Chapter 2
Someone once asked me to describe my job at EMS, and after some thought, the best description I came up with is this. EMS is twenty four hours of heart starting, blood pumping fun, broken up by periods of excruciating boredom. Now that may sound odd to the layman, but to anyone who ever pulled a shift at an EMS service knows just what I mean. We wait at the station, some stage in ambulances, but I can only speak for my experience, we wait at the station sometimes for hours on end, for that moment when someone’s world crashes down around them, and then we roll to the rescue. There are days when we have a lot of downtime, but then there are those days when the wheels of the ambulance never stop rolling. Walking into the station in the morning you never know what you’ll see or do nor when it will come. Oh, of course we all have some little superstition or ritual that we hope will keep the trauma gods at bay, but by and large, its like playing roulette or dice, you never know what will hit or when.
There are unwritten and often unspoken rules that we live and abide by, and I’ve yet to see these in any book or taught in any class I’ve ever attended. But you learn them quickly when you branch off into this line of work. One quickly learns never to say the “Q” word, just saying “quiet” at EMS will earn you a lot of grief, as will asking if they’ve been busy. The same goes for making the statement, “I’m bored.” Planning a nap is asking for a call, as is planning or attempting to cook a meal at the station. In fact, in EMS never cook or buy a meal that can’t be eaten on a slice of bread or while running 90 mph down the highway. Always keep Imodium in close proximity, never think you’ll put off that trip to the john for a few more moments. These are the things one learns early on, and adheres to.
If one breaks these rules, well, it will come to haunt you. And that is the beginning of this tale, we dared flaunt the rules, and thus, did we pay.
It started out innocently enough, it had been a slow morning, a beautiful day, middle of the week, which is usually a slow time for us, so thoughts turned to lunch. We were bantering around ideas for what we wanted, we had long since worked our way through the menus of every eating establishment in the town, and we resolved to cook something, thus we broke rule number one.
One of our paramedics decided that she wanted to cook chicken and dumplings for the whole shift, she always swore she couldn’t cook, but when she did, it made for some fine eating. Everyone quickly chipped in for the groceries before she changed her mind, and she headed out for the store. Little did we know the extent we had just angered the Trauma Gods at this point.
A short while later, the aroma of bubbling chicken and dumplings filled the station, a large pan of cornbread baked in the oven, and we were all drooling in anticipation of a wonderful lunch. Then, with only a few minutes more until time to eat, without warning, it struck.
The blaring Klaxon beep of the Rescue tones shattered the calm and stillness of the station, scattering thoughts of food and rest like glass against a brick wall.
“COUNTY EMS, SHERIFFS DEPT, COUNTY FIRE, RESPOND TO 4732 HIGHWAY 41 SOUTH, REFERENCE TO A STRUCTURE FIRE, FLAMES VISIBILE”
Even before the dispatcher had finished paging the call out, there came from the kitchen came the crash of pots being slid to the back burners, muttered curses and a loud exclamation as skin came into contact with a hot pan of cornbread. Out of the kitchen like a battering ram, flew our cook, for alas, she was on the rescue truck, and rescue responds to fire calls in the county.
“If all that food gets ate before I get back you all DIE!” she threatened as she went through the door to the bay.
The rescue unit rattled to life in a cloud of blue smoke, and she rolled out of the bay, lights and sirens wailing, cutting off a carload of startled old ladies from the church next door, and headed south.
We listened as she called enroute, and the dispatcher began to give her more information about the call.
“RESCUE ONE, YOU ARE RESPONDING TO 10-70 STRUCTURE FLAMES VISIBLE, NO PATIENT INFORMATION AT THIS TIME”
We settled back into the couch, this was most likely just another routine call, stand by on scene while the firefighters played with the hoses and stumbled around in their turnout gear, nothing to get excited about. We debated eating but decided the threats might be real.
In the background we could hear the fire radio chattering away as various volunteer units reported in, calling on scene, directing each other into positions. You always listen, but for the most part you tune it out unless it sounds interesting. Occasionally a voice would catch your attention with its excited pitch, or more so, the humor of a layman trying to sound professional over the air.
“Tanker one, back that big sombitch in right thar … HEY Billy Ray, tell him to keep off them damn hoses … Damn that bitch is blazin…”
Occasionally you would recognize one of the voices and chuckle, “there that damn Buddy…”
“RESCUE ONE ON SCENE RADIO” came the voice of our paramedic.
A moment of silence settled over the radio.
Then with a new timbre in her voice, she came over the radio again.
“RESCUE ONE RADIO, GET ME A MED UNIT HERE STAT”
The Trauma Gods had made their presence known. My partner and I jumped up and ran for the truck even as the tones began to sound again. At this point we didn’t know what it was, but if she was requesting us that urgently, we knew that it was serious. She didn’t cry Wolf unless the crap was hitting the fan.
As we rolled out my partner called us in service and requested a patient update, because at this point we had no idea other than a burn what we were headed to.
“M2 STANDBY, RESCUE YOU ADVISE LAUNCH AIR MED?” this from dispatch.
“AFFIRMITIVE LAUNCH AIR MED” the rest of her transmission was garbled and cut out.
My foot automatically went to the floor, and we flew through the city headed south, passing cars scurrying out of our way. My partner flipped rapidly through the map book looking for the nearest landing zone to the scene. I strained to hear what was being said on the radio, even as I watched for cars and other hazards in our path. Dodging an old man in a ragged rusty pickup, I turned onto the highway leading south into the county, as I passed him he stuck his arm out the window and shook his fist at me.
