Merry Christmas

No "Happy Holidays" here... No Holiday Tree or Seasonal Music for me.  Gimme a break.  A wise man once said that "Political Correctness is a doctrine fostered by a delusional, illogical liberal minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end."  


On that note, here's the 12 Days of Christmas, as penned by the writers of Scrubs.

On the twelfth day of Christmas
My true love gave to me
Twelve beaten children 
Eleven drive-by shootings 
Ten frozen homeless 
Nine amputations 
Eight burn victims 
Seven strangled shoppers 
Six random knifings 
Five suicides 
Four beaten wives 
Three O.D.'s 
Two shattered skulls 
And a drunk who drove into a tree...

Be safe out there!

New Station Update

So, it's pretty nice.  It could be way nicer, but I'm stoked to be here.  Sorry for the lack of updates recently... Standby to standby, as a new post is coming shortly...

New Station

I first heard rumors of a new station back in 2005.  Originally built as a firehouse back in World War II, the station I work out of started life as a single purpose fire house.  It became an EMS house around the time I was born, and it was pretty decrepit back then.  In early 2005, the brass finally decided our home was no longer suitable for occupation.

After endless debate by the Board of Aldermen, Environmental Impact Reports, a drawn out RFP/bidding process, union foot dragging, construction delays, supplier shortfalls, bad weather and a number of zombie attacks, our new station is projected to open on Wednesday.

I'm on my days off, and come back in on Thursday morning.  I'm so thankful to miss all the hoopla, pomp and circumstance that'll come along with opening day.

The new station looks something like this:

You'll have to excuse the architectural liberty here; apparently the architect thought he was building a station in Pleasantville or something. 

The neighborhood gentrification projects have made the area nice, but it's not as nice as this rendering would have you believe.  Regardless, though, I'm not gonna lie -- it looks pretty nice.  We'll run two squads and have an EMS captain in the house.  It'll be interesting having the boss around all day, but (at least on my tour) he's a good guy.

Hospitals

My last post about Homeboy Ambulance reminded me that I still haven't talked about the major hospitals in Fairview.

There are more hospitals in the downtown area than I've got listed on the map, and there are quite a few in the outlying areas that may come up later.  For now, though, I'll talk about the Big Four:  FMH, SMH, UMC and RVH.

Fairview Memorial Hospital, map page A-3
FMH is in the heart of Metro Center.  During the day Metro Center is pretty well filled with high powered corporate firms, but at night you get a crazy mix of street dwellers and tourists.  Accordingly, in FMH's waiting room it's not uncommon to see bums and executives argue about triage priority.  It's a zoo on an average day, but on the weekends?  Fuhgeddaboudit.  Picture the ER in, well, ER.  While it hasn't been a trauma center since the 80s, they constantly act like they should handle any trauma west of the river.  Their cath lab is down a lot, and once Heartland Medical Center opens up I think all the cardiac patients in the area will go there.

Saint Mary's Hospital, map page E-3
Originally started by an order of nuns as a Women and Children's Hospital, Saint Mary's has grown considerably and treats just about everything except major trauma.  While it's a great pediatric facility, the really sick kids typically go to U-Med.  Despite its... um... historic looking exterior, the facility is well equipped and employs some of the best practitioners I've ever dealt with.

University Medical Center, map page D-3
At the cutting edge of technology and a damn good teaching hospital, U-Med (or UMC) is where I'd want to go if I end up in a bad way.  They do it all here.  They're a bitchin' trauma center and offer some of the best burn treatment in the country.  It's also Fairview's de facto Children's Hospital.

Riverview Hospital, map page C-1
Great for everything except cardiac and neuro issues.  There's been talk about them trying to get some specialized neuro services going, but so far it's just been talk.  They're well known for their oncology services, and most of our cancer patients end up going to Riverview.

Note: Heartland Medical Center is supposed to open in mid-2011.  It will primarily cater to cardiac patients, though it will offer basic emergency services.

Homeboy Ambulance

Another beautiful fall day in Fairview:  I've just finished up a run, the gurney is back together, the run report is done, and I'm just waiting for an ambulance that'd blocked mine in to move out of the way.

While I stand there playing with my phone, a Homeboy Ambulance rig flies into the ambulance bay at Fairview Memorial Hospital.

Homeboy Ambulance, you may wonder.  What on Earth is that?

Here's the definition according to Urban Dictionary:

Homeboy Ambulance

noun; 

1.  A car which is used to drop off victims at a hospital or police station. The vehicle usually drives into the ambulance bay, or to the front of the hospital, where the patient is pushed out, and the homeboy ambulance leaves quickly, without making any contact with hospital staff. Most patients dropped off by these homeboy ambulances are gang members or hookers. Usually seen in urban areas and county hospitals.

This is a fairly typical example of a higher end unit:

So, anyway, the driver gets out and yells, "You've gotta help me, man!  My buddy's been shot!"

I look around, and there's nobody else in the ambulance bay to help.  Wonderful. 

I walk to the passenger side of the 'ambulance', in this case a purple metallic-flake El Camino, and observe a conscious, alert and very lethargic 25 year old Latino male sprawled across the bench seat.  He says his name is Junior, and he says he's really scared.  He states that he was minding his own business in an area notorious for drug and gang activity when a 'whip' pulled up, 'a bunch' of guys got out and 'someone' shot him.

