Silent Siren, page 9
The helicopter hovers high in the sky as it lowers a corpsman and a Stokes basket made of wire mesh. The rescue basket is secured by a single thin line and I pray it doesn’t break under the woman’s weight. The corpsman assures me it won’t. We load her into the Stokes basket and she ascends into the darkness, the corpsman riding alongside, assuring that she won’t twirl out of control.
She is transferred to Legacy Emmanuel Hospital in Portland. Weeks later, my supervisor calls to tell me the woman had dropped off a thank-you note at AMR headquarters station in Portland, well and with no after-effects, to acknowledge our rescue. Somehow her acknowledgement of our efforts to stabilize and transport her to safety makes her seem more human to me, no longer simply an overweight, unconscious near-corpse, but a person much like myself, fearful of her own extinction, with plans and hopes for the future, grateful to be able to breathe and think and move on this Earth, even if just for a little while longer.
Adventures in Lawn Mowing
Everyone makes a bad decision from time to time. Really bad decisions may involve a call to 911—among those, the decision to get drunk and then mow the lawn.
It is early autumn and has been getting darker earlier and earlier in the evening. This does not deter one lawn care enthusiast from drinking a twelve-pack of beer and then hopping on his mower for some after-dinner lawn maintenance. The fact that his immense lawn is severely sloped and that there is no light seems of no consequence to him as he hefts his three hundred-pound body onto his trusty steed and ventures into the yard—a diligent if fool-hardy homeowner.
We get the call as “possible leg fracture” and receive very little additional information en route. Arriving on scene to the blinding strobe lights of an Oregon City fire engine, we make our way down the narrow driveway to where some of the volunteers have begun removing equipment from their unit. A backboard, cervical collar, and spider straps are brought through the darkness to the patient’s side, with the assistance of a flashlight.
Our hapless patient lies on his back in the cold. Thankfully, he has managed to extricate himself from underneath his mower but is not able to right himself. He hollers in pain, a cordless telephone beside him.
Cutting his jeans, I note a deformity to his upper thigh—a femur fracture, caused by the considerable weight of the mower on his leg.
The fire volunteers and I roll him to the side, slipping the narrow backboard underneath him, and then roll him, howling with pain, back down again. The backboard is not nearly big enough and his girth completely envelops it. This makes the task of securing the straps to the board very difficult. It is even more difficult to carry him a hundred yards up steep terrain, in the dark, to the waiting medic unit. Prior to making our way up the hill, we place a metal-framed device known as a Hare Traction Splint on his fractured leg. The elongation procedure usually causes an instantaneous decrease in the patient’s pain. I crank a wheel at the far end of it and his leg slightly elongates, relieving much of the pain of splintered bone ends riding past each other and thick muscles in spasm.
Once we have the man in the back of our ambulance, he begins to relate his sorrowful story. After becoming trapped under the mower, he had screamed for his wife, but after she came out of the house, he was so verbally abusive to her, she had said something to the effect of, “Call yourself, asshole. Here’s the phone.” Unbelievably, this is not the first time he has endeavored to ride his lawnmower drunk. The last episode had also ended badly, though I don’t recall what he said his injuries were the previous time he fell off his mower while inebriated.
“I…I jusht have an alcohol problem,” he slurs.
Gee, ya think?
The ride to the hospital is uneventful. I give him fentanyl and morphine to ease his pain. We transfer him to a bed in the Trauma Room at OHSU. The nurse looks amused as I tell the story. It is hard not to laugh. The man will be fine with the exception of some extra hardware in his femur after surgery and a strained relationship with his wife. Maybe he’ll sleep on the couch for a while.
I marvel at man’s great capacity for stupidity, possibly the number one root cause of calls to 911. I could get angry and throw my hands up in frustration at the paramedic’s role in thwarting Darwin’s Natural Selection. Often, I do.
Then again, stupidity keeps me in business.
EMS Superstition and the Heisenberg Uncertainty Principle
Superstition is part of EMS tradition, even among otherwise quite rational people. Those who have been involved in EMS long enough know never to utter the words, “Gee, it sure is quiet!” This seemingly innocent observation is sure to be met with glares or groans from the old-timers, possibly glee from the rookies. It is known as “The ‘Q’ word” and it’s the idea that the mere act of making an observation, say, of how few calls one has had that shift, will cause the EMS gods to rain havoc down on that shift, in the form of multiple 911 responses.
It occurs to me that this EMS superstition is related to the Heisenberg Uncertainty Principle, which states it is not possible to know with accuracy both the position and the momentum of a subatomic particle. The mere act of observing it changes its position.
Once, when I was feeling particularly bored on shift, I made the spontaneous observation to no one in particular that I hadn’t put flutter valves in anyone’s chest in quite a while. Flutter valves are large bore needles thrust through the chest wall of an individual suffering from a punctured lung. It is meant to relieve the deadly air pressure building up inside the chest cavity and is a very rarely done procedure in most systems. Within an hour, I found myself on the scene of a motorcycle accident in which a drunken man had struck a tree at high speed and, there I was, placing flutter valves.
