Saturday, January 31, 2009

Stop, just stop it already!

Ok. For the last few months I have been hearing a lot of crap about the world coming to an end in 2012 because the Myans stopped making their calendar there.

I think it's bullshit and here is my rational as to why.

The Myans lived from 300-900 AD. They built housing so they had contractors and engineers. They ate so they had farmers etc. They basically had most of the professions we have today right?

So it stands to reason they had teachers and scribes too.

Some poor sap got placed in a hut around 315AD and it was his job to make calendars. As he got older it was further his job to pass off the calendar making to some other non-athletic Myan. Given the average life span of a Myan of lets say, 70 years, that means that from the time they winked into existence around 300AD until the time they winked out of existence around 900 AD we have a span of 600 years.

That means if only 1 Myan was making calendars it took almost 9 of them to do nothing but make calendars for that 600 year period. (Of course you can multiply that number by a factor of 1000 easily as there were probably plenty of calendars)

It is my belief that somewhere down the line they just got tired of adding years. I mean, COME ON! If it were your job to make calendars what year would you say.. "Ok, to hell with it. We don't need to go any further than this!"

Some wrinkly old Myan got to 2012 and said "That looks good, here it is 898AD... Who the FUCK is going to live 1114 more years to even appreciate my work?" "If we happen to make it that far we will just start making calendars again, but this is good enough for now."

Lighten up people.. We are not going to wink out of existence in 2012 just because some Myan got tired of making calendars.

The only thing this serves is to remind ourselves that in EMS there will always be some nutter with a reason to be going crazy. Load up on your Haldol and Versed and start your day guys. There are plenty of nuts out there for all of us.


Friday, January 30, 2009

Now that takes balls!

One morning I was called to the emergency room by the head ER nurse. She directed me to a patient who had refused to describe his problem other then to say that he "needed a doctor who took care of men's troubles." The patient, about 40, was pale, febrile, and obviously uncomfortable, and had little to say as he gingerly opened his trousers to expose a bit of angry red and black-and-blue scrotal skin.

After I asked the nurse to leave us, the patient permitted me to remove his trousers, shorts, and two or three yards of foul-smelling, stained gauze wrapped about his scrotum, which was swollen to twice the size of a grapefruit and extremely tender. A jagged zig-zag laceration, oozing pus and blood, extended down the left scrotum.

Amid the matted hair, edematous skin, and various exudates, I saw some half-buried dark linear objects and asked the patient what they were. Several days earlier, he replied, he had injured himself in the machine shop where he worked, and had closed the laceration himself with a heavy-duty stapling gun. The dark objects were one-inch staples of the type used in putting up wallboard.

We x-rayed the patients scrotum to locate the staples; admitting him to the hospital; and gave him tetanus antitoxin, a broad-spectrum antibacterial therapy, and hexachlorophene sitz baths prior to surgery the next morning.

The procedure consisted of exploration and debridement of the left side of the scrotal pouch. Eight rusty staples were retrieved, and the skin edges were trimmed and freshened. The left testis had been avulsed and was missing. The stump of the spermatic cord was recovered at the inguinal canal, debrided, and the vessels ligated properly, though not much of a hematoma was present. Through-and through Penrose drains were sutured loosely in site, and the skin was loosely closed.

Convalescence was uneventful, and before his release from the hospital less then a week later, the patient confided the rest of his story to me.

An unmarried loner, he usually didn't leave the machine shop at lunchtime with his co-workers. Finding himself alone, he had begun the regular practice of masturbating by holding his penis against the canvas drive-belt of a large floor-based piece of running machinery. One day, as he approached orgasm, he lost his concentration and leaned too close to the belt. When his scrotum suddenly became caught between the pulley-wheel and the drive-belt, he was thrown into the air and landed a few feet away. Unaware that he had lost his left testis, and perhaps too stunned to feel much pain, he stapled the wound closed and resumed work.

I can only assume he abandoned this method of self-gratification.

By Dr. William A. Morton, Jr. MD, a retired urologist residing in West Chester, Pennsylvania.

Wednesday, January 28, 2009

There are angels all around us.

My truck is back together and so are the other two. I'm tired, I have a laceration to the top of my head and my back hurts like a son of a bitch... but he will live.

As we arrived on scene I saw 4 semi's jack-knifed and about 8 cars piled into them. The snow was pouring down and my partner had a concerned look on his face that I rarely see.

The police approached us and said there was one trapped in the wreckage of a semi. Every one else was just fine. We set off toward this huge pile of twisted metal that looked like a scrap yard and I peered inside the window. I could see the top half of a body in there and my stomach fell. The wreckage was one of the worst I have seen in 15 years and I was just about positive no one could have survived.

There was still a side window intact and I thought I could make entry there, so after we did a quick check for safety hazards I removed the window and started to crawl inside. I heard "Hello, hello... I'm stuck!" By God he was alive... I asked him his name and told him mine and we went to work trying to get him our of the carnage.

Both of his legs were crushed under the engine compartment and the steering wheel was pressed into his belly but he was A&O x 3 hanging upside down by his seat belt.

Within the next few minutes we had a couple firetrucks join us in the extrication and 2 more of my units as well. We took turns holding him up to keep the pressure of his body away from the steering wheel and seat belt. I didn't want to cut the belt yet since it was the only thing holding his upper half in place. If I released the seat belt all of his weight would strain against his lower extremities and I was positive they were in some nasty shape.

