Diabetic Emergency

Posted by on Nov 21, 2011 in Blog, Medical/EMS | 0 comments

EMS 4 diabetic emergency at 123 Fox Street, at 123 Fox Street on TACH Channel 12 I stuff the rest of my sandwich into my mouth and gulp down some water as I rush out of the fast food joint to hop into my ambulance. As my partner signals RESCOM (dispatch) we’re en route to the above (sample) call, I speed our ambulance down the road, lights and sirens. I won’t discuss the full assessment and treatment we’d perform on a diabetic patient, but if you want clarification or further explanation for your fictional writing needs, please ask me. On scene we find first responders assisting an unconscious male sitting slumped over in a Target bathroom. “His blood sugar is 12,” one of the firefighters tells me. “He works here and his co-workers say he takes insulin daily.” “Sir?” I say to the patient. “Can you hear me?” No response. His eyes are half open. His pupils are dilated and sluggish. My partner and I insert a line (IV), and push one 25g AMP (ampule) of D50 (dextrose 50% in water). I attach him to our cardiac monitor via a 12-lead (ECG patches), and assess his heart rhythm and all his vital signs. He’s in normal sinus rhythm and all his vits are within normal range; however he’s slightly tachycardic (heart rate too high), but an elevated HR is the body’s defense to survive a hypoglycemic episode (low blood sugar). “Sir?” I place my hand on his shoulder. “Hey, buddy, talk to us.” The patient remains unresponsive, so my partner and I push another 25g AMP of D50. Via a glucometer, we test his BGL (blood glucose level). It’s now 43. We’re headed in the right direction, but the patient is still unresponsive. We administer 1mg of glucagon IM (intramuscular injection). “Sir?” I squeeze his hand. “I need you to talk to me. Okay?” He stirs, his eyes attempt to focus. We load him onto our stretcher and wheel him inside our ambulance. Within a few minutes, he stares at me. “Where am I?” “You’re in an ambulance, sir. I’m EMT Benson.” I finish retaking his BGL again. It’s now 98 (within normal limits). “Do you...

Read More

EMS Call: Respiratory Arrest

Posted by on Oct 28, 2011 in Blog, Medical/EMS | 0 comments

Dianna is back for her monthly EMS post. I’d like to pass along my congratulations to her for winning in the ACFW Genesis contest this year! This is a much sought after award and will turn the heads of editors her way. I know we will be seeing her books published in the coming years. Today, she focuses on the aspects of a respiratory call. This will help add those factual details for your scenes. EMS 18, respiratory distress at 1234 Greene Road, at 1234 Greene Road on TACH channel 7. joeyvest As we climb into our ambulance posting (parked) at our station, my partner and I radio in we’re en route to the above scene. Lights and sirens, we rush out of the garage. En route, we’re notified via our computer that the patient is a 24-year-old female and is conscious and breathing. Once on scene, we find the scene is safe and no dispatched law enforcement. Typically a fire crew arrives on scene first (prior to us) since there are about three times more firehouses thanEMS stations globally, thus they’re closer than we are. However, fire is not always dispatched along with EMS, so for this sample EMS call we’ll say fire wasn’t dispatched. Upon our arrival at the patient’s side, my general impression of her is she’s SOB (short of breath) and in respiratory distress (dyspnea). She’s sitting in the tripod position (leaning far forward with her palms on her kneecaps) and she’s breathing shallow and fast (tachypnea). She’s not cyanotic (blue lips or fingernail beds), so she’s perfusing fine at the moment and not hypoxic (lack of efficient oxygen), but that can quickly change. I won’t discuss everything we’d do on a respiratory call like this, but if you need clarification or further explanation for your fictional writing needs, please do not hesitate to ask me. julezcourt As my partner whips out a non-rebreather mask and connects it to the oxygen tank at 15 lpm (liters per minute) then slips it over her mouth and nose, I assess her breathing rate and quality and find it definitely out of range, certainly labored and not efficient to sustain life, so I assemble a BVM (Bag Valve...

