Call For Assistance

[MedicPrincess]

Had a pt last night who thought he might decide to die in the back of my truck, which was definantly not in my treatment plan for him. Call came in as a fall. Pt fell out of his back door, down 5 stairs, unknown time before, probable loss of consciousness. CAOx4, pain to neck, back, numbness to lower extremities. After immobilization, as we were headed to the truck I looked at the pill bottles FD handed me. Valium, filled yesterday with 60, was empty. Morphine filled two weeks ago with 120 also empty. Ask the patient if he keeps a daily med container, he says, "Nope. I took them." I ask him, "You took all of these...When?" He says, "Earlier." Great.

There are very few circumstances, in either service I work for, that we don't transport to hospital of choice. This guy wanted to goto the one that was furthest from his house, about 32 miles. So we get headed down the road and start looking for IV access. He had none....at all. His initial VS were WNL.

Suddenly, it was like someone flipped the off switch. He became barely responsive to pain, his next VS were crap...HR 126, BP 62/29. Still no IV access, I'd stuck him a few times. We have IO option, and suddenly that looked good. Now unstable, I decide we are not going to where he wants, we are stopping at the closest facility which was still 12 miles in very heavy traffic. And then I made "the decision heard around the world."

We were getting ready to enter a fire district that is ALS. So I called for assistance from them. I was thinking a couple things. 1. I was quite unsuccessful at gaining IV access and have never used the IO drill we have. 2. An extra set of hands when this guy dies, sure would be nice. 3. I've only been a Medic for 2 weeks, so A LITTLE HELP HERE!!! I asked them to meet us at a given spot, and had my EMT stop there. One of their medics got on with me, and we continued to the ER.

My shift supervisor called me and when I explained what had happened with the patient, he was in agreement that calling for ALS FD was the right move, since he was not in the area to meet us. Apparently though, what I didn't know, was we (the medics at the private service I work for) are not supposed to get along with the medics from that ALS fire service. At least thats how I understood it from the EMT I had last night.

Thats BS. I will be running most of my calls with that fire service. I get along with just about everybody. Why should I start a "turf" war (our patients being the turf), when SILLY ME I am most concerned with whats best for that person being loaded into the back of my truck? I had noticed some of the people I have worked with so far seemed to ignore the FF, but I always ask them what they have and what they need if they are there first. We work great together, why make my job any harder by fighting with the guys that can be my greatest help?

 

[firecoins]

Calling for the FD medic was a good move. These "turf wars" are complete bull hit. Always get the help if you need it. It probably would have been a good idea to got the nearest hospital off the bat.

 

[Tincanfireman]

If "they" don't get along with the local fire guys, that's just history. If "it's always been that way" then maybe it's time for a change. If you want to get along with someone, the handshake is best accomplished when you offer more than one finger. Good on you for trying to change the future instead of re-inventing the past.

P.S. Good call on getting the backup. Too few are willing to swallow their pride and admit that the swamp is deep and the alligators are plentiful.

 

[reaper]

Don't fret calling for assistance. It's always ok.

One question! You have had your paramedic cert for two weeks and they have you alone on a truck? You must be with R/M or AMR!:wacko:

 

[Grady_emt]

Right call by my book calling for FD to lend a hand.

Mypartner and myself have been known to put the po-po to work too. We had a real low sick pt one night and it was just us, and a couple of PD officers and the pt was on the second floor of a tight house. We called for fire, but they were out on a working 2 alarm fire a few blocks down. Called for Supervisor, none available both out on calls already. Called for another unit, but due to low levels @ Level2, they were a good 10-12 out running hot. We managed to get the pt extricated, looked at the rookie cop and his FTO partner, partner goes "you know how to do CPR" which recieved a puzzled "yeah, I guess so", then , "good, hop in, and you(points at PD FTO) meet us at Grady for your partner back." Pt ended up not coding on us, but soon after arrival at hospital she did.

 

[Guardian]

I find that people group themselves together in fierce little tribes. You can see this on a large incident where the cops, fire, and ems are all standing in their own little groups with very little interaction between them. But everything changes when there is a true emergency. Suddenly, those invisible walls disappear. As far as you calling for help, I think that's great. Don't try and be a hero or worry about offending someone in that situation, just do what's best for your pt. The outcome of your pt is the only thing that really matters, or at least that's how I look at it.