As I extricate him into a wheelchair, I take a quick look at the entry wound in his stomach: small caliber, minimal exterior blood loss, no stippling.  I check his back, but there's no apparent exit wound.  Not much for me to do here except wheel him inside.

FMH isn't a trauma center, so I figure they'll be excited to have a shooting victim.

Boy, was I right.  And then some.

They freaked out.  Now, sure this kid is in rough shape, but panic seldom does anybody any good.  They cleared out the closest bed -- in the cardiac room -- and all the nurses went off to find a doctor.  Or maybe they all took a smoke break.

Either way, they were gone for two or three minutes, and I was alone with the patient.  I got him into the bed and got his shirt off without cutting it off, which I suppose is really helpful from an evidence preservation perspective.  We can't get away with that out in the field too much, but here there was no reason to destroy the evidence.

I again asked him about the circumstances of the shooting, and he was again very evasive.  He knew the assailants were male, and that was it.  No sex, age, height, weight or even ethnicity.  This kid clearly had some idea who they were, but he wanted to keep it to himself so his crew could score some revenge.  Amazing.

The ER staff suddenly reappears with a doctor in tow, so I tell the guy good luck and get out of the way.  He seemed to have a change of heart, though, and gave me a decent description of the shooter.  He lost consciousness shortly thereafter, and they scrambled to get him into emergency surgery.

FPD showed up, and I gave a statement to the officer.  Given the kid's shaky hold on life at that point, I went into the interview with the assumption that the guy's gonna die sooner rather than later.  If he ended up giving me his dying declaration, I'm glad he gave up who was behind the shooting.  If he ends up making it, hopefully he gives up bangin' and makes some positive changes.

Life's short enough as it is, y'know?

Back Up Units

I will never, ever be able to look at a back up rig the same way ever again.  I'm lucky enough to work out of the same squad most of the time, and when it goes in for service we usually get it back a few hours later.  Sometimes another ambulance covers our district, sometimes they just have us at the shop ready to respond in an extra car if everyone in the city suddenly calls 911.

When something more than routine maintenance comes up, we always get a back up bus.  It looks great and runs okay, but it's gettin' a little ragged around the edges.  It's definitely not my favorite squad to run in.  It kinda smells like a cross between grandma's house and a locker room.

Check out these ambulances, though:

 

I guess I could do way worse back up wise than a 6 year old car with 150,000 miles on it.  I know folks at other departments and agencies that are in 10 year old rigs that have more than 300,000 miles on them, but even they are riding in luxury compared to this.

I guess the moral is be thankful for what you have...

Downtown Fairview

I realized that it's a little hard to visualize Fairview when I'm writing about it, so I've put together a basic map of the city.  I'll try and refer back to the map grid when the location of something I mention is relevant.  The only difference between the two maps is that the first one has map grids for quick reference, while the second one doesn't.  Unfortunately some of the streets hide behind the grids...

Questions and comments are welcome!

New Year's Day

As promised, here's the second story of off-duty shenanigans.

It's New Year's Day, and I'm with 3 friends a million miles from Fairview.  We're a motley bunch, for sure.  My best friend is an Intelligence Specialist for the Army, and he's riding shotgun.  In the backseat, his ex-girlfriend (but now close friend) -- a Math Major -- and her best friend -- a 2nd year nursing student -- are excitedly talking about the wedding we're on our way to.  The girls both know the bride and groom, but me and my buddy... well, not so much.

So we approach a 3 way intersection very similar to the one below.  Assume that north is at the top of the picture. 

© 2010 www.portlandmaps.com

We're heading eastbound in the fast lane, and my light goes yellow.  I slow down and come to a stop.  I'm the only traffic heading east bound, and the traffic at the dead-end gets the green light.  A motorcycle that had been stopped at the light proceeds through the intersection, turning left in front of my vehicle.

As the motorcycle enters the westbound lane, the rider gooses the throttle.  It being New Years Day at 8 in the morning -- and a cold morning -- the predictable happens.

The rider gets tossed.

The women instantly freak out and tell me I've got to go help.  Now, the rider is in full racing gear, including an armored jacket.  He high-sided at 15 miles per hour.  As soon as he hit the ground he popped up and ran for the shoulder so nobody ran him over.  How can I possibly help?

So I pull the car out of the traffic lane and park in the (relative) safety of the buffer zone between the east and westbound lanes, just west of the intersection.  I get out of the car as another rider stops his bike.  We pick up the wrecked bike and wheel it to the shoulder of the westbound lanes and drop the kickstand.  There's minor damage to the bike -- mostly broken plastic -- and the wrecked rider (WR) seems to be okay.  He denies any injury, and he doesn't want to report the wreck.  I'm totally fine with this, and asks if he can borrow my phone to call a buddy with a truck to come pick up the bike.

While the Good Samaritan rider and I continue to talk to the WR, a huge Suburban screeches to a stop near the wrecked bike.

As the Hallelujah Chorus pours from the heavens, God's gift to EMS exits the vehicle and strides confidently toward us.

Wait.  Let's fix that...

As the Hallelujah Chorus pours from the heavens, God's Gift to EMS exits the vehicle and strides confidently toward us.  Okay, one more try.

The huge Suburban pumps exhaust in our face, and my worst nightmare jumps down from the truck.

"I'm first aid and CPR certified," he bellows, "and I'm assuming control of this scene!"

Really?!?  Did this goober really just say that?  Whatever.

"Thanks for stopping, sir" I reply, "but we've got this under control."

