Lonesome Paramedic

A Lonesome Paramedic

Even though I had two other paramedics on the island at this time, it seemed quite lonesome without my friends.  This is not to say that I wasn’t associating with the other two paramedics.  It’s just that for the last eleven years I had spent a great deal of time with these other two people.  One had taken medical first responder and basic EMT class from me, and together we all had taken the paramedic class.  So now without my good friends, I had to take over the business and the political end of BIEMS besides being the front man and a paramedic. 
At 0302 in the morning in August, BIEMS is paged to the Beaver Island Marine, formerly Beaver Haven Marina, and not to be confused with the public marina in the same harbor on Beaver Island.  It took us almost 15 minutes to get up, call in service, arrive at the marina, and locate the patient.  There, a 49 year old female was walking on the second floor of a yacht.  This needs some explanation.  The bottom part of the hull of this boat was like most others.  There were chairs and walk-in sliding doors to the master bedroom and bath on the “first floor”.  Up above this, there was an open air place much like a deck on a house with deck chairs and places for people to sit in the open air.  There wasn’t any kind of railing on this “second floor” to prevent the fall that happened to our 59 year old female.  She and her husband had been down to the local bar celebrating their wedding anniversary with dinner and drinks.  They had walked back to the boat and were continuing the celebration on the boat. 
The celebration was coming to an end sometime just before three in the morning when the wife “sort of blacked out” and fell from the upper deck to the lower deck.  She was complaining of left leg pain from her hip to her ankle.  No matter what we tried to do to help her, the patient yelled, “Oh, no! NO! NO! NO!”   Needless to say it took us quite a while to assess and treat this lady.  We splinted her bad leg to her good leg with a pillow in between using, you guessed it, triangle bandages.  We log rolled her onto a spine board which was no easy matter in the confined space of a boat, even though it was an open air deck.  We had her completely immobilized on a spine board with suction ready in case she had some vomiting due to the nausea caused by either the pain or the alcohol intake.
We started an IV after loading the patient into the lighted ambulance, and I called medical control for an order for pain medication.  The medical control physician authorized three milligrams of morphine as the initial dose with incremental doses of 2 milligrams as needed for pain throughout the transport.  The patient had a history of high blood pressure which explained the vital signs being slightly high in addition to the pain the patient was in.  We transported the patient to the local airport for a flight to Charlevoix and accompanied the patient all the way to the hospital.  We had provided excellent patient care, and we had taken our time to prevent further injury of the patient or further pain.  The patient was turned over to the staff in the ER at Charlevoix Hospital at just shy of 4:15 a.m., and we arrived back on Beaver Island at 5:20 a.m.  This was another two hour and twenty minute total time ambulance run which wasn’t much less than the average.  The husband and wife involved in this ambulance run were very grateful for our service, and we received a sizable donation in addition to the cost of the ambulance run. 
Guess how many EMS people showed up at three o’clock in the morning.  There were nine of us there helping to provide service to this patient.  This is what rural EMS is all about.  Coming out at an ungodly time in the morning to help a stranger, friend, or a relative is what we do 365 days per year.

Another difficult thing with providing EMS on an island in the middle of Lake Michigan, well, not the middle, but thirty-two miles out, is that the orders that we get from the medical control physician may be quite inconvenient if not outright impossible.  I remember transporting my wife’s former, now retired dentist to the local airport.  We had the patient loaded into the aircraft with the three nitroglycerins administered enroute due to the chest pain he was having.  We had also given him aspirin and oxygen.  He was loaded into the aircraft, and the aircraft was taxiing down the runway, getting ready to take off.  I overheard the order given on the medical channel from the medical control physician to “start a nitroglycerin drip at five to ten mikes per minute.”   I say I overheard it because I was not in any position to communicate with medical control.  I only had my handheld radio with its low wattage.  In addition to that, the IV pump and the drug box containing the supplies necessary for this order were on the way back to the ambulance garage to be restocked.  This medical control physician was fairly new to Beaver Island experience and hadn’t experienced nor had any opportunity to experience the impossibility of providing the ordered treatment in the back of a local airlines aircraft.  Even if I had already had that equipment aboard the aircraft, it would have been impossible to carry out that order on the plane.  This order required setting up an IV pump, mixing the drugs into a IV bag or bottle, labeling the bag or bottle, calculating the drip rate, converting that drip rate to milliliters per hour, bleeding the air out of the special IV pump tubing, hooking this up using a IV administration port with a needle, some tape, and a lot of hope, because we were bouncing around in the airplane after taking off from the local airport. 
It was quite literally impossible even with the equipment aboard.  All of these things required some area to move in, the ability to see, and the calm and brightly lighted environment in the back of the ambulance or in the examination room of the medical center or the ER.  We had none of these, so, needless to say, the patient had to wait until he arrived in the ER at Charlevoix Hospital for this treatment to take place.  It is essential that most, if not all of the stabilization, be taken care of before we get on the aircraft.

