Ahm not a smaht man, but I know what a trauma ee-is

Monday, September 19 2005

About two in the morning we’re toned out for a possible unconscious, “Caller reports patient lying in roadway”. We arrive to find an elderly man lying face-down in the thick mud between the curb and the sidewalk, where one day the construction company will place sod. His head, chest, and arms are covered with mud, but a ragged laceration in his forehead has bled much of the mud off his face. A baseball cap lies on the ground perhaps ten feet away.

Was this guy hit by a car and thrown onto the sidewalk? Was he mugged? Did he just trip? No way of telling. I take c-spine while the crew grabs backboard and cot.

“I’m okay, I’m okay,” the man says in a very weak voice. “Can I go home now?”

“No, sir, we need to check you out. What happened?”

“I fell, I think. Can I go home now?”

Backboard is ready, we roll the patient onto it and begin strapping him on. The whole time he’s whispering, “I just want to go home,” over and over. We place a collar.

The patient stops talking. And moving.

“Oh shit oh dear,” says DTs. “Sir!” No response. Sternal rub. No response. One of the crew takes the patient’s wrist, says, “I can feel a pulse.” Carotid pulse is present also. I look, the patient is indeed breathing – he’s just not responding. In EMS lingo, he’s DFO – done fell out.

DTs is precepting a young lady to become an EMT-B lead. She calls the county to ask if a medic is available for this call, and is told “negative” – all the medics are busy. Phooey.

Load and go. We grab a quick set of vitals, then the lead preceptee asks me to call the hospital while she and our third cut the patient’s clothing to check for non-obvious injuries.

“Charles Cullen Memorial ER.”

“Hi, ambulance 502, we’re responding to you with a male, 65, found prone on a sidewalk, periods of unresponsiveness, head lac, unknown mechanism, boarded, collared, vital signs BP 174/91, pulse 109, pupils PERL, Sa02 99% room air, dexy 120, see you in three minutes.”

“Okay,” says the ER.

The patient’s O2 sats do not warrant oxygen, but we give him a non-rebreather at 15lpm anyway – we’ve noted a tendency for his breathing to slow when he goes unresponsive, which he does twice en route. Each time, though, he pops back up within ten seconds and says, “I want to go home.”

We arrive, wheeling the patient into the ER. Recent construction has modified the nurses station to include partitions so they don’t have to see you when you walk in. Our driver wends through the mini-cubicles to the admitting nurse.

“Ambulance 502,” he says.

“Yes, I know,” she says. “Just wait.”

“Hey, we got this guy,” he says.

“I’ll be with you in a minute,” she says. The driver peers around the partition to give us a helpless shrug.

“Okay, put him in the hallway,” says the nurse.

“Hallway,” our driver says to us.

We move the patient on the board to the bed parked in the hallway. Another nurse comes up.

“What are his O2 sats?” he asks.

“99% on room air, but -”

“Take that thing off his face,” the nurse orders. Goddamn, I’m starting to get a bit pissed, here.

The admitting nurse comes around to the bed. Her eagle eyes miss nothing.

“This patient is on a backboard!” she says.

“Of course,” says DTs.

“And this patient has a collar!” she exclaims. “Why is this patient on a backboard with a collar?”

“He was found prone on a sidewalk,” I begin, but she’s cleverly deduced everything.

“This is a trauma patient! This patient should be in a trauma room!”

“Yes, yes!” says DTs. She’s getting it! There is hope!

“Did you call this in as a trauma?”

“Yes.”

“Where’s the medic?”

“There was no medic,” our young preceptee begins.

“Should have been a medic. Why didn’t you call a medic? You’re just a basic unit. This patient needs a medic…”

What this patient needs, I thinks to meself, is for you to STFU and call a doc; what this patient needed was our four minute transport to the hospital, versus waiting on scene 10 minutes until a medic was available. What this patient needed was to not wait five minutes until you graciously allowed us to place him in a goddamn hallway bed.

A doc arrives, gets things moving in the trauma room, then steps outside to get the story from the precepting lead. He nods his head a few times, says, “Okay,” then turns back into the trauma room.

Later, the doc pulls the preceptee aside. “You did exactly the right thing,” he says. The patient was suffering from ETOH mixed with a lot of heavy-duty prescriptions – not something a medic could have done anything about anyway, had they been available.

The next time we came in with a patient, the same nurse was there, and a sight more friendly and responsive. I wonder why?

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