The funny thing about hospitals is that not all of them do the same things. Some of them are what is known as Level I Trauma Centers, that means that at any given time you can take the victim of a car accident or other "event of badness", as my medic instructor would say, for immediate surgical treatment. Still others have 24 hour cath labs. Others specialize in certain infectious diseases.
When I worked in Holden I didn't have to transport. AMR would provide a paramedic ambulance to come and whisk away the sick and injured. Sometimes I would have to drive or in really bad calls get in the back and either do CPR or help the medics do their medic things. All of the hospitals in Worcester were Level One, they all had cath labs. It was great because there was very little thought involved and you could focus on patient care. Wherever you end up based on diversion, traffic patterns or being pissed off at a nurse because she wouldn't give you fresh linens , you would get what you need and your patient could receive optimum care.
In Rhode Island (as most things related to the emergency service system are) its a bit different. Kent Hosptial, the one I usually transport to out of proximity and just plain easiness is not a Level One nor is it a cath lab. Usually thats fine because grandma drippy butt with pneumonia and a fever of 103 does not need surgery or catherization. She needs drugs, lots of them very quickly and Kent is good at that. Kent excells at little old lady fall down and go boom calls. Kent works very well on cardiac arrest calls so long as no cath lab is needed. Kent even has a barriatric pressure chamber for injured divers. In short, usually Kent gets the job done and there is no need to get on 95 and shoot up to RIH.
Rhode Island Hospital is the only Level One Trauma Center in RI. It is one of two 24 hour cath labs, the other being in the ass end of nowhere or as Rhode Islanders call it "Pawtucket". So last night when Warwick Rescue brought a lady into Kent for chest pain, they were doing right by her. There was no problem bringing a chest pain patient to Kent, shit, I do it all the time. But when that lady started having severe ST elevations and her once high blood pressure went down to 70/30 she was in a bit of trouble. Intially the blood pressure will sky rocket then as the person starst to circle the drain it will fall through the floor, all the while as the pulse drops. At one point Li'l Miss Chest Pain had a pulse of 27. Not good.
So Kent decides to ship her to RIH, a trully necessary and brilliant deceision on the part of the staff. I say this in all seriousness because it is hard to say "We can't handle this, you need to go somwhere else" and make the patient suffer through another transport. I had to do it twice at the Norwood, calling for a bird to take very critical patients into the BW and Mass General. Its difficult to admit defeat and call for help. So what the staff at Kent did last night was commendable.
I get dispatched for the transfer, a critical care run because of the amount of pumps, monitors and drugs running, around 10 last night. We pick up the lady complete with a little Indian man who is a transport nurse. He tells us that he is studying to be a paramedic and wants to get more experience.
All in all he did a good job. He was nervous as hell, couldn't get a decent blood pressure but when you are used to working in a hospital, where its quiet and controlled, I can imagine the back of a movin ambulance with sirens going would be pretty difficult. Jokingly I told him to wait until he tries to get a BP in the back of a mangled car when the boys have the Hurst kit going. He turned bone white and asked if we could take a pressure for him. 70/20. no real change of note, but he got nervous as her heart rate fell from the atropine induced 65 back to 50 again. He begged us to go faster as he pushed another half miligram of the heart rate increasing Atropine. She perked up and asked us to call her daughter and have her take in the meatballs she left on the counter.
I asked her the recipe and she went on and on about garlic and peppers, onions, tomato paste before even getting to how to prepare the meatballs. "The secret is in the gravy." Only a Rhode Islander will call the thick, delicious tomato sauce "gravy".
When we get to RIH or as I call it on the radio "Trauma" we rush right through the emergency room, passing drunks and stabbing victims. The triage nurse says "Hey what the..... O you called for the cath lab, go on up." As if we were going to stop but she has her hands full with a 17 year old who thought it was a good idea to get drunk and try to fly off of his father's tool shed and a regular named Bernie who I have jokingly threatened, to his face, to "shit the beat out of him." Not to mention countless other ED dwellers and a trio of Providence rescues (again a fancy name for an ambulance, not the heavy rescue stuff I did when on the job) whose crews are trying to figgure out where they can get new equipment because the supply closet is quite litterally bare.
So we bring our lady upstairs, watching as she occasionally blacks out and we have to yell at her to wake up. I start demanding to know more about her meatballs and sausage recipes as we run through the halls. The male nurse frantically looks for the BVM thinking our lady will code and I simply and calmly tell him. "Knock that shit off, you wanna tempt God here?" He manages a nervous laugh and I ask if Miss CP knows any good ways to make garlic bread.
We finally end up depositing the woman in the cath lab, rushing her into a kind of holding area where we can slide her to a special bed festooned with even more pumps and gizmos. Its much bigger than the Norwood's Cath Lab and for a second I miss working with my old friends like Kerri and Terri and the ancient, brillian ED guru Janet. I miss Nick G, the former special forces soilider turned nurse, I miss Karren, the X Ray tech who was almost bitten by one of the ubiquitous Dedham drunks. I even miss Dave, the psych nurse who once got mad at me for using an uninhabited psych room to store a body when the morgue was full.
But then I snap out of it, give my report and pack all of my stuff up and prepare to bring the unnamed nurse back to Kent to finnish his shift and study up on EKG recognition as in the back of a bouncing truck everything looks the same. On the way out I steal an O2 key because I have never had one and the hospital had an extra just sitting there....tempting me. Now its looped to my shears with a hospital ID bracelet and I wear it tucked into my belt at the lower back as opposed to in the back of my Leatherman sheath. I like it better that way.