Monday, September 08, 2008


I started this post two days ago - this is the first opportunity I've had to write about my tours. What started out as a busy Thursday quickly turned into a nightmare. By the time I got out on Friday, I'd been awake for nearly 28 straight hours and driving home after work was extremely difficult.

During the Thursday shift I worked with Jesse, a basic-level EMT. He's a sharp guy, quite skilled, knows his business. It was a pleasure to work with him. For the most part, I don't remember the order of the calls we did during the day, but we had a few things go on, including two ED to ICU transports and a couple of priority 1 calls to the East campus. The last one we had during the day and early evening was for a 21 year-old female with increased shortness of breath over the two days prior to going to see the doctor. We picked her up at the medical practice on the East campus affiliated with the hospital. She's a student at one of the area colleges and she had just moved into a new apartment. Her symptoms started as she was finishing moving her belongings into her new place.

The doctor that saw her wanted to send her to the ED because she was having the following symptoms in addition to the breathing issues: epigastric pain on inspiration with radiation into the mid-sternum, mild tachycardia, and a low grade fever at 102.1 F. All of those symptoms, at least to me, point to a pulmonary embolism. So sending her was the right thing to do.

After 1900 we had the coverage for Children's Hospital, and from 2000 on we had the team with us. The first trip we took with them sent us to the Cape Cod Hospital in Hyannis to pick up a 10 month-old female with a seizure history who needed to be seen for issues with vomiting and continued seizing prior to being seen at the hospital. She was seizure-free when we arrived at the hospital and continued to be that way on the way to Boston. She had a feeding tube as well as a cerebral shunt, was also deaf, and had some issues with her eyesight. Mom went with us and I worked in the back with the nurses. Not a problem, but it was a tight fit in the back of the ambulance with three of us back there.

On the way back to Boston we were notified that there was another pickup at the Brockton Hospital – a septic 3-day old male who was being sent to rule out Sepsis. He was pretty sick – he was febrile, tachycardic, and really dry. We had to take precautions with him because of the possibility of his being positive. Another tight trip in the back of the ambulance – mother traveled with us again, and it was a little more difficult because the baby was in the isolette.

We almost went back to Brockton to the Good Samaritan for a set of newborn twins – we actually got on the road at 0530 but were canceled on the way. The day crew was going to take the trip, and it was a good thing that they did; we wouldn't have gotten out until near 1000 otherwise.

Saturday was a different day; we only did three calls during the entire shift, but two of them were after midnight. The second was a patient at the Hebrew Rehab who was a question of a GI bleed but “was stable”, according to the staff on the floor. We arrived there to find a 90 year-old female, alert but lethargic with a blood pressure of 70/40 and a heart rate of 110. She was pale, almost jaundiced-looking, cool, and she had vomited coffee grounds-like matter about an hour before we were called. She looked pretty bad, so I got a second Paramedic (I was working with a Basic; a problem when you can't work fully as a Paramedic in Massachusetts if you're by yourself) so that we could do whatever we had to. I was glad I had help; she had almost no IV access because of her crummy pressure, and she was somewhat hypoxic as well – on 6 LPM of Oxygen her saturation level was only in the high 80% range. So she got put on high-flow Oxygen before we even left the rehab. We did everything else on the way to the Beth Israel, and when we arrived we got grief from the triage nurse because we didn't patch in. In my own undiplomatic fashion I told her that we were rather busy, and she backed off then. We got the patient into a resuscitation room and they called her what is known as a “trigger” patient – she was high acuity and needed to be treated as such. I don't know her outcome; my suspicion is that at the very least she was admitted, but I don't know if anything further was to be done; her age certainly is a factor against her. If she was to be treated, it's uncertain whether or not she would survive it.

Today I am working in Nashua on ALS-7. As with any other shift I've worked here, it could go either way. We'll see how the day goes. So far we've done an "ambulance doing wheelchair" call, and on our way back operations let us know (in a rather testy manner) that we needed to sign on with Nashua Fire. We hadn't gotten back to change vehicles at that point. Now that it's done, it will be interesting to see what happens for the rest of the shift. It's 1045 now - I only have to last a little over 6 hours.....

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