In fact, the same principle seems to apply to any effort made to relax on shift. Taking off one’s boots to relax on the couch, for instance, is sure to generate a call. The same applies to attempting to eat lunch or taking a nap after a long stretch of calls. Inevitably that bell will ring and it will be time to go to work. Oddly, if one were to decide to take a nap and then decide against it due to some suspicion of an imminent 911 response, the response seems not to occur.
While it makes no logical sense that to simply make a flippant observation or attempt to relax will cause mayhem to reign in one’s response area, this superstition is still taken rather seriously.
A similar superstition is known as “Rider’s syndrome.” When an EMT student or other individual eager for action “rides along” with the medic unit to observe interesting calls, those interesting calls rarely happen. It can be a blessing to see those fresh-faced folks walk through the door, full of enthusiasm, and know that the day will most likely be slow.
Back to School
I worked for AMR in Portland for six months and felt that I was beginning to get my feet under me as a new paramedic. I would be still there today if it weren’t for the low pay—at $28,000 a year, I could scarcely afford to pay rent on a middle-of-the-road apartment and pay for food at the same time.
Lee Kimzey, my former advisor in the Bainbridge Island Fire Department Explorer post, called me up one day to tell me that Evergreen Medic One, the EMS agency he worked for at the time, was hiring, and he invited me to come up to the Seattle area to test.
I was reluctant at first; I had tested for Evergreen Medic One twice before and was not hired. The screening process was intense and involved a written test, physical agility test, and three candidate panels, the first two with paramedics and other representatives from the hospital, and the third with the Medical Program Director of Seattle Fire Department, Dr. Michael Copass.
Evergreen Medic One was one of two agencies remaining in King County that were not fire-department based. The agency was supported by King County tax levies and administered by Evergreen Hospital in Kirkland. The pay was superb and the working conditions excellent, I had heard. The caveat was that I would need to go through paramedic school again. Every paramedic, whether he had a year or twenty years on the street in another system, was required to complete the rigorous nine-month Seattle Fire/University of Washington Medical School paramedic course to qualify for work in King County. It is “an anomalous system,” as my former medic school instructor put it—the only one of its type in the nation.
I tested with about three hundred other candidates in a lecture hall. At each step, more candidates were eliminated until they arrived at six to send through paramedic school. This time, I was one of the six.
White-coated and nervous, thirty paramedic students gathered into Harborview Hall our first day as paramedic students. Across the street at the Emergency Department, hospital gown-draped patients, gaunt and leaning on IV poles, puffed on cigarettes and shivered against the cold.
Dr. Michael Copass, a short but powerful man who wore a sweater vest and multiple pagers on his belt, stood at a lectern and introduced himself, referring to “this auspicious occasion” on which we were to embark in an “immersion in medicine” that was to last nine months. Dr. Copass, a legend in the Emergency Medical Services community, became the medical director of Paramedic Training in 1975. In addition to his leadership of Medic One, he is chief attending physician at Harborview Emergency Room, Medical Director of Airlift Northwest, Professor at University of Washington Medical School, and practicing neurologist. Dr. Copass always dresses the same way—khaki pants, a white shirt, tie, and a sweater vest. Though short, he is an imposing figure and his expectations for the physicians, medical students, and paramedics that work under him is very high. He wears three pagers on his belt and carries with him a portable radio. At any hour of the day or night, 365 days a year, Dr. Copass can be reached as “Portable 55.”
History of Medic One
The Harborview/University of Washington Paramedic Program was started in the early 1970s by two individuals, Dr. Leonard Cobb, a cardiologist, and Chief Gordon Vickery of Seattle Fire Department. A study was performed to see if physician-level care could be brought to the streets. The study was completed in 1968 and the first class of paramedics graduated in 1970.
Seattle Fire’s very first medic unit was a converted RV known as “Moby Pig.” Placed into service in 1969, it resembled a slug with red lights and was essentially an emergency room on wheels, carrying cardiac drugs, airway supplies, and a ponderous cardiac monitor/defibrillator that was so large it needed to be wheeled into the scene.
The program evolved into a 3,000-hour training program, with the average student exposed to seven hundred patient contacts. (The average in other programs is two hundred.)
In 1974 and due to the success of the program, Seattle was reported as “the best place in the country to have a heart attack.” More accurately, it is the best place in the country to have a cardiac arrest. In 2006, the out-of-hospital cardiac arrest save rate was an astounding 46%. During that year, Detroit returned a dismal 0% save rate.
Though Medic One is a recognized leader in the EMS community, Dr. Copass, who trained in the military, believed in simplicity and in tried-and-true methods that often fly in the face of modern protocols. Early in my EMS career, I watched paramedics perform blood-letting, formally known as therapeutic phlebotomy, on congestive heart failure patients. The theory was that a weak and failing heart had too much peripheral pressure to pump against, so through phlebotomy the volume of blood was lowered and strain was, in turn, reduced. Medic One paramedics also employed rotating tourniquets for these same patients—elastic bands on three out of four extremities that would reduce the flow of blood back to an overwhelmed heart.