 

[medicdan]

So... what happened? Did your pt. make it? Were the FF medics helpful? Did you get IV/IO access? You cant just leave us hanging...

 

[MedicPrincess]

One question! You have had your paramedic cert for two weeks and they have you alone on a truck? You must be with R/M or AMR!:wacko:

Neither. But for both services I work for (1 private, 1 county) its my EMT and me. Medics are to hard to come by to let a dual medic crew be happening.

So... what happened? Did your pt. make it? Were the FF medics helpful? Did you get IV/IO access? You cant just leave us hanging...

Definantly helpful. And we even gave him a ride "home" so they wouldn't have to put a truck OOS to come and get him (apparently, thats "not done" either.) Once I had him back there, we were able to get an EJ. I hadn't wanted to do it by myself, d/t the possible cervical spine injury. But with him back there, we were able to control that and get the line. The patient was alive when I left him at the ER. Didn't get back to that hospital for the rest of the night though.

 

[mtmedic]

Neither. But for both services I work for (1 private, 1 county) its my EMT and me. Medics are to hard to come by to let a dual medic crew be happening.

Princess... I am not picking on you or your service but am concerned with the amount of time you do not get to precept. 1. Are you comfortable being sent out as a brand new medic without an FTO and taking on all the responsibility? 2. Is your medical director comfortable with this approach to placing a green medic on the streets without direct supervision. 3. Apparently both your services are comfortable with this approach but then it is not them that will be hung out to dry should something unspeakable happen. Chances are there will be some accountability for them and your MD but it is your license and career on the line.


Now that being said I truly applaud you for your humble approach to this call and your ability to ask for help. Your positive attitude towards your FD is great. I work in system where the we are better than them attitude exists on both sides and we are working to correct that. I personally get along with 99% of the FD because I believe we are there to serve one person and that is the pt. Like I said earlier... Not picking but just curious and concerned...

 

[Rattletrap]

I can understand everyones concerns for her being thrown to the wolves like that. This is not a perfect world. In many areas, as EMTPrincess stated, there are not enough Paramedics to go around. I was also hung out there like that. At the time I got my card I was put out in a remote station without backup. The I work for did not have enough medics to be able to put me on a double medic truck and frequently only has Intermediates staffing trucks without backup, sometimes backing up the county 911 vollie trucks. Medic shortages are a nationwide crises.

 

[triemal04]

Sounds like you made the best of a bad situation overall, but there are a few things to remember.

Like has been said allready, it's nothing against you, but is the supe in charge nuts? Did you have any time with a preceptor at all after getting your cert? Even if you're running an extremely busy car, having been a medic for only 2 weeks isn't enough time to prepare you to work on your own. But, good for you for knowing your own limitations and calling for help.

If you ever get into that situation where you have to call for assistance while you're enroute to the hospital, be sure to consider who's closer; another unit or the ER. Sometimes it is better to treat with diesel. You didn't say so I'll just toss that out.

When someone tells with you with very credible evidence that they just OD'd on large amounts valium and morphine...be prepared for something bad to happen. Fast. Also be sure and ask why they took those pills; if they indicate that it was a suicide attempt, then they have lost all rights as a pt. They no longer have any say over their care, and that includes where they want to go. Which leads to...

It's always nice to take someone where they want to, but that may not always be the best spot. Here you had someone with a probable OD and possible spinal cord injury. Taking them 20 miles out of the way (unless that was the more appropriate hospital) might not have been the best choice. That'll depend on your system too, but if you explain things to people in very plain English (we need to go to the close hospital or you might never walk again) they'll often understand. And don't forget your medical control.

If you've got equipment on the ambulance you damn well better know how to use it. Everything else you said isn't horrible wrong, it's just those things that happen to everyone until they get some street experience. But not knowing how to use a tool that you have to use...that is utterly inexscusable. Period.

