The third crime scene I'd like to address is stabbings. The "stabbing" call could actually be a cut, puncture, stab, slash, chop, clice, thrust or scrape, all of the above or none of the above. Like shootings, they are often very dynamic and charged scenes. While bullets differ mainly in size and velocity, edged weapons come in all shapes in sizes, and there is a huge variety of wounds that can be inflicted by them.
Many of the points from the CSI: Fairview - Shootings post apply to stabbings, but there are a few additional considerations. Take a look to refresh your memory - I'll wait - and then we can explore the differences.
Again, hopefully you'll stage until law enforcement has arrived on scene and cleared the scene to the best of their ability. You'll still want to enter carefully, scanning for evidence and not stepping in puddles of blood whenever possible.
It's nice to think you won't have to look as carefully for shell casings, but don't fall into that trap. It amazes me how many people think it's a good idea to bring a knife to a gun fight. It's also very important to note that shootings and stabbings are often confused for each other, either by the calling party, the call taking dispatcher, the radio dispatcher, or even the patient.
I think a lot of the problem lies with the person reporting the emergency. They may not hear shots and assume it's a stabbing, or they may have heard some loud noise and just assumed that stab wound is actually a bullet hole. The fight or flight response has a way of skewing people's perceptions and recall, so that's a factor, too. Further complicating matters is that the Emergency Medical Dispatch (EMD) code is the same - 27 - for both shootings and stabbings, as they're both penetrating trauma.
Don't assume that you don't have to pay attention to your surroundings just because the call came in as a _________ and not a shooting or other obvious crime scene.
So, being mindful of evidence as you approach, you size up your scene, evaluate your surroundings, and assess your patient. If the butcher knife/ice pick/ninja sword is still penetrating the patient's body, secure it as you would any other impaled object.
I've heard of a paramedic intern (or rookie paramedic, or a stupid paramedic) who responded to a stabbing and found a large steak knife lodged in the unconscious patient's chest. Without thinking, he quickly pulled the knife out. When he realized that he'd breached protocol by removing the impaled object, he immediately replaced it in the original wound in the patient's chest. That's right - the paramedic stabbed his own patient. Since the patient would have died no matter what, the paramedic only got a slap on the wrist. Now, this is almost certainly an urban legend - very non-specific details coupled with very specific details never strike me as believable - but it illustrates the point well. Don't remove any impaled objects that you don't need to. The chances that you'll need to are very rare indeed.
Anyhow, that little digression aside, let's continue.
If the weapon is no longer embedded in the patient but it is on scene, try to obtain a description of it. Again, the weapon is evidence, and you should not disturb it without the knowledge and consent of the law enforcement officers on scene. While a description is great, a picture can be very helpful too. A picture of a knife may or may not indicate scale, but a picture of a knife with a ruler or other common object next to it for scale - quarter, dollar bill, trauma shears, etc - paints a much more accurate picture for the hospital staff. If your agency prohibits taking pictures, don't do anything that risks you getting fired though.
If the assailant fled with the weapon, you may be able to ask the patient what the weapon was. The wound itself may give you an idea of how big the weapon was, but not necessarily. It will likely be impossible to tell how deep the wound is.
Remember that the patient may be altered or otherwise combative, and remember that the patient might not be an innocent victim. Watch the hands, and check for weapons.
It's important to again point out that the patient may be suffering from more than one wound, so do a complete and thorough physical exam. Remove the clothing carefully, and don't cut through any puncture holes if at all possible. Keep the clothes together, and don't dispose of them at the hospital.
My earlier points about patient statements being important evidence are still applicable, so be sure to accurately document the patient's description of the weapon, assailant and circumstances. You'll probably remember the guy attacked by a ninja sword for the rest of your life, but the guy that was stabbed by a pocket knife may not be as memorable. Both runs could land you in court, though, so be sure to document thoroughly.
So to recap: treat your patient appropriately and professionally while maintaining vigilant situational awareness, preserving the evidence and thoroughly documenting the circumstances. It may be easier said than done, but it gets a lot easier with practice.
Again, this isn't all-inclusive, and I welcome input from other responders. Whether you're a stockbroker whose only public safety experience is getting stopped for speeding and watching Third Watch reruns or fire chief/SWAT medic/Navy SEAL/dog catcher/paperboy, the odds are that you've got good ideas and a different perspective than me, so let me hear it.
