MVA Update

Unfournately the little old lady in my last post did not make it. We received word yesterday when the medical examiner called looking for information about the car accident itself. It was not the best news to hear, but we really did the best we could for her and I like to think that I was kind and caring to her durring her last moments of lucidity before she couldn't fight anymore.

Minor MVA?

A private ambulance was on scene already, they had been transfering a non emergent patient somewhere when they came across a car off the roa, slammed into a tree down in the ditch, a good six foot drop from the pavement. The airbag had been deployed and the white shirted EMT is standing there with a pair of bloodied gloves on when we arrive.
"Okay, so I'm transfering the scene to you." She says, very officially and I try not to laugh, she must be new as this is something left unspoken except for major incidents with multiple jursdictions.
"Whats up?" I ask her as the captain gets the cot and the board. The patient is still in the car, a C Collar in place and the EMT tells me she was complaining of lower neck pain, she's concious and oriented and when I talk to her she appears to have no major issues. She has strong and equal grips, her pupils are equal and reactive, she says the base of her neck hurts a little bit but its nothing major.
When I ask her how she ended up off the road she says that she thinks she fell asleep, a relative of hers is very ill and she was traveling to go and see her, she'd been driving a lot over the past few weeks and it must have caught up with her.
We eventually extricate her, carefully slidding the backboard under her and securing her because of the neck pain. She has a minor laceration to her face which at some point stopped bleeding. When I was if she has any medical history she tells me that she has A fib and that she's on a blood thinner called Comudin. In medic school they always teach us that Comudin makes a trauma patient very dangerous. They can have internal bleeding at the littlest trauma. But she seems fine and requests that we take her to a smaller hospital because its closer to her home and all of her doctors are there. Our assessments reveal nothing freightening so we agree and transport her to H.
On the transport in, she's talkative, answering all of my questions with no problems, her vitals remain rock stable and she shows no neurological signs.
When we drop her off in their trauma room she tanks us for our care and signs our paperwork. We leave and return to quarters.
Within an hour we are back at H, a walk in medical had requested a ride to that hospital. He's not critical so we transport him there with no real issues or treatments. An IV, a cardiac strip and a history, vitals. We place him in one of the rooms and I sit down to write my report.
One of the nurses comes in and says "I hope you don't want your back board back. Its on its way to Maine."
Apparently our first patient was still on the board, an MRI revealed fractures to the C 3 C4 and C5 vertbrae. A bleed had also developed in her brain. When I went in the trauma room to check in, her face was swollen and she had no idea where she was or what was going on.
I felt horrible but none of my assessments or tests had showed any reason not to take her to the hospital she requested. I am still trying to acquire follow up information on her but I am suspecting it will not end well.

