# A pretty bad day



## btkspot89 (Apr 3, 2011)

We were dispatched for the leaking surgical site on the Buttocks. From the location we were dispatched to I wasn't surprised. While were enroute were told by our dispatcher that the patient was about 300 pounds and could fit on our regular stretcher. That gave my self and my partner a red flag that something wasn't going to be right. So my partner goes ahead and starts singing "Another Bites the Dust"  He should have known better. When we got there we found the patient was about 450 pounds and wouldn't fit on our regular strecher. We asked our dispatcher about a bariatric truck. None available it was a sunday and my paid company chooses not to run one. Good thing we had the Stryker Power Stretcher.

 So the patient is fully alert and oriented and can stand and walk to the stretcher. She does this and upon sitting down she goes unresponsive. The patient comes back a minute later. We already called ALS to be safe. When we move the patient out to the rig she goes out again. ALS arrives and starts their EKG. The Patient Flat Lines.  We get to the Hospital and start moving the patient out. This time the stretcher some how misses the catch....Of course the strecther had to fall. Anyways we get the patient to the bed and she is pronounced shortly after. On the good side we got a call back from the medics thanking us for our help and good work. Still not a day I want to do again.


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## abckidsmom (Apr 3, 2011)

It is never pretty when something goes wrong loading and unloading the patient.  Learn from it, don't ever let this happen again.

Then move on.  A bariatric patient who is post-op has one foot in the grave...it is a big job to pull them back once they start the downhill slide.


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## Veneficus (Apr 3, 2011)

Well the call was dispatched as somebody that is strangely affiliated with taking a dump or a pain in the ***


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## usafmedic45 (Apr 3, 2011)

At least she was dead before she hit the ground.


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## beandip4all (Apr 3, 2011)

man, sounds rough.  sorry to hear about it.  i have yet to have the stretcher miss the catch with a pt on it, although it's happened with no load.  always so paranoid about it!


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## firetender (Apr 4, 2011)

Just wait 'til things get weird!


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## lightsandsirens5 (Apr 4, 2011)

firetender said:


> Just wait 'til things get weird!



Yea....read his book. ^_^


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## 82nd medic (Apr 4, 2011)

450 lbs? Some people invite their misfortunes on themselves... Can't feel too bad about that, it's their decision overall.


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## VFlutter (Apr 4, 2011)

82nd medic said:


> 450 lbs? Some people invite their misfortunes on themselves... Can't feel too bad about that, it's their decision overall.



That is some what of a bold statment to make about a patient without any medical history or personal knowledge of the situation.


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## Lady_EMT (Apr 4, 2011)

btkspot89 said:


> Good thing we had the Stryker Power Stretcher....
> 
> ...This time the stretcher some how misses the catch....Of course the strecther had to fall.



I had a trauma call once, 16yo male, severe head trauma following a head on collision between his car and a tree.

The local helicopter crew was in the back of our rig, got him all knocked out and ready for transport. As we were taking him out, one of the firefighters dropped the stretcher, and it came crashing down while someone was bagging, and another person was trying to keep all the lines from ripping out. The air medic gave me the dirtiest look, and I gave her the famous ol' Oh S*** look back. Luckily the kid was out.

It was mortifying


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## Medic2409 (Apr 5, 2011)

Thankfully I've never had the cot drop...with a pt.  on it.^_^

After having had it happen with, luckily, nothing but equipment I self instituted an iron rule...if the cot is being unloaded with a pt. on it, someone stay up by the head and watch to make sure it doesn't come out too far!

Back on topic:  We've all had those days, and if you haven't had a day like that, trust me, you will!


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## EMSrush (Apr 5, 2011)

I didn't realize how often this happened. I wish there were a few more back ups available...


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## medicdan (Apr 5, 2011)

I was at a local ED a few weeks ago, sitting on the back bumper of my truck writing a report, when I saw another private BLS truck drive up, and unload their (respiratory) patient. I hear some commotion inside the ED, and presumed it was a code, or the like, and wen't back to my report.
A minute or so later, I see one of the EMTs come out, take a board, collar and straps out of his truck, and walk right back into the ED. 
It turns out, the crew dropped their stretcher somehow at triage, and were boarding their patient inside the ED. 

Stretcher failures/drops suck, and it only needs to happen to you once before you are super-careful in the future. I've had my scare (near-drop), and now double check every click, every removal from the truck, every time we wheel.


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## Sasha (Apr 5, 2011)

Darn leaky surgical sites!


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## abckidsmom (Apr 5, 2011)

EMSrush said:


> I didn't realize how often this happened. I wish there were a few more back ups available...



It's just complacency.  You have to visualize the hook catching, every single time.  I know my hand would automatically go to release the hook before the wheels were down and locked.  That's how it happens.


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## EMSrush (Apr 5, 2011)

abckidsmom said:


> It's just complacency.  You have to visualize the hook catching, every single time.  I know my hand would automatically go to release the hook before the wheels were down and locked.  That's how it happens.



I did exactly that during a clinical rotation, and got yelled at. I didn't even think about it while I was doing it. I'm glad someone pointed it out to me!


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## Sasha (Apr 5, 2011)

abckidsmom said:


> It's just complacency.  You have to visualize the hook catching, every single time.  I know my hand would automatically go to release the hook before the wheels were down and locked.  That's how it happens.



Back story, when we first got the power stretchers, they had to redo the hooks for some reason. They put them in a weird place off to the side too much where they would sometimes miss the lock bar all together.