Stay safe out there...
Traumatic License - a peek inside the crazy world of pre-hospital medicine in Fairview, USA
Wednesday, October 26, 2011
Tuesday, October 18, 2011
Priceless, Part 2
After the goofiness of Saturday morning, I figured maybe Saturday night would continue the douchebaggery.
I wasn't disappointed.
Just after we finished cleaning up the kitchen after dinner, we decided it'd be good to go out for ice cream. A lot of the time we'll have ice cream in the house, but the Lieutenant and Captain both had family in town this weekend so we decided to go out and invade a Cold Stone.
The whole house emptied out, and close to 30 of us (between the engine, truck, us and the family members) walked in together. The bill came to almost $150 for everyone, and the Captain's brother - a retired cop - picked up the tab for all of us, which was mighty nice of him.
Good times.
We ended up closing the joint down, and got a call as we walked out. The run came in for an elderly woman having a heart attack, with law enforcement already on scene.
So we have an uneventful response, and pull in to the patient's neighborhood. We don't look at house numbers as we approach the cross streets, and there are no police cruisers in sight. The street wraps around to a cul-de-sac, and we fail to see any cops anywhere.
We make a victory lap through the neighborhood, this time paying attention to the house numbers. We locate the home, and my partner parks the rig.
The home is a well-kept bungalow with a large, brightly lit American flag flying proudly in the crisp autumn night. The house, despite being blacked out, manages to still look warm and inviting. It probably has something to do with the antique decorative fire plug in the yard, but maybe not.
I advise the dispatcher that we are at the reported address, but that there is no law enforcement presence. We knock on the door, but after 30 seconds there's no answer. I let dispatch know our situation, and we begin to look for a non-destructive way to force entry. They advise me to standby before attempting entry and that the call came in from the State Police. I pull out the cell phone and call their dispatch to obtain further information about the response.
The dispatcher states that a trooper had initiated a traffic stop on a vehicle for excessive speed. Upon making contact with the violator - a 17 year old girl - and hearing her story, the trooper called for our response. Per the dispatcher, the trooper was told that the girl was driving down the road at 95 miles per hour because her grandma was having a heart attack. The girl provided her grandmother's address to the trooper, and that's how we got dispatched. The typical too-many-links-in-the communication-chain situation resulted in our belief that the cops were on scene of our call. No big deal... at least, it won't be unless the patient isn't breathing.
Now that we know the patient is inside, we knock much louder, this time at multiple doors and windows. The lights pop on, and the sweetest little old lady in town opens the door. She's wearing an expensive robe and well-worn pink bunny slippers. Despite being obviously asleep a minute ago, she smiles warmly. She's my new hero.
"Good evening, boys. Is everything okay?"
"Well, ma'am, we hope so," I begin, "are you Elizabeth Jones (not her real name)?"
She pales slightly, and the smile turns into a frown.
"Yes, I am. You wouldn't be here if everything was okay. Did Eunice have another stroke?"
We inform her her that Eunice - we later learn that's her neighbor of nearly 60 years - is, as far as we know, just fine. She invites us in out of the cold, and we walk in.
We ask her if she's okay, and she assures us that she's fine. We learn that her husband was a retired firefighter that died peacefully in his sleep a decade ago, and that she lives alone. Aside from a touch of hypertension, she's healthy, and she is most assuredly not having a heart attack.
We thank her for her time, apologize for waking her up, and politely decline the plate of cookies she offers us.
My partner advises our dispatch that there is no patient at this address and that we're available. I pull out my phone and call the State Police back. I tell the dispatcher that Mrs. Jones is fine and there's no emergency at her house. The dispatcher tells me that she'll pass that on to her trooper, and wishes me a safe night before hanging up.
I hear the dispatcher's voice over the scanner as she advises the trooper of the situation. He copies her, advises that he has one suspect in custody, and requests a tow truck for the suspect's car.
So, twice in less than 24 hours, we had knuckleheads lie to the cops to get out of traffic tickets, generate dangerous lights and sirens fire & EMS responses, and go to jail for their efforts.
Congratulations, morons - you're a big part of what's wrong with the world today...
I wasn't disappointed.