Read More

Personal Protective Equipment (PPE)

Posted by on Sep 14, 2011 in Blog, Medical/EMS | 0 comments

Dianna Benson is back for her monthly post discussing the different types of personal protective equipment healthcare professionals wear in different types of situations. As a writer, these will help you write authentically. As an EMT, a Haz-Mat-Operative, and a FEMA Mass Casualty Incident Operative, PPE (Personal Protective Equipment) is vital to my safety and health. At a bare minimum, I wear medical gloves and wash my hands post removing those gloves. At a maximum, I wear my bio hazard suit, head to boot, complete with full face respirator, air tank and haz-mat outer gloves. Depending on the type of EMS call and the situation, I could wear one, all, or a combination of the following PPE: long armed and legged paper gown, plastic face shield, plastic eye goggles, a HEPA or N95 (mouth and nose surgical mask), and a helmet. In a MVC (motor vehicle collision) I wear a bright yellow traffic vest stamped with EMS on the back. If I need to climb inside a damaged vehicle on scene to medically examine, assess, and treat a patient as well as help extricate them onto a backboard and stretcher, I wear my turn out gear: heavy thick pants, coat and gloves over my EMS uniform and medical gloves, plus I wear a helmet with a thick plastic face shield and I slip the yellow traffic vest over the coat. If I have a blood borne pathogen exposure via a contaminated needle or a patient’s mucous membranes, blood, urine, vomitus, feces, etc. or an airborne pathogen exposure, I immediately contact my district chief 24/7. Within minutes, my district chief will inform theEMS medical team and they will advise me on how to proceed in seeking medical care for myself. Never in the history of EMS, fire or law enforcement have any of us contracted HIV while performing our duties due to the fact the HIV virus dies once it’s exposed to either air or light. Hepatitis C and MRSA (Methicillin-resistant Staphylococcus Aureus) are two diseases I’m concerned about contracting from a patient. Unlike Hepatitis A and B (both of which I was vaccinated against before my first EMS shift back in 2005) there currently is no Hepatitis C vaccination. Along with about...

Read More

Medical Question: Submerged Vehicle Part 1/2

Posted by on Jul 11, 2011 in Blog, Medical/EMS | 0 comments

Mart asks a fairly detailed medical question so I’m going to split this post up over two days. Today, our resident EMS expert, Dianna Benson, will offer the EMS response. Next post, I’ll cover the emergency department treatment. Mart asks: This is the scenario: Ruby, Gio and their parents are in a car that submerges in the river.  Some of the things I need to know: 1.      What happens when paramedics get to them? 2.      Do they do CPR and if so for how long (with no pulse of a drowning victim and one that has a pulse but ends up being in a coma) 3.      Who declares them dead? I’ve read that it depends on the state. Sometimes the doctor does. This takes place in NY. Ruby is the only one conscious. Do they treat her in any way? What happens to her sister if she is in a coma? Is that possible? What happens to her dead parents? Dianna(EMS Response): Clinical Definitions: Drowning: An incident in which a victim has been submerged in water and dies within 24 hours of submersion. Photobucket/Moonstruck1977 Near-drowning: An incident in which a victim has suffered a submersion but has not died or dies more than 24 hours after the incident. A near-drowning patient must be treated for at least one submersion-related complication or it’s not considered a near-drowning. Submersion: An incident where a victim is submerged in water and requires some type of emergency care due to the submersion. When we (EMS) are dispatched to a water-related emergency, we often suspect a possible spinal injury. In the case of a car landing in water somehow, we’d definitely take spinal precautions, and thus apply a neck collar and strap the patient onto a backboard while the patient is still in the water. Cold water and warm water emergencies are different. If a victim goes into cardiac arrest in cold water (68 degrees or colder), the mammalian diving reflex may prevent death even after prolonged submersion (even 30 minutes)  – a body could be frozen in cold water temperatures to the point all the systems go into a hibernation-like state.  Firefighters do not extricate victims from submerged vehicles unless they are trained...

