Attempt

ALS 4 from 5 p to 7 am on overtime. It had been one of those horrendous nights where we left at around five pm and didnt make it back until about 4 am. Almost every patient was an ALS call. But the one that came in at quarter of five in the morning was the worst. I had been asleep for a little over forty five minutes when the tones dropped for an overdose on the other end of town.
"Engine Five, ALS 4 respond to XXXX for an overdose."
Groggily, realizing I still have to work a transfer truck for 12 hours, begining in less than six hours, I key the mike. "Four's responding. Is PD enroute?" Overdoses, especially ones that come in at this early in the morning usually end up being Code 10s, dead on arrival with obvious signs of being dead for several hours. In other words, long gone.
"Negative, patient is a 48 year old woman, shallow respirations. Shes known to us, possible suicide attempt."
Maggie, my chaufer for the shift gets in the driver's seat and states. "I know right where this is." She hits the lights and I drift back to sleep on the ride over to the apartment complex.
I wake up from my little nap when the radio chirps. "ALS 4 from Engine 5, just back right in up to the steps and bring in all of your stuff. We'll get the stair chair but bring in all of your stuff." I sigh and reply that we will, when they say that, the patient is usually very critical.
And she was.
Forty eight years old, snoring respirations at four to five times a minute. Her right eye is pinpoint and her left one totally blown. One of the firefighters gives me a quick report. "Breathing like four times a minute, pressure is at 70/palp. Pulse around 110. Jaw is wicked clenched, I can't even get an OPA in." The small piece of plastic used to hold open an airway when a tube is not possible.
We bundle her into the chair, take her down the stairs and drop her on the cot. Once in the back of the truck I cut off her nightgown and throw on cardiac leads. Shes in a sinus tach with occasional PVCs. We drop a nasal trumpet and I steal a firefighter to bag. The lieutenant hands me an empty bottle of psych meds. It was filled with 60 pills two days ago and now its empty.
We try for two IVs and get little more than flash before the lines blow. Her sugar comes back at 102, normal and not the problem. I pop an IO into her right leg and it flows fine. We transport, a quick little jog down to the Elliot. My patch was simple but it got the job done.
"Elliot Hospital, Elliot Hospital. Status One traffic, five minutes out on Med 1"
"Elliot, go ahead and please identify."
"Good morning, ALS4. I'm about five from your facility with a forty something year old female. Took a full bottle of at least 60 psych pills. Vitals unstable full report on arrival, I'm busy now. Have a team standing by."
I push 2mg of Narcan and nothing happens. Big shock, I didn't expect it to but on the off chance there's narcs in there I wanted to try. Her teeth are still clenched but we're pulling into the Elliot.
Once inside I help them work her up, I bag her while they push RSI meds to parlyze her and then help the doc get the tube. She was really anterior and I had to force her trachea down for him to see it.
They bring in a ventilator as the cops show up and tell us the rest of the story.
Apparently the woman is very well known, numerous suicide attempts with an extensive depression and bi polar history. Her husband had come home at around seven the night before and found her sitting in the chair much like we did in the morning and thought she was sleeping so he left her alone. When he woke up to take a piss int he morning he found her still sitting there and tried to wake her up, then he found the bottle of pills with nothing but dust in it and called 911.
Manchester is one of those typical New England urban centers, the largest city north of Boston. As such it attracts the typical urban problems of drug abuse, assaults, homeless people and the mentally ill who gravitate toward large urban areas. The over taxed healthcare system tries to do a treat and release that relies on people who want to kill themselves being trusted to take home quantities of meds capable of producing that goal and then following the propper dosage plan.
The city has four ALS trucks in 911 rotation. We basically serve as the reset button for a population that bounces in and out of care facilities. When the inevitable happens, we are there to pick up the pieces.