Just after we finished cleaning up the kitchen after dinner, we decided it'd be good to go out for ice cream. A lot of the time we'll have ice cream in the house, but the Lieutenant and Captain both had family in town this weekend so we decided to go out and invade a Cold Stone.
The whole house emptied out, and close to 30 of us (between the engine, truck, us and the family members) walked in together. The bill came to almost $150 for everyone, and the Captain's brother - a retired cop - picked up the tab for all of us, which was mighty nice of him.
Good times.
We ended up closing the joint down, and got a call as we walked out. The run came in for an elderly woman having a heart attack, with law enforcement already on scene.
So we have an uneventful response, and pull in to the patient's neighborhood. We don't look at house numbers as we approach the cross streets, and there are no police cruisers in sight. The street wraps around to a cul-de-sac, and we fail to see any cops anywhere.
We make a victory lap through the neighborhood, this time paying attention to the house numbers. We locate the home, and my partner parks the rig.
The home is a well-kept bungalow with a large, brightly lit American flag flying proudly in the crisp autumn night. The house, despite being blacked out, manages to still look warm and inviting. It probably has something to do with the antique decorative fire plug in the yard, but maybe not.
I advise the dispatcher that we are at the reported address, but that there is no law enforcement presence. We knock on the door, but after 30 seconds there's no answer. I let dispatch know our situation, and we begin to look for a non-destructive way to force entry. They advise me to standby before attempting entry and that the call came in from the State Police. I pull out the cell phone and call their dispatch to obtain further information about the response.
The dispatcher states that a trooper had initiated a traffic stop on a vehicle for excessive speed. Upon making contact with the violator - a 17 year old girl - and hearing her story, the trooper called for our response. Per the dispatcher, the trooper was told that the girl was driving down the road at 95 miles per hour because her grandma was having a heart attack. The girl provided her grandmother's address to the trooper, and that's how we got dispatched. The typical too-many-links-in-the communication-chain situation resulted in our belief that the cops were on scene of our call. No big deal... at least, it won't be unless the patient isn't breathing.
Now that we know the patient is inside, we knock much louder, this time at multiple doors and windows. The lights pop on, and the sweetest little old lady in town opens the door. She's wearing an expensive robe and well-worn pink bunny slippers. Despite being obviously asleep a minute ago, she smiles warmly. She's my new hero.
"Good evening, boys. Is everything okay?"
"Well, ma'am, we hope so," I begin, "are you Elizabeth Jones (not her real name)?"
She pales slightly, and the smile turns into a frown.
"Yes, I am. You wouldn't be here if everything was okay. Did Eunice have another stroke?"
We inform her her that Eunice - we later learn that's her neighbor of nearly 60 years - is, as far as we know, just fine. She invites us in out of the cold, and we walk in.
We ask her if she's okay, and she assures us that she's fine. We learn that her husband was a retired firefighter that died peacefully in his sleep a decade ago, and that she lives alone. Aside from a touch of hypertension, she's healthy, and she is most assuredly not having a heart attack.
We thank her for her time, apologize for waking her up, and politely decline the plate of cookies she offers us.
My partner advises our dispatch that there is no patient at this address and that we're available. I pull out my phone and call the State Police back. I tell the dispatcher that Mrs. Jones is fine and there's no emergency at her house. The dispatcher tells me that she'll pass that on to her trooper, and wishes me a safe night before hanging up.
I hear the dispatcher's voice over the scanner as she advises the trooper of the situation. He copies her, advises that he has one suspect in custody, and requests a tow truck for the suspect's car.
So, twice in less than 24 hours, we had knuckleheads lie to the cops to get out of traffic tickets, generate dangerous lights and sirens fire & EMS responses, and go to jail for their efforts.
Congratulations, morons - you're a big part of what's wrong with the world today...
Monday, October 17, 2011
Priceless
It's early on a Saturday morning, and I've been in bed for about 15 minutes. I'm in that awkward not-quite-asleep daze of relaxation when the alert comes in.
For a maternity.
On the expressway.
Wonderful.
I make it to the rig as my partner fires up the engine, and we head toward the scene. After a 3 minute uneventful response through the nearly deserted 3am Fairview streets to the expressway, we pull up to a Honda Civic with it's hazard lights on sitting on the shoulder. There's a trooper on scene already, and he doesn't look happy.