Ricky Rescue?  More like Risky Rescue... but how about this: God's Gift (GG) pulls a cell phone from his hip holster (lame) and calls 911 to report the wreck.  When SHP answers the 911 call, the first words out of GG's mouth are, "We're gonna need some help here!"  I die a little inside, and once again try to get him to leave.  After giving the location of the wreck, he hangs up.

He immediately grabs the wrecked rider's head.  Oh, so now he's gonna hold C-Spine?  Nope, he's gonna try to tug the still-strapped helmet off the rider!

WR yells, the Samaritan yells, I yell: "Hey!"  GG is not to be deterred.  I grab him and say, "Sir!  I need you to step back!  You're gonna kill somebody with a stunt that!"  He slunk away in shame, never to be seen again.  Or so I thought.

With GG out of the picture, the WR asks the Samaritan and I to help him remove his helmet.  Since I witnessed the wreck and was familiar with lack of mechanism, it wasn't too hard to remove the helmet.  For liability's sake, though, I went through the Ambulatory Post-Crash Spinal Clearance Protocol.  Everything checked out, and we pulled the helmet off. 

We stand around for a minute, and, with nothing better to do, we start talking bikes.  WR says that his big, a brand new R-1, has just over 600 miles on it.  He feels like a total chump, even though it could've happened to anyone.  He's an experienced rider, and his ego is pretty bruised.

I look at the Samaritan rider, and realize he looks familiar.  Being nearly 250 miles from Fairview, I take a wild shot in the dark.

"Hey, do you ride at Fairview Raceway?"

"Yeah..."

"Did you go down in turn three a few months ago?"

"Yeah!  How did you know that?  Are you a corner worker or something?"

"No, man, I was the one that took you back to your pit in the ambulance!"

Recognition fills his eyes and we laugh about the coincidental circumstances.  I didn't even transport the guy to the hospital, and was only with him for a few minutes, but happened to both come across him AND recognize him, 250 miles and 3 months later.  Crazy

We're now a few minutes into this ordeal, and the adrenaline starts to drain from WR's system.  He says that his left arm is starting to hurt, and he asks for help pulling his jacket off.  I ask him if there's a position of comfort (POC), and if so to try and maintain it while we pull the coat off.  He lets his arm dangles much lower than the right when he finds his POC.  Wait a tic...

The Samaritan helps WR pull his right arm out of the jacket, and the movement jars a big fat drop of blood out of the left sleeve.

"Hey, buddy," I casually ask, "where're you bleedin' from?"

"I'm bleeding?"

"Yep, some blood just dripped out of your sleeve."

"Well my arm is really starting to hurt."

I tell WR that we'll slowly and carefully work the jacket off, but he tells the Samaritan to quickly pull it off.  As the jacket comes off, I see where the blood is coming from.  Apparently WR hit the bad luck lottery.  He apparently landed just wrong, resulting in a compound humerus fracture AND a compound radius/ulna fracture.  Bad times.

We sit WR down on the small embankment on the northern edge of the roadway, and I explain the need for immediate medical and surgical intervention.  He tells me his arm really throbbing now, and I explain that, while pain management is at the discretion of the responding medic, he is a suitable candidate for some morphine or Fentanyl.

GG, to everyone's distinct misfortune, hasn't gone away yet.  He sees us sit WR down, and comes back over to be nosy.  He sees the fractures, and his eyes go wide.  He grabs the cell phone again and calls 911 again.  The very first thing he says is "We've got a compound fracture here, tell the ambulance to step it up!"  Unreal.  No location information or anything, just pure wigging out.  What a yahoo.

The dispatcher, God bless her, patiently talked some sense into him and calmed him down.

GG hung up and told WR that the ambulance was about 8 minutes out.   He then tried to move WR's hand (WR was holding the left arm in a POC with the right hand) to look at the injury.

That's it.  I'm done.  No more Mr. Nice Guy.

"Sir!"  To my surprise I was interrupted by the Samaritan.

"Hey, asshole, this guy's a paramedic, so why don't you just go away?"  Not diplomatic, but sometimes diplomacy's overrated.  I wouldn't have put it in those words, exactly, but the Samaritan made sure that GG got the message.

With GG gone again, there wasn't much to do except shoot the breeze until the cavalry showed up.  Despite that compound fractures, there was very minimal blood loss.  WR was uncomfortable, but he maintained his arm in a POC and didn't complain much.

Two SHP units arrived on scene about 45 seconds ahead of the ambulance, and sure enough, GG couldn't wait to give a statement.  His first words to the trooper?

"I saw everything, and I think he's drunk!"  Wrong on both counts.  He saw nothing, and WR was stone cold sober.  But whatever, stupid is as stupid does. 

The other trooper approached me and asked for my statement.  I kept it short and sweet:  Solo vehicle/rider, cold tires, goosed throttle, high side, no booze.  My statement was done by the time the rig pulled up on scene.

I approached the medic at the ambulance and gave him the quick rundown:  Low speed, isolated fractures, no loss of consciousness, fully alert, significant pain.  He thanks me, and I go back to the car.  Despite everything, I'm sure the poor guy ended up on a backboard.  Hopefully they took him to a trauma center or receiving hospital with some good orthopedic surgeons.

As I drove away, GG was still blabbering to the cops.  Big surprise.

My friends acted like I saved the world for a few minutes, but it was a really easy call to run.  I guess it was a good thing I listened to the women and stopped -- GG probably would've killed the patient, or at least driven him crazy, if left to his own devices.