NASCAR Detail

Last weekend I made the last minute deceision to extend my 34 hour shift to 52 by picking up a detail at the New Hampshire International Speedway in Loudon, for those that don't know its a NASCAR track and they held the Lennox 301 there last Sunday. I figgured it would be a helluva show watching all the drunks and rednecks mingle through the stadium and that I could probably BS my way out into the infield of the track to see the cars go by.
My wife's father worked for a now defunct auto parts company and her childhood was spent going from track to track meeting different race car drivers and such. Because of that, we meet almost weekly at the inlaws to have homemade onion rings and beers and other goodies while we watch NASCAR. At first I wasn't interested in anything but the food but the more I watched and the more I drank the more interesting it became with the drafting and the bumping and what not.
So when my shift at the firehouse ended I put on my uniform shirt, I usually just wear a class C t shirt or poloshirt, and drove over to the racetrack to staff one of the private ambulances that had been rented to provide ALS care to the racegoers and, if need be, the drivers themselves.
I ended up being assigned to Grand Stand Aid with a bunch of medics from somewhere down in Connecticut. Its always interesting working with career private ambulance guys or even career EMS guys for that matter. But the career private people are usually a bit interesting and these guys from CT were no exception, they all wore police style belts with pouches for trauma shears and gloves and window punches, they wore huge MagLite flashlights even though we were in a well lit clinic type aid station.
I wore my Leatherman, a tool I wear whether I am working or not.
The day went pretty well despite the strangeness from Connecticut. We had several walk in patients. A guy in Home Depot racing team sweatpants and an AutoPalace sweatshirt comes in and asks us to rebandage his finger, the top of which is missing from some redneck racing related accident three days earlier. Its clearly infected but he refuses to be transported to the hospital claiming he has no insurance. Despite assurances that it won't matter, he still refuses. A few drunks wander in after falling over. We patch them up, hydrate them and sent them off.
For most of the day I sit outside the clinic on a golf cart and watch the parade of drunk and drunker people stagger by. Because of my badge a few of them think I am a cop and try to act sober when they stumble by which is even more entertaining. My official reason for being there was to staff one of the transporting ambulances at the paramedic level with an EMT from further up in the Lakes Region.
At about noon a call comes in from the middle of the track, because of severe mismanagement of the call by those in a position of power (private ambulances, not fire department or municipal personel) I end up being sent to the infield and spend a good portion of the race there until we are recalled to grandstand aid. I snap a few pictures with my cellphone of the cars whipping by and stand at attention for the cameras while they sing the national anthem and fly F 16 fighter jets over the stadium. Richard Petty zipps by on a tiny motorized scooter and thanks us for our service.
At one point I see a bunch of people in Lennox Tools Team t shirts and remember a friend from college who works for them, her father is Hackman, a guy who cuts apart cars with a Sawzall to demonstrate the reliablity of Lennox blades. I ask them if shes here and they tell me she's up in the suite. I call and leave a message telling her to come down and slum it with the rescue guys.
When we end up back in GSA we see a bunch of patients strewn accross the beds. The three CT guys are trying to start a line on a 15 year old girl with virtually no symptoms other than a headache while a 50 something year old guy sits unattended on a cot with his very nervous daughter. She's nervous for good reason, her father has been complaining of chest pain and nausea. His IV is infiltrated and he's shivering like crazy in the 80 degree weather.
I go over and pop another IV in him, discontinuing the 22 they had running and replacing it with a 16 guage in his Left AC. His daughter tells me he doesn't travel much and that he might have over done it.
I tell the CT guys to get a monitor and do a 12 lead, which takes them several minutes of wide eyed scariness to do. When they finally do, the monitor has no paper in it and the guy assures me "The 12 lead's fine." I take the patient and shoot off to Concord Hospital.
When we get back we are, thankfully, told to stage with the Loudon Fire guys at the TV entrance and I end up sitting there as the rain starts to fall. We get sent to meet Hillsborough County sheriffs deputies with a head injury at the other end of the stadium
On arrival we find several guys in Mass State Police sweatshirts trying to convince their intoxicated buddy that his 4 inch gash that goes to the skull over his left eye is worthy of going to the hospital.
Eventually we convince him, again another uninsured race goer, to seek help. On the way in his pressure drops and he starts projectile vommiting. Zofran calms that down and he becomes rousable only to sternal rubs, and even then minimally. All because he'd been horsing around with his buddies and fell, hitting a rock.
All in all it was a good day, despite dealing with whackers. And come September, I'll probably put in for the detail again.

ALS Skills

http://www.youtube.com/watch?v=3pZxOqfB3YA

I recently read a post on FlyingVan, a blog by a San Diego Fire Rescue helicopter paramedic. Apparently his coverage area approved the EZ IO drill for use in prehospital care. We've had it in New England for a little while now and in fact have just approved it for use by New Hampshire EMT Intermediates in adult patients.
The EZ IO itself is something I have used on several patients, basically its a power drill that inserts a needle dirrectly into the bone for vascular access. While it sounds fairly barbaric it is a lot better than the old IntraOseous system which was pretty much an awl that used the brute strength of the medic to drive the hollow needle into the bone.
There's been some debate in New Hampshire as to whether or not the Intermediates should have been given access to the IO but my theory is that with the right training and propper guidance they can use this new tool effectively as paramedics.
The IO drill or bone gun as we call it in my service area, is particularly useful for dead and dying patients with poor blood pressure or compromised vascular access due to drug use or just plain "bad veins". When you absolutely, positively must have a line, the IO is there to bail you out with its easy Black and Decker style usage.
Its also not something to be taken lightly, like a lot of the paramedic toys. I recently had a student riding third on the ambulance, he's one of our volunteers, and I told him "A good call is when the ALS boxes stay closed." And its true, I am not a lazy medic but every ALS skill has consequences and reprecussions. BLS comes before ALS for a reason.
Having said that, some patients trully need ALS interventions for either life saving or life quality preservation.
Such as last night, I was working out of Station 1 when we were toned to a pizza dough manufacturing plant for a worker who had got his hand wrapped up in the dough hook of a mixer. He'd luckily self extricated before our arrival but his right hand was clearly deformed, starting at the wrist and swelling to about four times the size. His fingers were cool and clammy to the touch and his hand was continuing to swell.
He complained of 7 out of ten pain, stating that he felt fine otherwise. We propped his hand on pillows and towels in an effort to make him as comfortable as possible. His blood pressure was around 160/palp so I decided to push 4mg of morphine. All that did was lower his pressure slightly and did very little to touch the pain, but he asked me not to push anymore because it "Made me feel like when I used to use, I don't need that shit."
Fair enough, I pushed Toridol in an effort try and relieve some of the pain, the combination of both dropped his pain level to a more barable 5 out of ten.
ALS interventions do have their place and its not always for "lifesaving" purposes.
I also find it rather surprising that it has taken a California system this long to have brought out the IOs, it was always my impression they were far more advanced than us on the east coast.