Rules

I recently got my yearly performance review. While it was generally positive, there was a small attached list of behaviors which are now forbidden to your truly. I thought I would share a few.

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Per dispatch center request, please do not respond to dispatch directions with "delightful," "by your command," or "pip, pip, righto, guv!" Additionally, please refrain from speaking on the radio in any foreign language.

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Per fire agency request, please do not provide an exterior building size-up on medical calls, request "the first-in engine company bring up my gurney on arrival," add your ambulance to box alarms, or assume Command on a chest pain.

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Per chart review committee request, please do not use the phrases "poor life choices," "pharmacologically assisted gravity attack," or "terminal deceleration syndrome" in your documentation. Additionally, we wish to remind you that "Funny Lookin' Beats" is not an acceptable description of ECG ectopy.

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Per fleet maintenance request, please refrain from turning in a vehicle failure report with reason listed as "PONTOONS DO NOT INFLATE FULLY WHEN ENTERING WATER." Additionally, please refrain from submitting requests for nitrous systems, afterburners, in-seat DVD players, or "bitchen' rims."

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Finally, per management request, please refrain from operating a lemonade stand, massage parlour, off-track betting establishment, or payday check loan business out of your station.

Moments (IV)

We drive east, in the darkness and rain, bluegrass and crackling radio traffic in our ears.

Thirty minutes ago, we were giving report to nurses and a doctor, swapping the O2 over, 1-2-3 lift, there we go, no allergies, had three neb treatments, what else can we tell you?

Forty minutes ago, I watch my partner rip out a BVM, in the rear view mirror, and my fingers are resting lightly on the EMERG MASTER switch before he even gives me the nod. Yeah. Blinkies and woo-woos now.

An hour ago, we load a little old lady in the back of the car. She doesn't look great, but her sats perked up nicely on the neb, and she doesn't look awful or anything.

Eighty minutes ago, a firefighter is telling my partner what he knows, as I try to tease information out of an anxious son, carefully as any detective handling a skittish murder witness, firm but kind.

One hundred minutes ago, I was on the phone with my wife. Wait a sec, I said, as tones started whistling on county dispatch. Whoops. That's us. Gotta go. See you in the morning.

Love you.


Twenty minutes ago, through the hospital curtain, I heard a son, talking to a mother who might not have even been able to hear him. I'm here. We're here. Be strong.

Love you.

Spine

In a quiet, unassuming way, the call is terrifying. In two ways, actually.

She's laying at the bottom of a half-staircase, surrounded by a fire crew. Nothing appears unremarkable. She's awake and talking. She's pink, warm, and dry. She isn't covered in blood. No bones project from her skin.

She isn't moving anything below her waist.

The fire paramedic looks up at me, and gives me a short report. It's all fine until he closes with, "We called medical control to ask about solumedrol -- they said no."

It's all I can do not to gape and shake my head. We move on with the call. Backboard, trauma entry, code 3 to the big hospital. She has true neuro and motor deficits below the level of her bellybutton.

I try to comfort her, reassure her, but she knows exactly what's going on and how ominous it is. I try so hard not to lie to my patients. It's a struggle not to tell her everything will be alright. I don't know that it will be. She's an avid cyclist. She talks about riding hundred-mile races.

After we leave her in the capable care of the trauma team, I ponder the fire medic's seemingly-innocuous words. Did he know anything about the solumedrol he'd asked for, or had he just heard somewhere that it could be used for spinal injury? Did he know about the plethora of studies that question it's effectiveness, or even the dose? I'm sure he didn't realize it would have taken 11 or 12 of the 125mg vials we carry to reach the 30mg/kg dose in this comparatively small patient.

I am forced by these circumstances to come back to my previous point, which is that we should all stick to our areas of expertise. I don't know step one about fighting a house fire. I know just enough about vehicle extrication to be dangerous. I know enough about HazMat to run the hell away. I leave those things to the fire department -- it's their expertise.

But I do know about prehospital medicine. I know the protocols, and the science and medicine behind the protocols, and when medication X or procedure Y is really necessary. I have an idea of when you can step outside the protocols, call medical control for permission to do something unusual.

I know enough to know that asking a doctor if you can give a patient steroids for a spinal injury, in the city, without knowing the dose, only makes you look a fool. That's my area of expertise.