“RADIO M2 YOU ARE RESPONDING TO A 30 YEAR OLD FEMALE PATIENT INVOLVED IN A STRUCTURE FIRE, STANDBY FOR FUTHER”
“Bet this was a grease fire, being its right at lunch time” offered my partner. “People just don’t pay attention to what they are doing.”
We both began to think through our treatment protocols as we discussed the possible extent of injury we were probably going to see. We rolled on towards the scene as the radio chatter droned on. Nearing the scene my partner pulled out gloves for us, and donned hers.
As we rounded the curve, we saw the Rescue unit sitting beside the road way, blue and red lights flashed everywhere, and a sheriffs deputy flagged us into the driveway in front of the rescue truck. Jumping out of the truck, I looked quickly around and spotted the patient who had somehow transformed from a female to a male. He was standing in front of the rescue truck, our paramedic was rapidly pouring water from an Igloo cooler onto his arms and torso.
“Lets get him in the ambulance” I said, as I reached her, I turned to the patient and the extent of his injuries startled me. His skin hung in tattered sheets from his arms, looking for all the world like large loose vinyl gauntlets, his hair and beard were singed almost to the flesh, his eyebrows and lashes non existent. His shirt was ripped and holed and through the holes and tears, angry red flesh showed. He trembled as she doused him with water, and screamed for her not to stop. I reached to lead him to the truck, then dropped my hand as I realized there wasn’t anywhere I could touch him without causing him further injury.
We moved quickly to the ambulance, my partner going ahead to open the rear doors as we approached. When we got to the back of the ambulance, we realized that we had no choice but to take hold of his hands or arms to get him inside. He screamed in agony as we lifted him into the box and onto the stretcher, the flow of obscenities would have killed a preacher at a hundred yards.
Seating him on the stretcher, we cut his shirt off, and soon after his trousers, leaving him in his underwear which he refused to relinquish, modesty it seems overwhelms pain. From his pubic line upwards he was burned horribly, mostly second and third degree burns, his neck was burned almost as badly, as were his lips and ears. His arms, which he held up to keep from touching anything, had lost most of the skin and looked as if something from a horror movie. As the other two medics rapidly began to wrap his arms in sterile gauze, I placed him on a Non Rebreather Mask with 100 percent oxygen, then picked up the radio and called Medical Control for orders for pain medication, if there was ever a candidate for Morphine, he was. The Emergency room doctor quickly granted permission for medication, and I reached for the drug box while telling my co-workers to get me an IV established. This too proved to be a challenge, as he was burned so badly that finding a site was nearly impossible, even his legs, which I hadn’t noticed earlier, were burned.
There isn’t a way to describe to the layman the challenges involved in treating someone who is terribly burned, even something as routine as taking a blood pressure is difficult. With his arms burned as they were, and his legs, we had to find the least damaged area to work with, trying to assess his oxygen saturation level was nearly impossible too. We settled on using a pediatric pulse-ox on his one undamaged ear. Looking at the monitor, I could see that his oxygen levels were critically low, even on 100 % oxygen, a bad sign indeed.
Taking my penlight, I looked into his mouth and up his nostrils for signs of inhalation burns, to my dismay, the inside of his nostrils were seared and the nasal hair was singed off. I grabbed my stethoscope and listened to his chest, to hear his lung sounds. Thankfully they were clear with no wheezes or sounds of fluid. Perhaps he had a chance. As I leaned over him, I noticed a strong chemical odor, like acetone or paint thinner. Realization dawned on me, this was not a typical house fire, I looked over his body quickly, noting the pattern of burns, yep, an explosion. If two and two add up to four, then this was most likely a Meth lab explosion.
We administered 4 milligrams of Morphine to our patient, having to go intra-muscular instead of IV, which had the same effect as if we’d given him nothing at all. He continued to scream and toss about on the stretcher, complicating our attempts to establish an IV. We spotted a large vein standing up on his upper arm, and I held him as one of my partners started the line. Having successfully started the IV, we quickly hung fluids on him, and instructed a nearby firefighter to drive us to the landing zone.
If you’ve never ridden in the back of an ambulance with two other people and a critical, combative patient, while being driven by an excited firefighter, you just haven’t lived. We were tossed around and jolted nearly to death, as we careened towards the landing zone. Trying to keep from falling all over our patient we grabbed for any hand hold possible, to include each other, in a manner that would have gotten someone slapped at a minimum and most likely a sexual harassment suit in any other circumstance.
En-route to the landing zone, I updated the air medic crew via radio on our patients condition, telling them what to expect and any and all interventions we’d done. After what seemed a lifetime, we reached the field and slammed to a stop. Looking out the window I could see a crowd gathered around the perimeter of the field. I could hear the high pitched whine of the helicopter engine, and I saw through the window the crew rushing towards us with their stretcher.
Opening the door of the ambulance, they jumped in and began to assess the patient, one of the flight medics quickly administered a sedative and more painkiller. We quickly transferred care over to them, and they loaded him up and took off towards the burn center.
After they left, we gathered ourselves together, cleaned our gear, spent almost a half-hour answering questions by the deputies, then headed back to the station. We’d done all we could, and hopefully it was enough.