Oh, and we made it to the wedding with about 10 minutes to spare.

Road Trip

I'm wrapping up a 72 hour shift, and my partner, Vince, looks at me and asks if I want to take a random road trip. With 4 days off and nothing planned, I say sure.

After we go off duty, I run over to his house and help him lug his stuff 7 stories down to the parking lot. We knock out a quick round of rock-paper-scissors (which, incidentally, is how many decisions are made on the squad) and I jump behind the wheel for the first part of the drive.

12 hours later, I'm still driving. He's racked out in the seat next to me, no doubt dreaming of a world where our patients never have maggots on them and GI bleeds smell like roses.

As I drive through Albuquerque on Interstate 40, I see a bunch of brake lights blink on a quarter mile ahead of us. It's after midnight, and while there is some light roadway maintenance work going on, there's no obvious reason for the whole freeway to come to a standstill.

A minute later I make it to the bottleneck.

A midsize sedan has rear-ended an 18 wheeler, and the tow truck operator is preparing for the vehicle recovery. Or so it appears. A quick survey of the scene reveals that there is no EMS, fire or law enforcement presence. No flares, no cones, nothing but a lone tow operator that's clearly overwhelmed.

The tow truck has clearly happened upon the wreck, which has just happened. Outstanding.

I wake Vince up, and he groggily tells me that another crew can handle the wreck. I tell him we're off duty and he really needs to wake up. After a moment of confusion, he realizes what's happening.

I pull the car behind the cones separating the construction work zone from the freeway and get out of the car.

The scene is pretty contained and presents as a relatively simple incident. We have a passenger vehicle vs a standard 53 foot big rig trailer hauling electronic goods for a major retailer. The truck driver is uninjured, and the driver of the sedan has self extricated through the hole left by the roof being sheared off of his car. The truck driver states that he was stopped at the time of the collision, and the lack of skid marks from the sedan, coupled with the extensive damage to the car, seem to suggest that the sedan was traveling at highway speed.

The tow operator's dispatch had already advised the appropriate folks of the incident, so I don't bother calling 911.

We approach the patient and hold C-spine. As I begin my assessment, an unmarked Crown Vic screeches to a stop next to the tow truck with it's stealth lights blazing. I figure it's Albuquerque PD or New Mexico State Police, but to my surprise and dismay, a 40-something lady in street clothes jump out and says, "I'm a retired EMT, how can I help?"

Great. A 'retired' EMT? What does that even mean? And why is she in a cop car?

Whatever. She hands me gloves, and my opinion of her markedly improves. She also had a c-collar, which was helpful.

So back to the assessment. The patient is a male in his mid-thirties who is alert and oriented to person, place, time and event. He admits to recent alcohol consumption, and complains of ear pain. Physical exam reveals that his left ear is nearly torn in half, but is otherwise unremarkable. Had he been sitting upright, he would have been killed. Since he was slumped over in a drunken stupor, though, his ear was turn in half. The luck o' the drunk, I guess.

Vince walks up to the destroyed sedan to make sure there's nobody else in the car, and get an idea of the mechanism of injury. Ha. So while he pokes his around around the wreckage, I start talking to the patient. He wants to call his mom and let her know that he's okay, so I dial his phone for him, as his drunken finger fumbling wasn't very productive.

While the patient cries to mom, a New Mexico State Trooper pulls up and rolls his window down.

"Howdy. What's going on here?"
"Not too much. One patient, minor injuries."
"That's it? Okey-doke. We've got a fatal outside town, and I need to get to that. APD will be here when they get here."

Before I can reply, he's off like a flash. Great. So we still have no flares, no cones, and a couple of unequipped first responders.  Thank God we at least had the tow driver and 'retired' EMT directing traffic.

As the trooper beats feet away from the scene, Vince walks back up. The patient is telling him mom that he almost made it to Louisiana, and Vince's eyes go wide.

"He's altered! Louisiana?!?" I laugh and point behind Vince at a large road sign:

(Not my picture - originally posted at crosscountryroads.com)

Funny stuff.

So fire and EMS show up, followed by a couple APD units and another trooper. I gave a quick report, and faded into the background.

I'm not typically one to stop, unless A) I witnessed the wreck, or B) ALL of the following are true:

1) There are no responders on scene
2) There are obvious injuries (or a significant mechanism. Snicker.)
3) It is safe for me to do so.

In ten years, I've stopped at a total of 4 wrecks. There have been a few that looked legit but were unsafe to stop at, so I made 911 calls giving the accurate location and a brief size-up based on what I saw while passing the scene.

The other three I've stopped for are interesting stories in their own right, so look for those in the future.

As Vince and I got back on the road, we laughed about his mistake on the whole altered-Louisiana bit. We also talked about the retired EMT. She was very eager to please, and wasn't nearly the nuisance I initially thought she would be. But still... why the undercover cop car?

The rest of the trip was uneventful, and thankfully we never came across the fatal that NMSP had told us about as he flew through the scene.

Apologies for the absence...

Dealing with some pretty major family health issues -- should be back to posting here again shortly.

911 is your friend (at least when used appropriately)

So I'm taking a much deserved break from work. I grab a tall frosty glass of lemonade and sit down to watch a little TV.

Now, I don't watch too much TV, especially when I'm on vacation. I try to stay informed, though, so I flip it to the news.

