I had a few interesting calls this weekend.

We got toned out for “difficulty breathing on home oxygen.” The call was way out in the sticks; not right to the edge of our rural call area, but far enough out that the nearest hospital is twenty minutes away. Our response time was about twenty minutes and there was a first responder on scene before we got there. We arrived at the same time as two additional first responders.

We were met at the door by an elderly female. “Sorry you had to come all this way,” she said. “He was having one of his episodes and I couldn’t remember how to turn on the oxygen tank. He’s much better now.”

No problem, we said. We explained that our protocols dictate that we have to take a set of vitals and fill out some paperwork when we are called out but do not transport a patient. The woman agreed that we could take a set of vitals. We went downstairs where the patient sat slumped on a sofa with the first responder kneeling beside him. The patient didn’t look so good; pale, not moving. His eyes were open and he was following motion around the room, though. The patient was wearing a pediatric oxygen mask which covered his nose and not much else.

As the first responders started to collect the vitals, we got a little more history from the wife. The patient had congestive heart failure and had infrequent ‘episodes’.

Given the patient’s presentation and the CHF history, I decided that the sign-off process should include an EKG. I went out to the bus and grabbed the monitor, brought it in and hooked up the patient.

ekgstrip_Medium

I wasn’t very happy with the strip. It was immediately clear that this wasn’t a sign-off.

I said that the man needed to go to the hospital. The wife disagreed.

We discussed for about ten minutes. She had called her son in Boston; he was driving up and she wanted to wait ’til he arrived before she made a decision. We finally convinced her that her husband needed to go; she then wanted to drive him herself. We took another few minutes to make her understand that he really needed to go by ambulance. Then she wanted to go to a hospital about forty minutes away.

Meanwhile, the monitor showed the husband’s heart rhythms changing every few seconds. None of it looked good.

At one point, the wife asked which one of us was the doctor. There were a few seconds of silence. I was in charge of the scene as the highest-certificated EMT, but I didn’t really want to say so. My partner admitted that none of us were doctors but that we were highly trained.

After a while, the insistent alarms of the monitor every few seconds and my partner pointedly stating that she was putting her husband’s life at risk with the delay got through to her. She went to change clothes.

We quickly put the patient on the stretcher and got under way. On the way out the door, the patient went into ventricular tachycardia. I was not at all happy; I thought the patient was going to code in the back of the ambulance.

The ride to the hospital was tense but uneventful. The patient’s rhythms continued to be unstable but his ticker continued ticking. We got him to the hospital and thankfully turned over care to the emergency department staff.

The wife arrived and seemed to have had a change of attitude. She warmly thanked us for our help. We could tell that she had been in complete denial about her husband’s condition.

As we cleaned out the back of the bus, my partner brought up the exchange regarding the doctor question.

“I hope I didn’t step on your [toes] when I answered her question, princess.”

“That was great. I wasn’t going to admit that I was in charge.”

He called me an unprintable name.

The following day, Mrs. Turquoise and I transferred the patient from the local hospital ICU to the regional big hospital’s ICU. We saw the wife on both sides of the transfer; she was very nice. When we dropped the patient off at the big hospital, she gave me a hug and a kiss and thanked me warmly. The patient himself was more lively and thanked me for the trips.

I was pretty happy with that set of calls. I think that my deciding to run an EKG strip before allowing the patient to sign off had a huge impact on the outcome.

In other news, someone played a prank at the department.

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This is a lieutenant’s locker filled with leaves.

Circumstantially, it looks like another particular lieutenant was behind this. That lieutenant came in yesterday and knows that he will be blamed. He’s very defensive. He claims that he has an alibi for the six-hour period where it appears that this could have been done.

Do I know anything? Was I somehow involved?

I’m just disappointed that I won’t be there to see the fireworks.

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