Been a long stretch of shifts, this one. And as loosely cross-posted over on
Envisage 365, marked by a particularly difficult speedbump. Patients who're miscarrying are always unpleasant (well, not their demeanor, I just mean the care is always unpleasant) because of all the ick, the paperwork, and the emotion. But when there's a tiny little person with fingers and toes and even a name, and a set of parents who really, truly were excited to welcome this little person into their family in a matter of months...well, it's devastating instead of just unpleasant. I've said it before, if I hit a point where a dead baby doesn't make me cry, I'll look at changing careers - and apparently I'm not there yet, I left the room when it was all said and done and bawled standing there at the nurses' station. It was awful.
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And a couple of ugly car crashes in this stretch. One that worked out like it should have, and another that worked out like they usually do. I'll explain.
Usually, when a normal person gets into a car accident, they have a split second or better when they know beyond the shadow of a doubt that there's going to be an impact, but there's nothing more they can do about it. So naturally, we brace ourselves. All the muscles tense - and are in that tensed position when that impact occurs, so those muscles get stretched, strained, or torn. But it doesn't work that way when you're trashed, three-sheets-to-the-wind, shitfaced drunk. As too many of the drivers we take care of are. Nope, if you're nice and relaxed with a slowed-down reaction time, you're loose as a goose when impact happens, and maybe you bounce off something inside the car like the steering wheel or the window - but you avoid all that shearing injury from having anticipated the wreck a second early.
Crash A: Drunk person, hauling ass, crosses the wide grassy median and plows into another someone at a frontal angle. The another someone, a sober ATTORNEY (sucks to be the drunkie) checks out fine, just a scratch or two. The drunk person: a few broken bones and an expensive hospital admission.
Translation: That's fair, as far as I'm concerned.
Crash B: Drunk person, evidently clipping along, drives into the path of quickly oncoming traffic and is clobbered and spun and slammed into a curb. From the pictures of the car...this person ought to be dead. And yet...not a single injury. Thanks to Jose Cuervo. The driver and passenger of the other car that couldn't stop in time when dipshit showed up in their way were still okay, some facial injuries and neck strains, so it could have been worse.
And that's the way they usually are, the drunk person scoots through the whole ordeal with nary an injury - only usually there's a more serious injury or death to someone whose fault it wasn't.
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Had a little exercise in prehospital-to-ER communication, as well - and a somebody hopefully learned a smidgen about when NOT to hang around on scene for a half hour looking at the car and saying "gawrsh, that looks BAD."
Folks, it's like this. For those of you in other lines of work, I'll explain. For those in the biz, humor me and/or skip the next paragraph.
When an ambulance is inbound, either the EMT or the Paramedic (whoever is in back, working with the patient, and this depends on the condition of the patient and how advanced of care they require) will "patch" or call ahead on the radio to the ER they're enroute to and give them a very brief heads-up of what they're bringing, usually roughly taking the following form: "This is John on AMR 6, inbound to your facility non-emergent with an 86 eight-six year old female complaining of acute onset shortness of breath with one to two word dyspnea. Lung sounds coarse, pulse ox 82% on scene, now up to 94% on a nonrebreather, she's sinus on the monitor with a rate of 90 and no ectopy, pressure 154/82 and resps 24 and labored. We'll be there in about 5, any questions or orders?" Which gives us all the information we need to assign a room, give the doc and the nurse a heads-up, and set up the room with any equipment or extra staff we need there (like a respiratory therapist with a CPAP machine maybe).
Anyhow. Sometimes the patch contains more information, sometimes less, most of the time depending on the seriousness of the patient and the experience of the paramedic or EMT (neither of which are fond of being called 'ambulance drivers,' FYI). Inexperienced EMTs often give way too much information; experienced medics with a truly sick patient will know exactly which facts to give, and if information is sketchy we depend on our knowledge of the person who's doing the patching. That's where it gets tricky. If, say, Scott patches and says "AMR 9, 5 out with a 6 year old fall, need a trauma team," then I will call a trauma team, no questions asked. I will always err on the side of caution, unless the medic appears totally clueless and the patient sounds stable, in which case we will have the team on standby.
So let's say a new medic to our system patches with "AMR 5, on scene with a 48 year old male who was involved in a high speed MVA, 5-6 feet intrusion, we'll need a (modified trauma) team and we'll probably be there in 10-12." Regardless of who it is, he gives me one pertinent detail that guides my actions: 5-6 feet of intrusion into a passenger compartment is not usually an indication of a healthy patient. I called the team, and mostly ignored the little voice in my head that said "but why are they still on scene if the mechanism is so impressive?" A few minutes later I get a call on the recorded line from the EMT, who I do know and trust, but who doesn't have the pecking order to call the shots - and he says "There is about 2 feet of intrusion, and we need a full trauma team." Okay, again. I err on the side of caution and upgrade to a full team. By now, I'm getting calls from the trauma surgeon, OR, chaplain, everybody wondering what's coming, and I give them what meager info I have. Then, the idiot medic patches again, and I hear sirens in the background: "Uh, AMR 5, coming emergent now with that MVA, complaining of right arm pain, self-extricated and ambulatory on scene, ETA 3." Okay, now I'm really confused, because I'm not sure why this medic has NOW chosen to come code 3, and he didn't mention anything new that tips me off.
They roll in a couple minutes later, and then my sweetie calls me and clears the confusion up. Scott was the second medic on scene, and basically got there and ran the show the way the first medic should have - explained the accident to me, it all made sense then. All of it except why the first medic was clueless. It's incredibly lucky the patient didn't have a massive head bleed or internal injuries, because the 20 minutes of dawdling on scene wouldn'ta done him any favors.
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I've rambled enough. More later.