We make contact with him, and he tells us that he initiated a traffic stop on the patient's vehicle after it passed him in excess of 110 miles per hour. Upon making contact with the patient's boyfriend (the driver), he was told that she was in labor and they were rushing to the hospital. The trooper detected signs of intoxication and notified us of the impending birth of baby Asphalt. Or Blacktop. Or Concrete. Or whatever.
I conduct an initial assessment, which reveals a 21 year old woman in no apparent distress. I cancel the incoming engine company and continue the assessment.
She states her last menstrual period was 31 weeks ago, and denies recent alcohol use. This is interesting, since I haven't asked her about drinking. She freely admits to smoking throughout the pregnancy, though, so she's obviously a real winner.
She states her due date is in three months - I'm no 'rithmetic expert, but that doesn't seem to add up - and she denies any prenatal care. I ask her about contractions and - big surprise - she starts to get evasive. She states that her water broke while she was at home asleep, which is weird because they're both dressed like they're coming from a party... Maybe cocktail dresses and tuxes double as pajamas for these folks, but I kinda doubt it.
The expressway at drunk time is one of my least favorite places to be, so I try to minimize my scene times whenever practical. This is one of those times, but she seems determined to drag this out as long as possible. After 10 minutes on scene with her stalling and evasion (and one 'contraction' that didn't seem legit at all), I tell her (as politely and firmly as possible) that the danger to all of us is excessive and unnecessary and we need to get her to the hospital.
She reluctantly climbs on the gurney and we load her into the ambulance. As the back doors slam shut, the trooper's handcuffs ratchet closed on baby daddy's wrists. The trooper is arresting him for drunk and reckless driving. The guy is crying as he takes a seat in the cruiser.
The patient goes ballistic and tells me that they can't be arresting him. I inform her that not only CAN he be arrested, he IS being arrested. She breaks down and admits that, while truly pregnant, she's not in labor - her water breaking was lie, and the 'contraction' was faked. I ask her if she still wants to go to the hospital, and she says no, so I have her fill out the refusal paperwork. I open the doors to the rig, and help her step down to the ground.
The trooper comes over to see what the problem is. I give him the rundown and he smiles knowingly. As I pull a tissue out of my pocket for my former patient, the trooper pulls out a gift of his own. The patient wipes her eyes as the trooper presents her with her new bracelets. Before she could even process what was going on, he had her cuffed and informed of her charges. Obstruction, false report of an emergency and contributing to the delinquency of a minor - turns out baby daddy wasn't quite 21 yet...
Apparently lying to a trooper about being in labor isn't a good plan. Neither is partying and having your intoxicated unborn baby's father drive you home. Smoking while pregnant seems like the least of the problems this poor kid'll have to deal with in the future...
Pack of smokes: $5
Party dress: $150
Bail money: $1,000
Look on trooper's face as he "limits out" on the traffic stop: Priceless
For a maternity.
On the expressway.
Wonderful.
I make it to the rig as my partner fires up the engine, and we head toward the scene. After a 3 minute uneventful response through the nearly deserted 3am Fairview streets to the expressway, we pull up to a Honda Civic with it's hazard lights on sitting on the shoulder. There's a trooper on scene already, and he doesn't look happy.
We make contact with him, and he tells us that he initiated a traffic stop on the patient's vehicle after it passed him in excess of 110 miles per hour. Upon making contact with the patient's boyfriend (the driver), he was told that she was in labor and they were rushing to the hospital. The trooper detected signs of intoxication and notified us of the impending birth of baby Asphalt. Or Blacktop. Or Concrete. Or whatever.
I conduct an initial assessment, which reveals a 21 year old woman in no apparent distress. I cancel the incoming engine company and continue the assessment.
She states her last menstrual period was 31 weeks ago, and denies recent alcohol use. This is interesting, since I haven't asked her about drinking. She freely admits to smoking throughout the pregnancy, though, so she's obviously a real winner.
She states her due date is in three months - I'm no 'rithmetic expert, but that doesn't seem to add up - and she denies any prenatal care. I ask her about contractions and - big surprise - she starts to get evasive. She states that her water broke while she was at home asleep, which is weird because they're both dressed like they're coming from a party... Maybe cocktail dresses and tuxes double as pajamas for these folks, but I kinda doubt it.