I was up at the woods in the middle of nowhere, and Fairview is the closest metro area. So, it's Fairview news or bust.

In the middle of some story about the economy, they interrupt with breaking news. SkyView 3 was flying over Metro Center when they saw some black smoke near Washington Park. They flew over to the fire and found a gas station involved in a rapidly developing fire.

There was a small crowd of bystanders watching the fire burn, but FFD was nowhere in sight. After 30 seconds or so of random newscaster babbling, fire still isn't on scene.

I call into the Comm Center to give an update on the fire's size and rate of spread.

Guess what?

Nobody had even reported the fire! All those knuckleheads standing around watching it burn, plus the news anchors talking about the FFD's slow response time, and nobody thought to actually notify the fire department. Unbelievable.

So from more than 100 miles away, I ended up being the first person to call it in. It's amazing that folks'll call 911 at 3 in the morning for the flu that they've had for a week but won't call in a significant structure fire in the middle of broad daylight.

Sheesh.

Wrong place, wrong time... (Part 2)

So, I've been trying to wrap my head around this for a few days. I'm still floored at the waste and tragedy here.

I hate gang violence.

Last week I posted about the senseless shooting and death of a young man in Centennial Park. I closed the post by saying that I hoped they caught the kid's murderer. The good news is that they did.

Unfortunately, though, the story gets worse.

Convinced that FPD wouldn't devote much time to the murder investigation of their family member, the kid's uncle and cousin (the uncle's son) decide to do some investigation of their own. While I can certainly understand their impatience and desire for a swift resolution to the case, FPD's Detective Division is top-notch. While they may get overwhelmed, their investigators work tirelessly to make this city a better place to live.

I wish they could have been a little more patient and allowed Fairview's Finest the chance to close the case.

Uncle and cousin had a pretty good idea who the suspect was, and they told other family members about their plan to locate the suspect, notify FPD of his whereabouts and (if necessary) detain him until the cops arrived.

Take note, folks: This plan wasn't remotely safe, even on paper. But planning on detaining a known gang member that carries a handgun AND has killed already this week? Cooler heads should have prevailed.

Uncle and cousin locate the suspect's vehicle about a mile and a half from where the first shooting occurred. Uncle pulls out his cell phone and calls the victim's mom (his sister) to tell her they found the suspect. He says they're going to follow the suspect and call FPD, and hangs up the phone.

At the same time and less than 1/10 mile away, I'm sitting in the station watching a movie. We hear two distinct pops, a brief pause, another pop, another pause, and then one final pop. We pause the movie and turn up the FPD radio.

Sure enough, FPD sends three units to a location right down the street from our station for multiple 911 calls of shots fired with two victims down.

Crap.

I happen to be working in a bigger station with two assigned ambulances, and we advise our dispatch that we copy PD's traffic and will be staging in place inside the relative safety of our station. The four of us walk out to the apparatus bay and fire up the ambulances and standby until PD clears us into the scene.

About two minutes later the cops advise that we're clear to enter. The bay doors go up, we pull out of the station, and advise that we're on scene. We park a whopping 500 feet from the day room where we'd been watching a movie just a few moments before. Yikes.

The story we get later is this: Apparently uncle and cousin pulled up beside the suspect's vehicle at a red light. Suspect realized what was going on and fired two rounds into the uncle's head from a range of less than 10 feet. Cousin watches his dad die, and flees the car. The suspect fires a round into the cousin's back to bring the kid down, gets out of his car, walks up to the injured teen and fires one more round into the kid's head, executing him.

The suspect apparently knew or at least assumed that the police had already been notified, and just waited for the police to arrive and arrest him.

So that's how we pull up on a very marginally secured scene with a suspect at gunpoint but not in custody. Lovely.

By unspoken agreement the other crew goes to the uncle and we go to the cousin. Both men have injuries that are incompatible with life, but each of them has pulses still. As we begin working our patient, PD gets the suspect into custody.

I'm not a fan of contaminating crime scenes or transporting traumatic cardiac arrests, but it looks like both scenarios are gonna play out here.

Despite the certainty that both men are going to succumb to their wounds, our protocols demand that we transport unless obvious signs of death are present.

So we package the patients for transport and take off for U-Med. By the time we arrive at the trauma center, both patients have arrested. The trauma team calls both patients shortly after arrival, and the poor family has lost 3 members in just under 48 hours.

The suspect knew it was only a matter of time before he got caught, and he knew that the gang is just as strong inside prison as it is on the outside, so he just gave up. Unfortunately, his poor choices devastated an entire family. And all because of an innocent smile at a pretty girl.

Hilarity

Got this in an email today, and it's freakin' brilliant...


FREEWAY PATROL - EP.5 from Joe Snuffy on Vimeo.

Do yourself a favor and watch all five episodes...

Wrong place, wrong time...

Picture this:

It's a pleasant autumn evening.  A crispness and freshness fills the air.  It's a Thursday night, about 10ish, and most residents of Fairview are settled down for the evening and enjoying a book or some TV before bed.

Out in Centennial Park, however, trouble is brewing.

I'm cruising down Centennial Avenue with my normal partner and Robbie, a dispatcher doing his semi-annual Field Observation & Orientation ride.  Yep -- FOO.  As in, I pity the foo' -- at least for the dispatchers that wanna hide in the comm center for their whole career and hide their heads in the sand, pretending that the chaos they send us into on a daily basis actually happens only in Fantasyland.