Gave him O2 and covered as much of him as we could with blankets. About 30 minutes into it we started placing hot packs in axial areas to keep his temp up. He remained awake and talking most of the time. At one point I told him he was not allowed to pass out without my permission. He laughed a little but I knew he was in some serious pain.

We all took turns holding him up and talking to him. When we were not squished into the cab with him we were outside running the jaws or the sawsall cutting away at the truck and the engine compartment trying to free his legs. He was in there very tight and from what I could see of his legs he was going to need a trauma center.

I called to request a bird, but they were not flying due to the weather, so I called the ER and told them the story and to have a MICU ready to take him to a trauma center after he was stabilized. Our little hospital is damn good, but this guy was going to need a specialist, of this I was sure.

I asked about his family and told him about mine. He has 6 kids.. I said "Buddy, how do you have time to make six babies when you drive truck?" He replied to me "That's all I got time to do man". We laughed about that a little but I could see that it was getting harder and harder to keep him awake. I kept reminding him he did not have my permission to pass out. He would say ok man, ok.

Almost 90 minutes into the extrication we were able to free his legs and pull him out onto a long board. We did the standard immobilization and got him into one of the units. As we were pulling him out his legs were hurting so much he almost passed out. I yelled his name and he promptly replied "I know, I don't have your permission." He then started thanking us. I told him there was still much to do and for him to be strong we would walk this road together.

In the squad we gave him a through once over and controlled the bleeding from his legs. He was in pretty bad shape but there were two legs there and we intended to deliver him to the ER with a good BP and perfusion to those legs.

Started an IV and gave him some morphine for the pain. Worked to realign and get pulses back to those feet with pretty decent results.

On arrival to the ER their trauma team was ready to stabilize and the mobile life was there ready to transport to a level 1 trauma center just as soon as the local guys could get everything under control.

Looking back on it I have to say: Today an angel was riding shotgun with that guy, I have never in 15 years seen an accident that bad have such a positive outcome. This guy will need surgery sure..probably lots of it, but he's alive and doing well when everything there said he should be dead.

Greetings Mr. President.

We traveled the 500 miles in just over 7 hours. 15 ALS units en route to provide medical support during the 2009 inauguration of President Obama.

The security was very tight and we ended up having several forms of identification we had to carry with us plus FEMA and USSS tags in the windshields of our units. FEMA had also lo-jacked all of our trucks and provided us with 2 cell phones in addition to the 2 phone we were already carrying and 2 radios per truck. It was obvious to everyone that they wanted to maintain contact with us at all times. It was further obvious that they wanted to know where the trucks were.

We started out staging about 12 miles from the DC area, we were not there long before they moved us to a park about 3 miles outside the capitol. The thing is though, in DC during any big public event, it can take you over an hour to travel 2 miles.

We sat at the park for about an hour and then FEMA assigned a DC firefighter to every unit as a spotter. These guys were supposed to know which roads were closed and the quickest ways to get around the capitol area. If you ask the crews, the firefighters were little to no help at all.

Eventually they broke our strike teams up and started assigning our units to DC fire stations. We could hear the traffic on the DC radios and there were literally hundreds of cold related calls within the first couple hours. I heard a couple full arrests come across too. With a crown of over 2.9 million people you had to expect that a few of them would die.

Reports were coming in of ambulances stuck in mobs. They could not respond, as the crowds completely over-took them and surrounded them on all sides. They were using small ATV type carts to get around inside of the venue area with just slightly better results. Some of them would not start and other times the medics on board would have to leave them to go off on foot. When they tried to return to them they couldn't find them. They either were moved of the crowd had just swelled so much they they got disoriented and couldn't find their way back.

My unit got staged at 14th Street and Congress Ave. It was quite a happening place there. I have never in my life seen so many tactical operators in one area. There were officers as far as the eye could see. As far as I could tell there was only 1 more unit in our area and they were sleeping in their truck. Fortunate for them, they were not part of my team, I think I would have had something to say to them.

My team performed exactly as they had been trained, no one missed a beat and everyone was very professional. We even decided that there was not going to be a debrief after this activation because there was really nothing that could have been improved upon. I was very proud of them.

When we got home I got quite a few calls saying things like "Good Job Chief, another activation down with no problems" I was quick to remind them that if not for the ENTIRE team things would have been very different. We have a fantastic group of operators, each one of them makes the team is as good as it is. All I do is gently (well sometimes not gently) steer them in the right direction.

It's good to be home, but now I'm up to my ass in snow...

Tuesday, January 20, 2009

A New Era

I didn't vote for him, but I'm willing to give him a chance to excel. I guess only time will tell if this proposed CHANGE is what is best for the country.

We have 15 trucks sitting here in DC as part of a FEMA response team. It's unlikely that we will be utilized but it was a huge honor to be asked to come. Our special operations team made the 8 hour trip and stayed in a hotel a couple nights while all of this was being put together.

We held down a parking lot yesterday, and today we are waiting in the wings. As it gets closer to noon we can hear all of the EMS traffic picking up. Lots of cold related emergencies, a few serious patients but all in all it doesn't seem too busy yet for the amount of people that were here. Just turn on a television and you'll see what I'm talking about.

I'll write more tomorrow, right now were just waiting to be pressed into service and I'm happily surfing the Internet and listening to the traffic.