Training
Didactic training was intense during the first three months. I learned in more depth the concepts of emergency medicine that I had learned previously at the College of Emergency Services. We rode the Seattle Fire Medic Units at night, and on the weekends our responsibilities ramped up as we gained more knowledge and more responsibility. We spent time between calls in Harborview’s emergency room.
We started out as “kit carriers” for the first couple of weeks, simply acting as medical Sherpas for the senior medics. This was the honeymoon period and enabled us to simply stand back and observe the assessments and decision-making processes of those with experience. We had no responsibility other than to match what we had learned in the classroom to what we observed the seniors do in the field.
As the training continued, our responsibilities in the field increased. We learned to start IVs—an especially painful process for all involved because our practice subjects were our fellow students. Since I had had prior experience, I didn’t inflict undue pain on my comrades—at least I hope I didn’t. This was not the case with several neophyte venipuncturists. On one occasion, I had nine holes in one arm. A nervous student struggled to gain entrance to my ropelike veins, meeting with little success. One catheter dangled from a growing bruise on my arm. A senior paramedic encouraged him to try “just one more time.” Finally, mercifully, he was successful. For several weeks, all of us looked like junkies with bruises all over our arms.
Though I did not personally witness the event, I overheard that one student had attempted an IV on a classmate, first puncturing the skin and then dropping his angle so severely he exited the skin in a sewing motion. The senior paramedic had stood watching this spectacle with her jaw on her chest. For the duration of IV training, he was known as Betsy Ross.
Seniors
Any Seattle Fire paramedic involved in our mentoring and evaluation process was referred to as a “senior,” whether he had one or thirty years of experience. Roughly thirty seniors with thirty personalities and sets of idiosyncrasies could often dictate how successful we would be on shift. Carlos forbade us from “staging” our medical tape on the grab bar, in preparation for IVs. Norris insisted on us prepping IV sites using concentric circles of iodine. Succeeding in Medic One training was as much about acquiring clinical skills as it was placating the senior paramedics. It was a lesson in humility as well as a preparation for the myriad of different personalities we would encounter as new paramedics. “Yes, sir” and “Yes, ma’am” was de rigueur, no matter your personal feelings about a particular senior.
The seniors ranged from brilliant to bizarre. One senior seemed to suffer from a kind of verbal anomia in which he would become flustered on a serious call and then demand the “whatchamacallit.” Everything was a watchchamacallit, from the heart monitor, to the device used to secure IVs, to the portable radio. Woe to the student who would fetch him the wrong watchamacallit! Another, now mercifully retired, reminded me of a bear that had been rudely awoken from hibernation. With an unruly mustache and a belly that protruded from beneath his untucked white paramedic smock, he was uncompromising with students. When he was required to ascend a staircase on a call, it would tire him out to such an extent that he would have to catch his breath at every landing. Once in a patient’s residence, he would immediately find somewhere to sit, often the drug box, preventing the students from accessing it. Always vigilant and paying attention to every detail of the student’s line of questioning and treatment, he would at times arise, grumble, make a “time-out” sign with his hands, and roar, “No! No! No!” while shaking his head vigorously from side to side. One paramedic was forced to work Christmas on Medic One with “The Bear” and referred to it as “the worst day of my life.”
Shunt
I’m assigned to Medic One, the flagship, with one of my fellow students, Jules Nelson. Blonde and deeply tanned, she is originally from New Zealand. It’s too cold for her here, and she harbors a desire to work eventually as a paramedic in her homeland. Still, she seems to maintain a sunny disposition and wears a permanent smile on her face, despite some trying days on the medic unit.
It’s early evening, but it may as well have been the middle of the night, as night and day all look the same in the windowless Zone 4 in the back of Harborview’s ER, where all the down-and-outers go. My patient is a heroin addict who has used up all the veins he can reach, so he has resorted to “skin-popping” or injecting heroin directly into his skin. For his troubles, he is now the proud owner of a festering, putrid-smelling staphylococcal abscess. For the last fifteen minutes, I have been surveying every available square inch of his skin for a useable vein. He’s infected, so he needs blood cultures sent to the lab.
I plunge a butterfly needle through the tough skin of his hand, striking nothing that resembles a vein. The needle doesn’t so much slide as it does scrape. Scar tissue.
“Ow, dude!” he snarls, pulling away his hand. “You’re rough!”
“Sorry, man. You just don’t have any veins left.” I think for a minute. “Turn over on your stomach.”
I glance down the hall at Jules, her straw-colored hair contrasting with her antiseptically white coat, bent over a grizzled old man dozing off a Wild Irish Rose-induced stupor. A bag of normal saline hangs from a hook above him. Jules wields a 20G IV needle, a gleam in her eye.
Somewhere close by a new medical intern has made the mistake of removing the socks of a homeless person for an examination. The stench is so awful it is almost visible. Any closer and I’d have to wear a respirator. That’s a mistake the intern will never make again.
I sigh and apply a tourniquet around the junkie’s pale, hairy thigh and poke my finger hopefully in the back of his knee, feeling for anything that resembles a vein.
