Everyone Needs Rural EMS

by Joe Moore

I can’t think of one old time Island name that hasn’t had a need to use the services of BIEMS one way or another with one exception, the Greens.  The Wojans, McDonoughs, Gillespies, McCaffertys, Ricksgers, Connaghans, Palmers, Boyles, and many more have used our services over the last 20 years.    On a day in May of 2002, we were paged to the porch of one of these old time island families for a 61 year old female.  She wasn’t there.  The patient was found in an exam room at the medical center.  She was complaining of leg weakness in both legs since yesterday.  Her legs were “shaky”, and she fell several times today.  She was alert and oriented.  She had movement and sensation in all four extremities.  There was no facial droop.  The patient denied any loss of consciousness.  The PA had started an IV to keep the vein open, and she was on a cardiac monitor.  Her vital signs were pulse of 58-68, respirations of 12-16, and blood pressure of 160-190 over 92-114.  She had a history of fainting possibly caused by TIAs, mini-strokes.  We transported her by normal means to Charlevoix Hospital.  Again we were paged to this same location a few days later.  The patient was found seated on her porch with the PA present with her.  The PA reported that the patient was unable to stand due to left sided weakness for the last one hour prior to the PA’s arrival.  The patient was alert and oriented on EMS arrival.  She had equal strength and grip in all four extremities.  There was no deficit in speech and no facial droop.  The patient stated, “Lots of things are going on that make her nervous,” and the patient was referring to the PA.  The patient was able to stand with a walker prior to placing the patient on the cot.  She had been seen at Charlevoix Hospital four days earlier with the same symptoms.  The patient was placed in a position of comfort and transported to the local airport with oxygen by nasal cannula at 2 liters per minute.  She was taken once again to the Charlevoix Hospital by normal means.  There was no final diagnosis other than TIAs, mini-strokes.

In June of this year, we were paged to the home of a 52 year old male who had lost his wife in the prior year about seven or eight months ago.  Upon our arrival at 5 p.m., the patient was found in bed upstairs by a friend.  He had a blood pressure of 84/50, a pulse rate of 96, and respirations of 20.  The patient smelled like alcohol so a search of the home found about one-half of a half gallon bottle of vodka in the kitchen.  He stated that he drank four glasses indicating a glass on the bedside table that holds about 10 ounces.  He stated that he also took some pain pills, “about fifteen in a handful”.  He stated that he “needed to be with my wife.”  The patient was diaphoretic (sweaty) and having a hard time staying awake.  He did not know how long ago he took the pills, perhaps a “while ago”.  The patient was placed on 100% oxygen by non-rebreather mask while an IV was started to provide a route to administer drugs.  He was also hooked up to a cardiac monitor.  Within ten minutes, we administered one amp of Narcan to block the effects of the narcotic.  His oximetry reading on oxygen was 98%.  We tried another amp of Narcan.  The patient was more awake and more easily aroused.  In talking with the patient, who was obviously not in his right mind being controlled by a condition know as depression which had led him to this suicide attempt, we convinced him that there were plenty of people who cared about him including his good friend that had found him as well as all of the responders.  Talking about the future about his kids and his grandkids seemed to help bring him to the point where we could move him without having to force him into the transport.  We loaded him onto our ambulance cot and transported him to Charlevoix Hospital by normal means.  He is back with us now, and we are so glad that he was not successful in this attempt.

On one day in June, we were paged to the medical center for a 73 year old female who was complaining of the “chills” at about noon.  The patient has been weak and dizzy all morning.  She had diarrhea all morning and was unable to get off the toilet.  The paramedic PA had started an IV already at the medical center.  One full liter of fluid had been infused while the patient was at the medical center.  The BIEMS paramedic changed the fluid to a warmed IV solution of Lactated Ringers.  The patient’s vital signs were originally blood pressure 90/50, pulse of 84, and respirations of 18.  After the fluid was running in for a while the second set of vitals showed a normal blood pressure of 116/66, pulse of 73, and respirations of 12.   The patient had been sick for at least three days and was dehydrated.  The medical control doctor wanted to evaluate her in the ER in Charlevoix so she was transported by normal means to the hospital where the BIEMS paramedic gave report and turned over care to the ER nurse.  Three days later, the patient had been discharged after one full day of observation in the hospital, we were called to her home again at noon.  She again had a sitting blood pressure of 90/60 with normal pulse rate of 64 and normal respirations.  Her blood glucose was within normal limits.  The patient again appeared to be dehydrated.  When the patient was sitting her pulse rate jumped to 88 from 64.  We hooked up the cardiac monitor and provided the patient with some Gatorade to drink because it has the electrolytes in it.  Blood was drawn by the PA when she arrived on scene.  The patient was found sitting in a chair, hunched over, looking sweaty, and was warm to the touch.  Patient again complained of being dizzy when she sat up.  The family signed a refusal of transport because the PA stated that she would send the blood across for blood tests.  The PA stated to the family that there was no need for the patient to go to the hospital.