The expressway at drunk time is one of my least favorite places to be, so I try to minimize my scene times whenever practical. This is one of those times, but she seems determined to drag this out as long as possible. After 10 minutes on scene with her stalling and evasion (and one 'contraction' that didn't seem legit at all), I tell her (as politely and firmly as possible) that the danger to all of us is excessive and unnecessary and we need to get her to the hospital.
She reluctantly climbs on the gurney and we load her into the ambulance. As the back doors slam shut, the trooper's handcuffs ratchet closed on baby daddy's wrists. The trooper is arresting him for drunk and reckless driving. The guy is crying as he takes a seat in the cruiser.
The patient goes ballistic and tells me that they can't be arresting him. I inform her that not only CAN he be arrested, he IS being arrested. She breaks down and admits that, while truly pregnant, she's not in labor - her water breaking was lie, and the 'contraction' was faked. I ask her if she still wants to go to the hospital, and she says no, so I have her fill out the refusal paperwork. I open the doors to the rig, and help her step down to the ground.
The trooper comes over to see what the problem is. I give him the rundown and he smiles knowingly. As I pull a tissue out of my pocket for my former patient, the trooper pulls out a gift of his own. The patient wipes her eyes as the trooper presents her with her new bracelets. Before she could even process what was going on, he had her cuffed and informed of her charges. Obstruction, false report of an emergency and contributing to the delinquency of a minor - turns out baby daddy wasn't quite 21 yet...
Apparently lying to a trooper about being in labor isn't a good plan. Neither is partying and having your intoxicated unborn baby's father drive you home. Smoking while pregnant seems like the least of the problems this poor kid'll have to deal with in the future...
Pack of smokes: $5
Party dress: $150
Bail money: $1,000
Look on trooper's face as he "limits out" on the traffic stop: Priceless
Tuesday, October 4, 2011
Those Kinds of Things
I have a confession to make: I watched Trauma when it was on the air.
Funniest. Show. Ever.
Seriously, it fell into the "so bad it's good" category for me. The lack of believability was spectacular, and it was, all things considered, one of the dumbest hours of TV I've ever watched. Trauma was exceptionally bad. Or good. Whatever.
But I watched it, so I guess the joke's on me.
I've been critical of the way that EMS is portrayed in pop culture for a long time. I dug Mother, Jugs & Speed, mostly because Bill Cosby is awesome and the zany shenanigans were so goofy. I really didn't care for Bringing Out the Dead - way too dark and depressing, and (at least to me) as unrealistic as Trauma. There was an indie film called Broken Vessels that did the "dark exploration of prehospital medicine" thing way better than Bringing Out the Dead and was interesting from a train wreck kind of perspective, but basically I don't think Hollywood has ever portrayed us well.
I like to think I watch quality TV shows, occasional guilty pleasures aside, and I really enjoy the complicated and dark world of Showtime's Dexter.
I think it does a great job of challenging morality and the sometimes blurry line between good and evil.
Having said that (thanks, Larry David!), though, I had serious issues with Sunday night's episode. Read on for details (and minor spoilers!)
SPOILERS BELOW!
If you're still reading, I'm assuming that you either: a) already saw the episode, b) never plan to see it, or c) don't care much about spoilers.
The first couple of minutes of last night's episode Those Kinds of Things were completely and totally preposterous. Absurdly unintelligent. Insultingly ridiculous.
And it's just propogating the misinformation out there about EMS.
So here's the set up:
Dexter's inner dialogue tells us about how wrong things have gone as he stumbles around with a bloody knife. He calls 911 from his cell phone and tells the dispatcher that he's been stabbed. The ambulance crew (Go Team 42!) responds, doesn't stage, and runs to the now-unconscious Dexter's side with no regard for their safety, minimal equipment (who carries a jump bag on their lap?) and (convenient tie in to my CSI Fairview posts!) absolutely no attempt at evidence preservation.
As they kneel next to him, Dexter pulls out two syringes and jabs both responders in the throat. See what I mean about the hands being dangerous? He then puts them in the back of the ambulance, interrogates them, and pretty much does the typical Dexter thing. Apparently these two knuckleheads were trafficking human organs out of their ambulance with the help of a crooked doctor, or some such nonsense.