Read More

Dangerous EMS Scenes

Posted by on Jun 8, 2011 in Blog, Medical/EMS | 0 comments

When Safe Scenes Turn Dangerous Unlike inside a hospital, EMS operates in uncontrolled settings and environments. At any given moment a scene can and does suddenly become unsafe for us while we’re in the process of medically treating a patient. As an EMS crew is enroute, responding to a 911-Call, if Dispatch informs us PD (police department) or LEOS (law enforcement officers) are also being dispatched, a crime has possibly been committed or the scene may somehow be unstable or unsafe. However, all rescue personnel on scene is responsible for his/her own safety. We can’t depend on PD or LEOS to protect us; instead, we must follow our own protocols and work the scene with all other rescue crews effectively. Regardless if PD or LEOS are on the scene with us or not, safe scenes can and do suddenly become unsafe in various ways with little to zero warning as we’re at the patient’s side giving medical care. The patient, the patient’s loved-ones, or bystanders can suddenly become violent or their behavior can drastically change due to: mental illness, fear, anxiety, drugs or alcohol, declining medical condition, they’ve committed a crime on scene, they’re a desperate criminal with a concealed weapon, etc. altering the safe scene to a dangerous situation. I can’t go into detail, but I’ll share the basics of two scenes that turned unsafe for me and my partner: 1) An attempted suicide patient – a prison inmate – grabbed a police officer’s weapon. We physically and then chemically restrained the man without anyone getting injured, but it wasn’t easy or quick. 2) Adult children of a bi-polar patient called 911 because their father became disoriented and agitated. After our arrival, the patient turned aggressive and combative. I called for PD back-up, but instructed them not to use force unless absolutely necessary. I used the talk-down technique to calm him as I also reassured and counseled his adult children. After an intense hour, I finally had the patient physically and chemically restrained in my ambulance. Hazardous material are another safety concern – if an EMS crew is dispatched without the knowledge haz-mats are on scene, our lives and health are at risk. Immediate recognition of haz-mats...

Read More

Haz-Mat Decontamination

Posted by on May 9, 2011 in Blog, Medical/EMS | 0 comments

Dianna’s back for her monthly blog post. Today, she focuses on HazMat Decon (otherwise known as cleaning gross stuff off of you that could kill you). I particularly love the photos she included to help aid the writer with those accurate descriptive details. Don’t forget, leave a comment this month and be eligible for Brandilyn Collin’s book Over the Edge. Winner announced June 1, 2011. This is amazing fodder for any author to add conflict and tension to a disaster situation. Decon can also be used on a very small scale as Dianna mentions. Possibly only one patient. Imagine a patient drenched in gasoline. Not only can the gas be caustic to the patient’s skin, but if that patient is brought into the ED, the fumes will permeate the department. This can pose a risk to other patients, particularly those with respiratory complaints. Welcome back, Dianna! HAZ-MAT Decontamination OSHA definition of decon: The removal of hazardous substances from employees and their equipment to the extent necessary to preclude foreseeable health effects. NFPA (National Fire Protection Agency) definition: The physical and/or chemical process of reducing or preventing the spread of contamination from person and equipment. Inclusive definition: The systematic process of removing or chemically changing a contaminant at the scene to prevent the spread of that contaminant from the scene and eliminate possible exposure to others. Contaminants are any chemical or biological compounds or agents capable of causing harm to people, property, or the environment and includes: 1)      Bloodborne pathogens 2)      Common chemicals 3)      Warfare agents 4)      Etiological agents 5)      Radiological agents Decon is located in the warm zone of an emergency incident, which is in between the cold zone and the hot zone. Once rescue personnel exit the hot zone, we must enter the warm zone and decon before entering the cold zone. Haz-mat trained and credentialed EMTs wear head-to-toe biohazard suits and enter haz-mat areas/situations to assess patients, give them medical care, and extricate them out of the hazardous hot zone to the decon area. There are five decon stations. 1)      Initial entry: I drop my loose (not attached to me) instruments and tools in buckets. 2)      Gross Rinse: While I’m still fully clothed in my bulky biohazard suit, another person thoroughly rinses me off (and everything...

Read More