Emergency Care

It was a quiet morning at the station with no call so far. The weather was   typical for July, warm with a few showers. The tones broke the silence of a slow morning. “Medic 1, Engine 1, Rescue 1 report of a car striking a utility pole. Power is out in the area. Caller reports one male appears to  be trapped in the vehicle.” Time out 0937.

The response time was short because the crash was only a few miles from the station. On our arrival we found a small car had slid into the pole. There was heavy damage to the car.

The driver appeared to be a young teenage boy and he was trapped in the vehicle. He appeared to have multiple injuries. 

Scene assessment revealed no power lines down. There was major damage to the pole and the transformer was hanging by what appeared to be one bolt. Any movement of the car caused the transformer to shift back and forth. A decision had to be made to stay back until the utility company arrived or take the chance to enter the car and start treating the patient. The young man needed help so we made the decision to enter the car. 

Upon entering the car I was amazed at what I found. The young man’s femur was broken. https://www.moveforwardpt.com The impact of the crash forced the lower half of the broken bone through the skin and over the bottom portion of the steering wheel. This was not going to be an easy or rapid extrication.

The young man exhibited the early signs of shock so two IVs were established to replenish some of the lost fluid. He had several deep lacerations to both arms and head. All bleeding was controlled. As I palpated his chest I could feel several fractured ribs. He was not in good shape but he remained conscious.

The utility company had been notified and were responding. When the state trooper arrived he was informed of the situation with transformer. He then called another trooper to provide an escort for the utility company truck. 

Once the patient had been somewhat stabilized, we had to figure out what to do with the leg injury. The protruding bone had a lot of debris on it so we flushed it the best we could. But the bone still had too much debris on it. Letting the bone slip back in the leg would cause him infection problems down the road.

We wrapped the bone with moist dressing. In addition we secured the injured leg to the bottom portion of the steering wheel. It was tight to prevent the bone from slipping back in the leg.

Next, we cut the lower half of the steering wheel and left it attached to the leg. Then we secured the leg in its current position. Now he could be moved without of the bone slipping back in.

As the extrication continued, the dash of the car had to be pushed forward and away from the patient. The drivers door was particularly wrapped around the utility pole so we decided to remove the roof of the car and extricated him straight up out of his seat. This proved to be quick and provided less movement of the patient’s leg. It worked and the patient was transported to the hospital with no further issues.

After surgery and rehab for his leg the young man made a complete recovery.

 “Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.” Isaiah 41:10.

It was a brisk fall evening when the dispatch tones pierced the quiet station. “Medic 1 respond to 5960 New Haven Road. 79 year old female sick and wants to be transported to the hospital.” Time out 1843.

The medic unit was out quickly and on our arrival we found a female standing on the front porch with her suitcase in hand. She started walking towards the medic unit before the vehicle came to a complete stop.

After the patient was placed inside the medic unit we obtained a history. She stated that she has been feeling bad for several days. Nauseous and neck pain were the two main symptoms. Vital signs were obtained and she was placed on the cardiac monitor.

As the patient was talking to us she shivered. When we asked what was wrong she stated she had a cold chill. Her eyes rolled back and she went into cardiac arrest. After a lengthy resuscitation the patient was pronounced dead.

This case teaches several lessons of importance. One, never discredit a patient. It would be easy to shrug off the patient because she has been ill for several days. Why call us now? After all she had her suitcase packed and she was waiting on the front porch for us. What the heck? Does she think we are a taxi service?

Our job is not to judge our patients but to care for them. Our patient was sick. Unfortunately she waited too long to seek medical attention. Hesitation cost her, her life. Compassion is a trait that defines the great medic verses a mediocre medic. If you don’t care get out of the profession.

The next lesson we were taught is women do not present with the same symptoms of heart attack as men. Here is a list of symptoms that women may have when experiencing a heart attack.

1. Neck pain

2. Jaw pain

3. Epigastric pain

4. Nausea

5. Vomiting

6. Arm pain

7. Chest pain or no chest pain

8. Back pain

9. Braking out in a cold sweat

10. General discomfort 

So as you can see women’s response to heart attacks are different. They may be subtle and may appear minor at first. Seek medical attention if you have any of the above signs and symptoms.

As each has received a gift, use it to serve one another

1Peter 4:10

Medic 1 respond to 9234 Kelsey Street, report of a 22 year old male with multiple gunshot wounds. Police are on scene. Time out 2314. After a short response we arrive on scene. We find a young man lying on the ground bleeding heavily from a chest wound and a leg wound.

The young man was attempting to rob a gas station when the police arrived and engaged the suspect. A shoot out resulted and the young man was shot twice. No other injuries were found at the scene.

The young man was semiconscious. His blood pressure was 86/52, pulse 122, respirations 28. The chest wound was bleeding badly and pressure was applied in an attempt to control the bleeding. 

Blood continued to flow in spite of the direct pressure. Next the the wound was packed with gauze, lots of gauze. The wound is packed with gauze until no more gauze can be packed. Pressure is then applied over the wound and it appears the bleeding is controlled. 

My partner has been working on the leg wound. It appears the femoral artery has been severed. A tourniquet has been applied above the wound and tightened. The bleeding did not stop so a second tourniquet was applied above the first. The bleeding appears to be controlled. 