Robbie is one of my favorite dispatchers -- cool under pressure, friendly, not much attitude -- and he gets major bonus points for riding with us whenever possible.  He worked the field before he tweaked his back, and while he can't lift anything heavier than a cardiac monitor, his mind is as sharp as ever.

But I digress.

As we approach Flint, I notice a Mitsubishi Eclipse that's high centered up on the dividing island that separates the northbound and southbound lanes of Centennial.  The Eclipse is resting up against a freshly planted tree that's maybe 2-3" in diameter.  Clearly the car wasn't going fast, or it would have knocked the new tree down.

I don't see anyone around the vehicle, and we flip around at Flint to take a closer look.  We stop in the fast lane of N/B (northbound) Centennial just south of the vehicle, and I advise PD of the vehicle's situation and location.  Traffic is light, and blocking the lane for a minute isn't going to be a big deal.  The car is mildly suspicious, but nothing too shady.  Until I get out of the ambulance, that is.

As I approach the vehicle, a bystander runs up to me and says, "he got hit!"

Huh.  There's no damage to the vehicle consistent with striking another vehicle or a pedestrian; in fact, there's no apparent damage at all.  I update PD with the bystander's report of a possible hit and run.  Still not a big deal.

I ask the bystander where the guy that got hit is at, and he tells me that he's in the passenger seat..

Huh.  It's getting stranger, but still doesn't seem too hinky.  The city had planted some trees all up and down Centennial to go along with the shrubs that were already there.  Unfortunately, the shrubs prevent me from easily accessing the passenger side of the car without walking around the rear.  As I approach the left rear quarter panel, the bystander yells, "Yo, man, look at that bullet hole!"

Huh?  HUH?!?  It clicks.  Hit meaning hit by a bullet, not hit by a car. And even worse, my partner and I (and my dispatcher) are walking around in what has suddenly become a very large and very uncontrolled crime scene.

I advise PD that we now have a shooting scene with one victim and 20-25 bystanders threatening the integrity of the scene.  Nobody seems to be anything but curious, but these people need to be removed from the equation ASAP.

God bless FPD -- less than fifteen seconds after I knew that it was a shooting and advised PD of the same I heard three different sets of sirens spool up around me.  Less than 45 seconds after that, I had 3 squad cars on scene with 5 cops clearing out our scene.  Impressive.

The sergeant takes a look at the car and gives us the go-ahead to make entry.  He stands aside to let us work, keeping a watchful eye on the scene to note any changes our work brings about.  We open the door and find a young adult male, unresponsive in the car.  Robbie hands me a backboard and c-collar, and we rapidly extricate our patient.  There's no apparent trauma, but as we move the kid I notice a small amount of fresh blood on the back of the seat.  Interesting...

We get the collar on the kid's neck and log roll him onto his side to check his back.  There's a small hole in the shirt, at around the level of the 12 rib and just to the left of the spinal column.  I make sure the cop sees the hole, and then cut the shirt off, making sure to keep the scissors far from that bullet hole.  Once the shirt is gone, a small caliber gunshot wound is revealed.  It's not bleeding (at least externally), so I toss a petroleum gauze bandage on it and move on.  We secure him to the board, and slide off his pants and leave them with the shirt.

Once we have the kid in his boxers, he starts to come around.  He's understandably a little confused, and more than a little cold.  The physical exam is unremarkable save for the sole entry wound, and we get him in the bus and prepare for transport.  I ask the sergeant if he wants to send an officer with us, which he declines.  The kid's talking now, so there'll be plenty of time to have a detective talk to him at the hospital, right?

We take off for University Medical Center and start to get the story from the kid.  It's about a 15 minute ride, and there's not too much in the way of patient care to do -- oxygen, IV, EKG, pulse oximetry... Pretty simple stuff.  So we talk.

The kid was at a party (on a Thursday?  Craziness...) and smiled at a girl from across the room.  He didn't even say a word to this girl, but her ex-boyfriend took serious offense.  Unfortunately for our patient, ex is a POS gang member and would rather not be reasonable.  He tells the patient not to say another word and just leave the party.

The patient says, "Hey man, I'm sorry... I'm leaving."  Apparently, he truly shouldn't have said a word because the douchebag banger pulls a pistol, yells, "I told you not to say a word" and pops off a round.  The kid runs to his car to drive away, but the banger -- intent on being the big man, no doubt -- follows him to the car and fires a second round.

The round goes through the trunk, through the back seat, through the driver's seat and into the patient.  He starts driving to Community Hospital, but gets dizzy as he approaches Flint.  He steers up onto the island, and tries to get out the passenger door.  He doesn't remember a thing until we have him out of the car in his underwear.

So basically this kid smiled at the wrong girl, and some waste of oxygen lights him up.  Lovely.

I make contact with U-Med and let them know what we've got, and the kid's level of consciousness starts to deteriorate.  He starts to get pale, and becomes increasingly hard to rouse.  By the time we pull up at the trauma bay, he's completely unresponsive again.  We hurry him inside and turn him over to the trauma team.  I give a quick report, and we get out of the way.  As the team wheels him into the ER, he stops breathing.

They end up terminating resuscitation efforts ten minutes into emergency surgery.

We walk outside and get the rig put back together.  A squad car rolls up, and the semi-bored looking street cop is shocked to hear that his aggravated assault victim is now a homicide victim.  We talk for a few minutes, as Robbie and I have heard the poor kid's dying declaration.

