combative.

Take a quick look at the deck, and realize that it's at least 20 ft off the ground, which makes the mechanism of injury significant, which translates to a recommended ALS response, and a consideration of transport to the trauma center. The semi-conscous nature also calls for ALS, and a possible trauma center, because we can't tell if it's alcohol, or a fall that is causing her to be semi-conscious and combative.

I run back to the rig, call dispatch and have them start ALS, and put the helicopter on standby. Run back and check on the crew, and ask K if he wants the patient to fly. We're not sure we need to, but the trauma center is a good 45 minutes from where we are standing, and we're not sure we're going to get a medic. At that point, dispatch comes back on the radio and tells us that indeed, we are not getting a medic, as the nigh unit is tied up at the moment, and we'll call our dispatch when they are free.

We make the decision to fly the patient to the trauma center. We package her on the backboard, and as we get ready to move to the rig, for further eval, and to begin transport, the medic unit signs on the air, looking for an update from our crew (they must have been almost clear at the local ER.)

For whatever reason, my portable radio won't reach the medics, so I call one of them on the phone, and give him the run down on the patient. The medics are understandably questioning how a emotionally disturbed patient with a leg injury has transformed into an ALS run, but settle down when I explain what's going on. We agree to meet at the landing zone for the helicopter.

We do the transport, and at one point during it, patient stops breathing, and then starts on her own again. We finish the transport, meet the medics, and they do their thing. They aren't sure the patient needs to fly either, but we can't rule it out, so we let the bird continue in.

Ends up the patient is transported to the trauma center, and is treated and released, no permanent damage.

The part of this story to make note of, we were dispatched to an emotionally disturbed patient with a leg injury. Both of those calls are BLS only. I'll give the dispatcher credit, it was an EDP, and she had a leg injury, but the whole, jumping off a second story deck, and being semi-consious, that's just a LITTLE important! We walked into a job and got blind sided, which should happen very very rarely!

Make sure the information that you get and pass along is as good as it possibly can be. The little pieces of information are often the most critical and are always the ones that are overlooked! (this holds true for everything, not just EMS.)

San Antonio Blogmeet

A bunch of the bloggers from the central / southern Texas areas are meeting at the Braken Rifle and Pistol Recreational Range just to the North East of San Antonio. The group is meeting at 0900 on Saturday 02-07-2009, but I'm driving down the night before.

From what I'm gathering, it looks like I'm going to have to pay for each gun that I want to shoot. I've never been billed for a range that way, so it'll be interesting to see. I've offered to the host of the meet to bring up to 7 different firearms, as seen in the pictures below.


I'm planning on bringing the following:

• Bushmaster AR-15, 5.56mm
  
• Henry .22LR Lever Gun, .22LR
  
• Ruger 22/45 Mark III, .22LR
  
• Ruger Single Six, .22 LR
• Glock 19 with CT grips, 9mm
• Springfield XD45 Service, .45ACP
• Kimber Custom TLE II/ RL with CT grips, .45ACP
  

And I laid the rest of my supplies in today for the blogmeet. I visited Champion Firearms in College Station and picked up the following:

• 200 rounds .45 ACP
• 100 rounds 9x19
• 200 rounds .223 Rem
• 50 rounds 7.62x25
• 40 rounds 7.62x54R

Also picked up a Serpa holster for XD45, a package of snap caps, and a set of Radians Electronic Muffs. I'll post a review of the new muffs after I get a chance to try them out at the blog meet.

Unfortunately, Champion was SOLD OUT of .22LR ammo. As a gun shop, how do you sell out of ammo for a .22? I headed over to Gander Mtn and picked up 1000 rounds of .22LR for the Henry and Ruger pistols.

Anyway, if you live in the San Antonio area, or want to make the trip, you're more then welcome to join everyone who's going to be there. Just for the record, I have never met any of the guys who are meeting up before.

Introduction to EMS

So I was told the other day that my blog needs more EMS stories and content. Although I'm not active on he ambulance like I was, I do have a couple of old stories floating around in my head.

When I first joined the volunteer first aid squad in June of 2002, I had already been a firefighter for about 3 years. I honestly expected them to be very similar atmospheres. I made it clear to the squad when I started that I was going to be a firefigter first. At least I had thought it was clear. See, about a year before I joined the first aid squad, the fire department decided they were going to start an EMS unit to help the local volunteer squads. At the time, in the firehouse, EMS was considered a second priority, meaning that if I went to a working fire with the fire department, they'd use me for firefighting, as opposed to EMS. They did have some people who did not have any fire training, who would be used for EMS at the fire jobs. I wanted that to continue on after joining the squad.

I joined the EMS unit in the fire station, and went through training to become an EMT, while most of the guys were content with a lower level of training. When I graduated EMT class, and the fire department started taking runs (I tested 2 weeks prior to the runs commencing), I was an EMT running with a bunch of first responders, and we were ALL inexperienced, so we had no institutional memory to help us. After a couple of months, I realized that I wasn't learning anything, and my comfort level was improving. I decided that I needed to start running EMS with people who could teach me better skills and help me learn, but I still wanted my priority to be on the fire station.