The patient is placed in the medic unit and and we proceed to the hospital. On the way two IVs are started to help replace some of the lost fluid. We must monitor the fluid carefully because if we raise his pressure too high it could cause the clots in his chest to break loose and bleeding would start up again. If we can keep his systolic pressure in the 90s that should be sufficient.

At the hospital, the patient is taken directly to the operating room, after a short examination in the ER. He will survive his wounds and stand trial for his crime.

Gunshot wounds demand quick and effective treatment to stop bleeding. You may not have the equipment that we have but you can improvise. Instead of gauze use a clean cloth. A belt or a wide piece of cloth may be used instead of a tourniquet. In today’s society it is a skill everyone should learn.

Let each of you look not only to his own interests, but also to the interests of others.

Philippians 2:4

Medic 1 respond to 1387 Riverside Court. Report of a twenty eight year old female in labor. Time out 1853. On arrival we found a young woman who appeared to be in active labor. Her face was red, she was sweating and contractions were less than two minutes apart. I asked if her water had broke and she responded yes. She also had an urge to push.

The next step is to determine if she is crowning. This is done by checking to see if the baby’s head can be seen in the birth canal. If it is visible we will deliver the baby now and not transport. Sure enough she is crowning. 

Being my first delivery, I was a little more than nervous. We obtained an O.B. Kit from the medic unit. This kit has all the material we will need during delivery. 

As the baby continues to move out of the birth canal, gentle pressure is applied to the top of the babies head with the backside of my fingers. This prevents an explosive birth that can lacerate the mother and create needless bleeding.

The head is now delivered and the nose is suctioned. (Babies are primarily nose breathers for several months. Suctioning prevents the baby from taking a breath and sucking fluid into the lungs.) Since the shoulders are wider than the head, the birth is slightly delayed. Gentle downward pressure on the shoulder followed by lifting upward on the other shoulder will allow the baby to deliver easily.

As the body of the baby is delivered a warm towel is wrapped around the baby to prevent loss of body heat. Baby’s go from an environment of 98 degrees to 70 degrees in a matter of seconds. A warm towel wrapped around the baby as it is delivered, makes for a more enjoyable entry into the world.

Once the baby is completely delivered, the umbilical cord must be cut after no pulse is felt in the cord. This is done by clamping the cord about six inches from the baby’s belly. A second clamp is placed about an inch further down the cord. It is then cut between the clamps.

Now the baby is dried and wrapped in additional towels. The head is covered. Baby’s lose much of their body heat from their head. Then the baby is given to mom so they can begin bonding.

Next we clean mom up and keep her warm for the trip to the hospital. An IV is established as a precaution for mom. If the trip is more than twenty minutes to the hospital it is possible that the placenta will deliver.

We then notify the hospital that we are in route. They are informed that mother, baby and paramedic are all doing well.

Birth is a natural process and it should be noted that the mother does most of the work. This being said, delivery of a baby is both exciting and nerve racking. In the case above, I was asked to sign the birth certificate. What a wonderful honor.

Since this first delivery, I now have a total of ten babies that I have delivered in the pre-hospital setting. Each one seemed like a miracle from God and I got to play a small part in bringing a new life into the world.

“Children are a gift from God, they are His reward.”

Psalm 127:3

You stop at a fast food restaurant for a quick lunch before returning to work. It’s a sunny day but very windy. The weather service has a high wind advisory posted for the area. 

While sitting eating your sandwich you hear a loud crash. You turn and see a young man staggering through the broken glass door. The wind caught the door as he opened it and propelled him through the glass. 

You run over to help him and you see his arm has a deep laceration to his arm. It is bleeding profusely and the blood is spurting from his arm. You lay the victim down and apply direct pressure with your hand and clean handkerchief over the wound. The blood continues to pour from the wound. He is loosing massive amounts of blood.

You give your keys to a bystander and ask her to retrieve your first aid kit from the trunk of your car. She returns quickly and you  ask her to obtain the tourniquet from the side pocket of your kit.

Now you ask another bystander to take over applying pressure while you apply the tourniquet. You loop the tourniquet around the victims arm above the large laceration. You tighten the loop and begin tightening the device. (Tourniquets are very painful so inform the victim of the expected pain) The bleeding has stopped. 

911 has been notified and is in route. You now assess the victim for shock from blood loss. The signs you are looking for are:

Cool, clammy skin and pale skin

Rapid pulse and breathing

Weakness

Confusion

Thirst

In severe cases unconsciousness.

From you evaluation you determine he is in mild to moderate shock. You elevate the legs to move more blood to the core of the body and help stabilize him. EMS arrives and transport the individual to the hospital.

In this case the victim had a full recovery. But how would the outcome have been different if no one was trained to control the bleeding? What if there was no tourniquet at the scene? 

People in high risk jobs should carry a tourniquet with them. Police officers, farmers and those working in industrial complexes should have a tourniquet and know how to use it.

When a person is bleeding profusely it only takes a matter of seconds to lose most of their blood volume. Quick action such as applying a tourniquet to one self, can mean the difference between life and death. 

If not already trained please consider doing so. You never know when it may just save a life.

The prudent sees danger and hides himself, but the simple go on and suffer for it.

Proverbs 22.3