Fortunately, the cops already had a few leads, and the minimal information we had seemed to match up with witness reports from the scene.

I really hope they catch the kid's killer... Who shoots someone for smiling at their ex?  I mean, even OJ was better than that...

With a Friend Like This Guy...

So I'm sitting there, minding my own business, wrapping up a run report at the hospital and looking at the clock.

0200ish.  WAY past my bedtime.  I finalize narrative on my report and pick up the radio mic to advise that we're back in service, but my partner asks me to wait a second so he can get a bottle of water before we clear.

It was a quiet night, and the only radio chatter was Fairview PD's gang unit running a surveillance detail.  Waiting to clear for an extra minute wasn't gonna be a big deal.

Or so I thought.

As he gets back in the car, FPD requests an ambulance for a TC -- traffic collision -- as the result of a pursuit.  The stated location is a whopping 3/4 of a mile from Fairview Memorial Hospital, and the nearest station is a couple miles away.  There's no mistaking it -- we're gonna be up for a while longer.

I go to advise dispatch that we can handle the TC, but my partner stops me, saying, "Man, don't clear.  They only want a tow truck, not an ambulance."

This is what gets frustrating about using esoteric codes on the air.  The cops used their standard 10 code for an ambulance, but my partner was sure that they used the tow truck code.  I was willing to bet my next paycheck that PD wanted us, but my partner swore he was right.  We made the standard bet -- a bottle of water -- and I cleared us from the hospital.  Turns out I was right and they wanted an ambulance.

Sure enough, as soon as we clear, we get the TC.

Being so close, we smoke FFD getting on scene.  Our total response time, from the moment that PD requested us, was about 70 seconds.  We arrive to find an unmarked FPD gang unit and a marked cruiser parked haphazardly, doing their best to block Fairview Boulevard and preserve the integrity of their crime scene.

We see a typical G-ride -- old Buick with a sound system worth far more than the car itself, sporting the finest hydraulics money can buy, complete with 22 inch spinners and a ridiculous paint job -- that has crashed into a pole.  The vehicle impacted at high speed, with the impact point at the right front of the car.  The engine had torn loose from the vehicle and flew more than 50 yards before embedding itself into the front of a business down the street.  The speed limit on that stretch of the Boulevard is 40 mph, and these jokers were clearly not too concerned about shattering that limit.

I get out of the ambulance and walk up to one of the gang unit guys, who reports that the vehicle was going in excess of 80 and running from the cops at the time of the wreck. He adds that these guys are known gang members, and the driver is very likely under the influence of drugs and alcohol.

So I approach the car and note three occupants that all appear to be pinned in and unresponsive.

I check the pulse on the driver, and it's strong and regular. There's no obvious trauma, and no passenger space intrusion to the driver's part of the passenger compartment. His breathing is normal, and he is completely unresponsive.

I check the left rear passenger. The force of the impact buckled the roof, forcing it into the kid's head. His neck is bent at an unnatural angle, with his head resting against his shoulder. I check the pulse, and it's strong but very irregular. Like, 30 beats per minute and slowing quickly.

I walk around the back of the car to check out who appears to be the right rear passenger. No pulse, and no visible trauma. Interesting, but I don't have time to really think about it right now.  I'll find out later that he had actually been the front seat passenger, but the impact was so severe that most of him ended up coming to rest in the back seat.  Yikes.

I return to the left rear passenger, and check his pulse again. LUB-DUB. Longish pause. Lub. Dub. Even longer pause. lub dub. And no more.

I advise fire that we have two black tags (dead) and a red tag (critical) and let the cops know that it's at least a double fatal.

The engine and truck arrive and extricate our driver. We package him up, start an IV and beat feet toward University Medical Center. He was protecting his airway really well, but I brought a fireman just in case he needed to be intubated. It turned out that intubation wasn't necessary, as the patient woke up halfway through the transport. He got really combative and belligerent and was just a general pain. He was fully alert and oriented, and his combativeness had nothing to do with a head injury and everything to do with him being a knucklehead -- and his drug use.

He finally got around to asking us about his friends, and the fireman mustered all his tact and professionalism and blurted out the unvarnished truth: "You killed both of them in the car crash."

Not the best death notification I've ever witnessed, but certainly not the worst. The patient got even more combative and had to be restrained. He ended up having no medical issues aside from intoxication and ended up being cut loose from the trauma ward before dawn. FPD took him directly to jail on the vehicular manslaughter charges, and I filled out my paperwork and went to bed.

The next weekend, FPD got together with FCSO, Fairview Heights PD and Fairmont PD to do a massive warrant sweep at the memorial service for the two dead guys. A number of gang members went to jail on outstanding warrants, and more than two dozen weapons were recovered from the bushes at one of our local gang parks.

What a waste. Nocturnal Urban Pharmaceutical Sales won't typical end up with the sales associates being dead, but it's a definite hazard of the job. Maybe they shouldn't have run. Or maybe they shouldn't have been cruising with their lit buddy. Or both.

At the end of the day, though, the good guys were all safe. No innocent bystanders were taken out, and the pole the car hit wasn't damaged enough to warrant replacement.