I first realized that EMS is a completely different animal from the fire house the first time I was at the squad house and a run was dispatched. See, my adrenaline jumped, and I was half-way to the bay when the guy I was meeting with motioned me back to my seat and told me there was a duty crew who would be handling the call. We would stay at the station and provide a backup crew if necessary.

I was floored, and couldn't believe what he was telling me. I was pumped, ready to go save a life, and then I was sitting on my hands.

Later in my time at the squad house, I would learn to throughly enjoy the small unit cohesion that I got to experience in the squad house. I enjoyed it so much, that I started spending less and less time at the fire house, and more and more time at the squad house. I loved my crew like family, and in some ways, I'm closer to them than I am to my own family.

Communication... or a lack there of!

One of the topics that evolved to become near and dear to my heart in relation to EMS is the efficient and correct communication of information. Communicating information is important in all facets of EMS, from the call taker getting proper information from the caller, to the dispatcher relaying the correct information to the responding ambulance, and even from one responder to another. As an example, I have an old war story to tell, and as usual, some things have been changed.

Once upon a merry time, I was hanging around at the squad house, one of the nights I was just hanging out, I wasn't on duty, had no responsibility to run any calls, etc. Upon this interesting night in question, the duty crew was scattered to the four winds, each having gone their own way for the night. That being the case, when the tones dropped for a 911 call, I jumped in the truck with the one person from the crew that was still around. Dispatched as follows: “Ruraltown EMS, respond to 91 Hill Country Rd. for the suicidal female with the leg injury.” The run was dispatched as BLS only, and didn't meet any criteria for an ALS assignment.

Just before my new partner and I were going to pull out of the bay and respond to the call, a second member to the duty crew arrived at the building. I offered to jump off the truck, didn't want to crowd their style, but they said go ahead and stay, it's a psych call anyway, we might need the help. While in the process of responding to the call, the third member of the crew called us on a cell phone to let us know he was also responding, and we could pick him up a Ruraltown Elementary. We picked him up and continued on to the scene.

Upon arrival, we noticed there were 2 police cars on location, signed out with dispatch, made contact with the fire department guys who were just arriving and proceeded to knock on the door. After about 2 minutes of knocking with no answer, we called dispatch on the radio and asked for a call back to the location to get them to answer the door. Shortly thereafter, one of the police officers and a middle aged man walked around from the back of the house. The motioned us to follow them.

As we rounded the back corner of the house, I noticed a second police officer and a middle aged lady standing behind the house on a slight incline. They appeared to be talking. Making the first mistake of the night, I assumed this was our patient. The rest of my crew also made this mistake. I started to speak with the man whom I took as her husband, to record the pertinent details for the run sheet. As one of my crew mates attempted to make contact with the “patient” and figure out what was going on, the police officer stopped us and said, “That's not her, the one you're looking for is over there,” and turned on his flashlight, illuminating the prone figure of a much younger woman laying on the ground.

A quick assessment revealed the patient was probably intoxicated, although we couldn't be sure, was only semi-conscious, and more then a little combative. We learned from the patient's parents that she had a mental health history, including suicidal tendencies, and had decided to jump off the back deck.

But deck you say, that would make this a victim of a fall, and because the deck is a second story deck, and we're on a hill, that's greater then twice the patient's height right? That's a significant mechanism of injury, and requires an ALS dispatch (at least in NJ.) And oh, she's only semi-conscious, lets get us some help coming this way pronto.

Call dispatch, have the ALS unit assigned to the job, and fly the trauma helicopter. Local protocols dictate that a transport of more then 20 minutes to the trauma center, and the patient meets fly criteria. Semi-conscious patient definitely meets trauma criteria, even though we were not sure if decreased level of consciousness was due to the fall, or the alcohol.

As the paramedics are responding, they call us on the radio, looking for an update. It's kind of like a “hey, we heard this get dispatched, why the hell are you bothering us for this. It should be no big deal” message. Because of the terrain and where we were, the portable radio I had was worthless, so I ended up calling one of the medics on the phone.

I gave him the scoop, and explained where we were, what was going on (rest of the crew had the patient packaged), and that we were rolling to the landing zone to meet the helicopter.

While we were transporting the patient to the LZ, she stopped breathing for appox. 30 seconds. Upon arrival at the LZ, the patient was breathing on her own again. Paramedics arrived, did their thing, and shortly thereafter, the helicopter arrived and transported the patient to Big Town Trauma.

The whole point of that story is this:

Dispatched as “Suicidal female with a leg injury.”

End result – yeah, she was suicidal, and she had a leg injury for sure. But somehow, I get the feeling that the whole jumping off a deck, and only being semi-conscious thing was just a LITTLE more important then the suicidal feelings at that point.

NOTE: I've also worked as both a dispatcher, and a call taker. I sympathize with those individuals truly and honestly, it is a tremendously stressful job. I'm merely attempting to show how a lack of communication can lead to major problems in the field.