His finishing move involves a Lifepak 10 (seriously? Those still exist?) and one paddle on each bad guy. If I'd only known you only needed one paddle/electrode to do the job, I could've saved literally seconds of my life over the years!
He didn't charge to 200 (or even Extra Crispy), didn't yell "CLEAR!" and shot all the American Heart Association's protocols to pieces.
Aye carumba, oy vey and holy schlamoly all rolled into one. It was really, really, ridiculously bad looking. For reals.
Making things worse is the fact that Dexter's voice is on a recorded 911 call, and the ambulance crew (crooked or not) would be missed very quickly. And stabbings always warrant a police response. None of this scenario made any sense. He could have just made a normal BS complaint - flu-like symptoms or toe pain, maybe - and gone from there.
Hopefully this was a bizarre detour from the normal exceptional production value and strong writing behind this show.
[end crotchety old man-style rant]
Stay tuned for the CSI: Fairview - Stabbings post!
Funniest. Show. Ever.
Seriously, it fell into the "so bad it's good" category for me. The lack of believability was spectacular, and it was, all things considered, one of the dumbest hours of TV I've ever watched. Trauma was exceptionally bad. Or good. Whatever.
But I watched it, so I guess the joke's on me.
I've been critical of the way that EMS is portrayed in pop culture for a long time. I dug Mother, Jugs & Speed, mostly because Bill Cosby is awesome and the zany shenanigans were so goofy. I really didn't care for Bringing Out the Dead - way too dark and depressing, and (at least to me) as unrealistic as Trauma. There was an indie film called Broken Vessels that did the "dark exploration of prehospital medicine" thing way better than Bringing Out the Dead and was interesting from a train wreck kind of perspective, but basically I don't think Hollywood has ever portrayed us well.
I like to think I watch quality TV shows, occasional guilty pleasures aside, and I really enjoy the complicated and dark world of Showtime's Dexter.
I think it does a great job of challenging morality and the sometimes blurry line between good and evil.
Having said that (thanks, Larry David!), though, I had serious issues with Sunday night's episode. Read on for details (and minor spoilers!)
SPOILERS BELOW!
If you're still reading, I'm assuming that you either: a) already saw the episode, b) never plan to see it, or c) don't care much about spoilers.
The first couple of minutes of last night's episode Those Kinds of Things were completely and totally preposterous. Absurdly unintelligent. Insultingly ridiculous.
And it's just propogating the misinformation out there about EMS.
So here's the set up:
Dexter's inner dialogue tells us about how wrong things have gone as he stumbles around with a bloody knife. He calls 911 from his cell phone and tells the dispatcher that he's been stabbed. The ambulance crew (Go Team 42!) responds, doesn't stage, and runs to the now-unconscious Dexter's side with no regard for their safety, minimal equipment (who carries a jump bag on their lap?) and (convenient tie in to my CSI Fairview posts!) absolutely no attempt at evidence preservation.
As they kneel next to him, Dexter pulls out two syringes and jabs both responders in the throat. See what I mean about the hands being dangerous? He then puts them in the back of the ambulance, interrogates them, and pretty much does the typical Dexter thing. Apparently these two knuckleheads were trafficking human organs out of their ambulance with the help of a crooked doctor, or some such nonsense.
His finishing move involves a Lifepak 10 (seriously? Those still exist?) and one paddle on each bad guy. If I'd only known you only needed one paddle/electrode to do the job, I could've saved literally seconds of my life over the years!
He didn't charge to 200 (or even Extra Crispy), didn't yell "CLEAR!" and shot all the American Heart Association's protocols to pieces.
Aye carumba, oy vey and holy schlamoly all rolled into one. It was really, really, ridiculously bad looking. For reals.
Making things worse is the fact that Dexter's voice is on a recorded 911 call, and the ambulance crew (crooked or not) would be missed very quickly. And stabbings always warrant a police response. None of this scenario made any sense. He could have just made a normal BS complaint - flu-like symptoms or toe pain, maybe - and gone from there.
Hopefully this was a bizarre detour from the normal exceptional production value and strong writing behind this show.
[end crotchety old man-style rant]
Stay tuned for the CSI: Fairview - Stabbings post!
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