So. Aside from the bone drill deal...live and learn. It sounds like you did things right and things wrong. Learn from your mistakes and move on. Doing something wrong once isn't always wrong in my book, it's when it happens repeatedly that it becomes an issue. Working in the field isn't like the textbook and this is a nice example of it. Good job on keeping the guy alive though. (and don't forget that an IV is not always the first thing that needs to be done )

 

[triemal04]

I can understand everyones concerns for her being thrown to the wolves like that. This is not a perfect world. In many areas, as EMTPrincess stated, there are not enough Paramedics to go around. I was also hung out there like that. At the time I got my card I was put out in a remote station without backup. The I work for did not have enough medics to be able to put me on a double medic truck and frequently only has Intermediates staffing trucks without backup, sometimes backing up the county 911 vollie trucks. Medic shortages are a nationwide crises.

There's kind of sort of maybe a medic shortage, depending on where you are and who you talk to. Regardless of that, and regardless of how you feel about a medic/emt car or a medic/medic car, the bigger issue is riding alone 2 weeks after getting her cert. Nothing against her at all, that is plain old fashioned bad management and a really bad day waiting to happen.

And now off my horse...

 

[MedicPrincess]

It's always nice to take someone where they want to, but that may not always be the best spot. Here you had someone with a probable OD and possible spinal cord injury. Taking them 20 miles out of the way (unless that was the more appropriate hospital) might not have been the best choice.

For the private service I work for, we regularly bypass the three local hospitals in the county, in order to take our patients where they will receive the level of care they need. The next county over, and the extra 20 miles, will take them to any 1 of 3 Level 2 trauma centers. The local hosptials do not have the capabilities to handle a whole heck of a lot. Not one of the three have L&D, Cath Labs, any neuro other than a CT Scanner, or Pediatrics. As long as we have the airway secure and vascular access we can bypass any of the local ERs without calling for bypass orders, in order to get the patients difinitive care. Its the same in the county service I work for, with the exception of there is 1 hospital in that county that has interventional cath lab and an open heart center.

As far as being out there alone...99% of the time I am okay, the rest of the time I find myself "stressing" a bit, however I am not afraid to pick up the phone and call for help when I need it. In both services the MD's are aware that they have brand new medics on trucks with EMTs. All of the medics in both services have the MD's personal cell phone numbers, and in the private service he has a company phone as well. They both encourage us to call them if we run into a situation where we are "alone" and reach that point where we don't know what to do next. In the private service, our MD regularly shows up on calls. I had in drop in on a suicide attempt by drowning last night at 0100hrs. He doesn't get in the way, simply asks how he can help.

The private service was in a kind of unique situation. They took over EMS operations for the county after the previous service did not get their contract renewed. There was not the opportunity to have a lengthy FTO process for anybody, because they started operating from the ground up in this area. I did get a look at the schedule that starts today. Currently, they have shifted most everyone around. One of the newest hires has been partnered with me, he is a medic. Apparently, he has been a medic for 15 years. I really am looking forward to having his brain to pick when I start getting into the "biting my lip thinking" mode. I don't foresee them keeping us partners for too awfully long though. Double medic trucks are UNHEARD OF in this area.

 

[firetender]

I just want to chime in with my support of your recognizing you were in over your head and asking for help.

We're all in over our heads until we figure out how to get to the surface. To some extent that happens on every call other than routine transport. It's always about figuring a way out. Sometimes it's within protocol, sometimes not.

Bottom line is that however you got there, you were a medic who was in a specific situation and worked as best you could with what you had. As long as you keep doing that, you'll be fine -- and so will a lot of other people!

 

[Ridryder911]

I just want to chime in with my support of your recognizing you were in over your head and asking for help.

Very good points, even if one is not "quite" over your head.. think of "what is best for your patient" and really to hell with the rest!

I had patient with CP whom appeared to be stable to all except me. I requested a Firefighter EMT to ride in with me. I could see the dumbstruck in all their eyes.. this patient was no longer even complaining of chest pain.

What I did see, where other did not, was that this patient was having a Bifascicular Hemiblock with increasing ST segment changes in anterior and inferior walls = death.

Fortunately, I have gained respect and trust from most, that when I ask I not second guessed or questioned. (This came from many years of proving myself).

As one would know it... yep, the patient arrested enroute. The jaws were dropping around me.. as one described.. how did you know?.. I just grinned and told him.. " it's my job to know. I again illustrated we are all there for one reason.... the patient. When someone asks, then help.. there should never be no questions asked.

R/r 911