One time we had an LBS dialysis patient who could be squished onto the regular stretcher in a pinch. We were busy that day they sent a regular stretcher. We asked for a lift assist, but didn't get one, so we were both at the foot of the stretcher. 

The lock bar didn't catch on the hook, and when we both lifted, the stretcher slid forward the fell over. There as nothing we could do. I probably actually made it worse by trying to hold my end with one hand and reach for the side to try and right the tipping. The patient ended up face down on the cement with a stretcher on top of her.

It was pretty difficult, my partner phoned our supervisor to tell them we were calling 911 while her husband was screaming at us and I was trying to reach under and unbuckle her to get the 150lb stretcher off of her. 

Supervisor told partner not to call 911, so we, IFT employees, were left to backboard and treat an LBS fall patient by ourselves and take her to the ER. She nearly hit the floor again when we were moving her back to the stretcher via backboard, since she was too heavy, but we got her on. 

I still feel terrible about that to this day. My partner blames me, blames the patient, blames family. Everyone but himself. It was our fault, I wont deny that. But it was a mistake and since then I've been vigilant about the stretcher catch, and every hook got moved to the proper place after that. So good came out of it, yes?


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## exodus (Apr 5, 2011)

WHY does everyone depend on the catch? It is not there to be used EVERY TIME!!! It's there JUST IN CASE you pull out too far. You pull the gurney out just enough to get the wheels down....


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## Sasha (Apr 5, 2011)

exodus said:


> WHY does everyone depend on the catch? It is not there to be used EVERY TIME!!! It's there JUST IN CASE you pull out too far. You pull the gurney out just enough to get the wheels down....



With most of our older vans the step doesn't go up, and you have to pull the stretcher out until the hook catches just to clear the step. So yes, it's to be used every single time.


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## abckidsmom (Apr 5, 2011)

exodus said:


> WHY does everyone depend on the catch? It is not there to be used EVERY TIME!!! It's there JUST IN CASE you pull out too far. You pull the gurney out just enough to get the wheels down....



And it doesn't catch every single time, but you have to visualize that area to make sure the wheels are still on the floor of the truck.  

My wakeup call came when we were unloading a lady after transporting her home, and either me or my partner (can't remember now) turned to shut the door of the ambulance before going into the house.  The stretcher rolled down the angled street, and tipped at the curb.  The lady hit the glass-covered sidewalk with her pregnant daughter watching from the porch.

It was a nightmare, and I hope that most people only have one experience like that.  

Stretching the standard procedures is usually when these things happen- that was our last call of the day and we were in a hurry to get off work.  Every. single. patient. deserves our utmost diligence.


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## btkspot89 (Apr 5, 2011)

Sasha said:


> Darn leaky surgical sites!



What I forgot to say was this was a surgical site that was closed for a year and started leaking 2 days prior to our dispatch. I suspected internal bleeding was the cause of her crashing on us. But of course I couldn't guess since its not in my protocol.


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## EMSrush (Apr 5, 2011)

Sasha said:


> One time we had an LBS dialysis patient who could be squished onto the regular stretcher in a pinch. We were busy that day they sent a regular stretcher. We asked for a lift assist, but didn't get one, so we were both at the foot of the stretcher.
> 
> The lock bar didn't catch on the hook, and when we both lifted, the stretcher slid forward the fell over. There as nothing we could do. I probably actually made it worse by trying to hold my end with one hand and reach for the side to try and right the tipping. The patient ended up face down on the cement with a stretcher on top of her.



Reading this ticks me off, because it reminds me of a couple of times when we requested lift assist and were denied. Not only were we denied, we were guilted for holding things up when we could have just "used some strength". There is a very good reason for asking for help when you need it, no one should be made to feel bad for it. I am quite curious as to what your supervisor had to say after the fact, assuming that he/she knew that you asked for help before the incident.


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## bigbaldguy (Apr 5, 2011)

abckidsmom said:


> It was a nightmare, and I hope that most people only have one experience like that.



Hmm just the one  I'm all paranoid now.


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## exodus (Apr 5, 2011)

Sasha said:


> With most of our older vans the step doesn't go up, and you have to pull the stretcher out until the hook catches just to clear the step. So yes, it's to be used every single time.



None of the steps go up on our vans go up either. And I HIGHLY doubt they are installed correctly if the only way to get the gurney out is to pull it out far enough to be pulling on that hook...  It catching it slightly is correct. It catching it and STOPPING the gurney, is incorrect and unsafe.


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## the_negro_puppy (Apr 5, 2011)

ChaseZ33 said:


> That is some what of a bold statment to make about a patient without any medical history or personal knowledge of the situation.



No matter which way you look at it, to sustain a weight of 450 lbs you need to consume an insane amount of food on a daily basis (pt CAN help this) and live a sedentary lifestyle (may not be able to help this). Either way this pt is at least partially to blame for their own ill health. Not everyone who is morbidly obese has some disease, genetic or thyroid problem that is responsible for their obesity.


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## dixie_flatline (Apr 6, 2011)

exodus said:


> None of the steps go up on our vans go up either. And I HIGHLY doubt they are installed correctly if the only way to get the gurney out is to pull it out far enough to be pulling on that hook...  It catching it slightly is correct. It catching it and STOPPING the gurney, is incorrect and unsafe.



I don't know, on our International/Hortons fitted with Fernos, you have to get the cot pulled until it catches in order to lower the wheels - and our back step does flip up.  I've never seen it fail to catch, though I suppose if enough gunk got in there it could conceivably get stuck in the "open" position, but I doubt this would go unnoticed.


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