Monkey See…

DTs is still precepting as a medic for the transport company. The rescue organization with which I run lacks the personnel to precept medics; when and if things change I suppose I’ll precept with them as well. In the meantime, the transport precept gives me some needed experience, but it is experience of a different flavor.

“Flavor?” Well, yes. Consider these two calls (with patient-confidentiality changes, of course):

A 40 year-old male with diabetic neuropathy (where the diabetes has adversely affected nerve conduction, especially in the extremities) has accidentally spilled onto himself industrial-strength oven cleaner, used in his workplace. He cleans it off his pants, thinks nothing of it. This occurs around lunchtime.

He leaves work at 17:00, goes to his child’s soccer game and cheers him on, goes home, eats dinner. Then he settles in to a relaxing evening around 19:30. He removes his work boots.

A good deal of the oven cleaner had, unbeknownst to him, spilled into one of his boots. His neuropathy ensured that there was no pain. Even so, oven cleaner + skin = bone. Most of the flesh of his foot was dissolved away. A tough guy, he has his wife saddle up the car and bring him into the ER, rather than call 911. Our transport company picked him up, stabilized and bandaged, for transport to a burn center.

A thirty year-old male is helping his neighbor work on a classic car. I’m not sure what they were attempting, but at one point the neighbor was pumping the gas pedal while the patient was directed to slowly pour gasoline straight into the carburetor. The car backfires, and the carburetor shoots flaming gasoline over the patient’s arm, resulting in extensive second-degree burns. Again, we’re called to the ER to transport once the patient has been bandaged and stabilized.

Now, had DTs been first on-scene to either of these calls, that would be one thing. I’ve noticed that we in EMS like to hear about calls like this not because we enjoy suffering, but rather to ask ourselves, “Would I have handled that the same way? Would I have started two lines on the oven-cleaner guy, instead of the one line he had? Run lactated ringers instead of normal saline? He’s not in pain, but this has got to be freaking him out somewhat, could he benefit from a teensy bit of sedation, and if so, how will that affect the “weeping” of his wound?”.

Or, “What if the gasoline burn guy needed another line for fluids? His other arm is shot. Where would be the best place for a second line, here? Could his arm have been bandaged differently, better?”

On the transport side, then, DTs gets a good chance to see how others are handling such emergencies, rather than being on the rescue side and having to figure it out himself. One would suppose that playing such second-guessing games now will help to save time on scene as a first responder, when something like this comes along.

So in that respect, it’s all good. All too soon, I know, it’ll be Monkey Do…

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