In July we were paged to the local public marina for a 56 year old female patient who had had a fainting spell after coughing and was “out for 2-3 seconds”.  The husband denied any type of seizure activity.  The patient denied any shortness of breath or chest pain.  She stated that she had been coughing yellow sputum.  The patient’s skin color, temperature and moisture was normal.  The patient requested transport to the medical center.  Vital signs were pulse of 60 and irregular, respirations of 20, and a blood pressure of 128/80.  She was conscious and alert, but complained of weakness, so we loaded her up on the ambulance cot and transported the patient to the medical center.  We had finished cleaning up the ambulance at the ambulance garage and had gotten home when we were paged back to the medical center for this same patient.  The vital signs were pulse of 108, respirations of 20, and blood pressure of 104/72.  The PA stated that the patient had had a “hypoxic seizure”; she had contacted medical control who advised transport.  BIEMS had blood drawn and an IV in place very quickly, the oximeter in place reading 95 with the patient on 2 liters of oxygen by nasal cannula.  The cardiac monitor was applied and it showed sinus tachycardia without any arythmias.  EMS had arrived just as the patient had finished a nebulizer treatment.  The patient’s lung sounds revealed wheezing in both lungs.  The patient was loaded up onto the ambulance cot with all equipment and transported her to Charlevoix Hospital by normal means.

CPR training is not all that long and is not all that difficult.  As the following story can attest, knowing CPR and performing its easy steps quickly in an emergency can make all the difference in the world to a victim, in this case a victim of near drowning.  In August we were paged to the public beach for a 3 year old female had been under the water for about two minutes.  A Michigan State Police Officer (SPO) on vacation on Beaver Island on the beach relaxing.  He saw the child go under the water.  He sprinted out and brought the child in to shore and  performed approximately 4 minutes of resuscitation doing CPR which produced spontaneous respirations just as BIEMS arrived on the scene.  The patient was in the arms of the SPO and was carried into the ambulance.  The patient was breathing on her own, but was very lethargic.  The patient’s pulse was 153, respirations of 40, and temperature of 92.4 under her arm.  She was immediately wrapped up in warm blankets after being dried off with towels and placed on oxygen.  A pulse oximeter reading was 99% on oxygen.  We transported the patient to the medical center for monitoring until her father could be found.  The patient was crying, and then became sleepy.  She was able to respond with short statement to EMS personnel.  There did not appear to be any neurologic deficits even though the patient was very lethargic.  We needed to agitate the patient to arouse her.  The father was located and was to meet us at the airport.  We loaded the patient up onto the ambulance cot and loaded her into the ambulance.  We were loading all equipment up into the aircraft to be prepared for a secondary drowning and/or cardiac arrest when the father arrived at the airport.  He verbally consented to the transport of his daughter and stated that “someone would meet her at the hospital to consent for treatment there.”  The patient was flown accompanied by BIEMS personnel to Charlevoix Airport and then on to Charlevoix Hospital.  BIEMS was ecstatic about the positive outcome which was due to the quick reaction of a trained State Police Officer.  BIEMS made certain that a letter was written to his commanding officer.  Enclosed with that letter was a certificate of appreciation from BIEMS and an American Heart Association “I Made CPR Count” patch.  The SPO’s CPR training had truly made CPR count, and he had truly saved a life on Beaver Island while on his vacation.

I have previously written about a wonderful lady with a history of atrial fibriallation.  In September of this same year, she was at the medical center when BIEMS was paged to help get her to the hospital at about 11 a.m.  This 58 year old female was on Coumadin.  When BIEMS arrived the patient was pale, sweaty, and complaining of shortness of breath.  “It’s hard to catch my breath,” was her statement.  She had fallen on her steps and had some pain in her lower back.  There was some bruising in that area.  She was immediately placed on 4 liters per minute of oxygen by nasal cannula and had an IV established in her right hand to keep the vein open.  She was hooked up to the cardiac monitor.   Vitals were pulse ranging from 100-163 very irregular with a rhythm of atrial fibrillation with fast conduction, respirations ranging from 16-24, and a blood pressure of 120/70.  Thirty minutes later we were in the local airline’s aircraft enroute to Cherry Capital Airport in Traverse City.  The patient’s blood pressure slowly started to decrease while in the air down to 90/64.   I turned the IV up to run some fluid in.  I titrated the amount of fluid based upon her blood pressure.  If her blood pressure started to decrease below 110, I turned the fluids back up.  I noticed also that her capillary refill time, the time for a blanched nail bed to get pink again, was extended now from the original two seconds to three seconds.  When we arrived at Traverse City Airport, it was nice to see a friendly face.  The Northflight manager who sometimes volunteered as a paramedic on Beaver Island was there to meet us.  When I gave him the report, I ended it with this statement, “You need to rule out an internal bleed due to the changes in blood pressure and the Coumadin.  The atrial fibrillation may also be a contributing factor.”  He said, “Thanks, Joe, we’ll take good care of your patient.  See you next weekend.”