Never Forgotten

In Memory of the Fallen

Allied Agencies

Just a quick note about the agencies that frequently respond on our runs. I'll probably use the acronyms more often than typing the whole thing out, so to alleviate some confusion (especially for those outside the US or civilians that might not get it...) here is a list:

FEMS - Fairview Emergency Medical Services - my agency
FFD - Fairview (City) Fire Department
FCFD - Fairview County Fire Department
FPD - Fairview Police Department
FCSO - Fairview County Sheriff's Office
SHP - State Highway Patrol

We also have other adjacent municipalities that respond with us on occasion, and I'll do my best to follow the same format:

FD - Fire Department (Typically a city)
CFD - County Fire Department
PD - Police Department
SO - Sheriff's Office
SD - Sheriff's Department

That being said, I am fortunate to respond with a great group.  Our firemen come with us on almost every call, and our cops are typically very good about doing everything they can to help us when we need it.

Involuntary Psychiatric Holds

Involuntary psychiatric holds.  Everyone's heard about these. Everyone calls 'em something different.  We call them IPHs, and they frequently start out as as general "psychiatric emergency" calls.  Out in California they're called 5150s, and down in Florida they use the Baker Act.  Here we just call them what they are.  Maybe that makes us weird.

Anyway, while statutes vary across the country, these holds generally allow law enforcement officers and qualified medical responders to involuntarily hold a patient for a specified amount of time (typically 3 days) for a mental health evaluation.  This is most commonly done for someone who is a grave danger to themselves (suicidal) or others (homicidal), and our goal is to get the patient into a mental health facility and get them the treatment they need.

So my partner and I respond to a busy downtown intersection to assist Fairview PD with a delusional subject.  We arrive to find a homeless 50 year old woman crying for help finding "Rebecca."  The officers reported that the woman had been walking aimlessly in traffic lanes, looking for her daughter.  They knew the patient from prior contacts, and knew that her daughter had been struck and killed by a drunk driver in the area some years before.  While the woman had been jaywalking and inciting gridlock, she obviously didn't need a ticket for that.  She needed some psychiatric help.  She had become an alcoholic after her daughter's death, and eventually lost her home.  While she had been homeless for some time, she never caused any trouble, and the delusions and/or desperation were new.

We make patient contact, and explain that the officers wanted her to get the help she needed.  As a diabetic alcoholic, she needed medical clearance prior to getting psychiatric help.  We explained that we were there to help, and she agreed to go with us.  The woman admitted to suicidal tendencies, and the officers handed us the IPH form.

As we loaded her up, she became hysterical and resumed yelling for Rebecca.  We applied soft restraints to keep her from flailing around too much.  While she wasn't intentionally violent, that's no small consolation when you get accidentally smacked all the way to the hospital.  We talked her down a bit and addressed her concerns about the IPH to her satisfaction, and she rested comfortably as we initiated transport to the hospital.

I asked her if I could get her ID out of her bag, and she gave me permission to rummage through the large backpack that contained most of her earthly possessions.

"Just don't steal my $15,000 dollars," she added.

Right. $15,000?

So I started going through her backpack, and couldn't find the ID.  When I asked her where it was, she said it was in a manila envelope with her money.  I quickly located the manila envelope and undid the clasp.

Sure enough, there was her ID.

Right on top of a large quantity of cash.

Now, I'm no banker, but I'd bet a good chunk of my next paycheck that it was right around fifteen grand.  This poor lady had lost her daughter to a drunk, and then her job, her house, and almost everything else she had to her own alcoholism.  But she had it together enough to carefully manage and account for 15Gs in cash as she slowly drank away what was left of her former life.

We dropped her off at the hospital fifteen minutes later, and she thanked us profusely for helping her.  She offered my partner and I some money for helping her, which we politely but firmly refused.  She was pretty pushy about it, but in the end seemed satisfied that we wouldn't take a penny from her for doing our jobs.

We never saw her again, and I really hope that the psych unit was a good place for her to get some help.  It still amazes me that this woman had more money in one envelope than I've ever had in my bank account at one time.

No matter how many calls I run, I never cease to be amazed by what I see...

Welcome!

Hi!  Welcome to Traumatic License.

If you're here, you probably either work in or have some interest in Emergency Services and the public safety sector.  Or you clicked on some link from the Oil Minister of Nigeria offering you millions of dollars for helping him smuggle money out of Africa.

Either way, now that you're here you'll probably find some war stories, as well as my thoughts on the Good, Bad & Ugly of Fire Protection, Emergency Medical Services and Law Enforcement.

I proudly serve in Fairview, USA.  My response area changes by the day, and includes everything from the inner-city urban environment to the very rural suburbs.  Fairview County covers a couple thousand square miles and more than a million people, so the opportunities for variety are many.  I've gone days without a run, and run more than 25 calls in 24 hours.

I'm always open to constructive criticism and comments of all kinds.  I welcome dissenting opinions, and I don't have any problems with the occasional healthy debate.  However, there are a few ground rules: Keep it civil, keep it reasonably intelligent, and divorce yourself from emotion long enough to completely read and attempt to understand what I've written.  While you're free to post whatever you'd like in the comments section, don't be surprised if I delete a comment that doesn't follow the rules.

Also, this whole operation is quasi-anonymous, and with good reason.  I won't identify patients, and certain identifying details will be changed to protect their privacy.  I also won't post photos that in any way violate anyone's privacy, and I won't identify myself, my agency or my coworkers.

That's the way the brass wants it, and that's the way I'll run it.  To paraphrase the immortal Calvin, you cannot trace me.  You cannot find me.  Sincerely, Fairview Medic.