The same situation happened to happen with a 26 year old female who had been kicked in the chest by a horse and was complaining of difficulty breathing.  She had pain on her left front chest and pain on the left back as well.  Her right arm and right shoulder were swollen and discolored.  We splinted her left side and fully immobilized her on a backboard.  We had a sling and swathe and had her chest padded with pillows.  Here breath sounds were clear, but she was in pain.  Her vital signs were all within normal limits and we were pretty quick getting her loaded into the ambulance and enroute to the local airport.  We had her loaded into the airplane after giving a quick radio report to the nurse in the ER at Charlevoix Hospital.  I always end my reports with, “Do you request anything further?”  I did not get any further orders at that time.  The patient and two Basic EMTs taxied down the runway for takeoff, and then we were called by the RN at the medical control hospital in Charlevoix.  She said, “The doctor would like an IV of Lactated Ringers run at 200 cc’s per hour as a precaution.”  I had to call back on the radio from the ambulance since I was not on the aircraft this time.  “I’m sorry Charlevoix.  What you ask is impossible because the aircraft took off three minutes ago with two basic EMTs aboard with the patient,” I explained as best I could.  It didn’t help that this patient was a nurse who worked at Munson Medical Center.  She will still to this day ask me when she sees me, “Are you sure you could have gotten that IV in the plane?”  I sometimes wonder what to respond to her so I usually don’t say anything.

We are paged to the South End Road, which if the furthest south you can get on the island for a very nice man who attends church with my wife’s family at the Beaver Island Non-Denominational Christian Church.  This 62 year old male patient was complaining earlier in the day about belching and an upset stomach after eating a peanut butter and jelly sandwich.  The patient was at home alone and had difficulty with speaking on the phone during the 911 call.  He said, “I just couldn’t do nothing, nothing at all.”  The patient had a history of cardiac bypass surgery two weeks prior with a “normal” recovery so far.  He had blurred vision on the left side, and we documented left sided muscle twitching.  His assessment revealed normal breath sounds, normal speech, normal movement and normal sensation.  The patient had seemed to recover without any problems, but he was transported to the medical center from the south end to be sure that nothing permanent would result from this ministroke or stroke. 
He was evaluated by the PA at the medical center.  While being evaluated, he started slurring his speech again.  Arrangements were made for this patient to be admitted to Northern Michigan Hospital by the PA.  We flew him using the local airlines and turned care over to Allied EMS at the Harbor Springs Airport.  The total time with this patient was just over two hours.  We flew back to Beaver Island content to have helped our neighbor and friend in about twenty five more minutes.  In the videotaped interview that this patient did when my son Philip Michael filmed his Master’s degree final project called, “32 Miles of Water”, this man said, “Beaver Island doesn’t have a doctor, but I’m not sure that a doctor could have done what this group of volunteer EMS people did.” 
He is referring, I believe, to the project it was getting this patient down from his second floor location.  We had a monitor and an IV and oxygen on this patient in his upstairs.  When it was time to move him down to the ambulance, we needed to use a stair chair, a specialized piece of equipment for getting the job done.  We used just about everyone on that scene inside and outside of the house.  With two people behind the EMS person walking backwards down the steps and two more people walking behind the person above the stair chair on the steps to hold the equipment, we slowly and carefully brought the person down to the ground floor using the outside steps from his second floor deck.  This was no easy process, not because the patient was so heavy, but because he is a tall man.  This would have been very difficult to do using just a household chair.  Once on the ground outside his house, moving him to the ambulance cot was a slow and carefully choreographed process as well so as not to lose the IV, the monitor cable electrodes, or the oximeter.  We managed to get him into the ambulance and on the way.  We also flew in the aircraft with the patient as well which seemed to impress him also, “And they road with me in the plane and everything.”

We were paged one Sunday to the Holy Cross Catholic Church for another wonderful person who was an 94 year old female.  Before I tell you about the patient, I need to tell you about the green EMT who worked this particular summer.  The Holy Cross Catholic Church is less than a softball throw from the ambulance garage.  The church property truly ends right where the property begins that houses our ambulance.  The newbie EMT got the ambulance out of the garage, and she drove lights and siren right past the Catholic Church down the Back Highway to the Episcopal Mission.  Not finding the echo car at the Episcopal Mission, she turned onto the back road going lights and siren to the Christian Church.  Again, not finding the echo car, she drove back toward the ambulance garage on the King’s Highway and finally saw the echo car’s flashing lights in front of the Catholic Church. 
I, of course, did not know this until she confessed the special trip to me after the patient was transported.  This wonderful elderly lady had fainted in church, and BIEMS found her lying in the back church pew.  She was alert with an irregular pulse at 50-60 beats per minute.  We found that her glucose reading was within normal limits, her respirations were 22, a little high, her blood pressure 92/44, a little low, and her pulse ranging from 48-56. Her husband told us that she was passed out for a little more than one minute.  The patient’s lungs were clear on both sides with equal breath sounds.  The patient was moved to the ambulance where an IV was initiated.  A cardiac monitor and oxygen were applied. 
The plan was to get this patient to Northern Michigan Hospital by flying a local airline aircraft to Harbor Springs.  No stop was made at the medical center.  We arrived at the airport and loaded the patient into the aircraft.  One of the paramedics needed to stay on the island, and I was elected this time to stay.  The plane took off with every intention of flying and landing at the Harbor Springs Airport, but the weather again got in the way of this plan.  The aircraft had to divert to Charlevoix Airport due to fog in Harbor Springs.  The patient was having an oximeter reading of 86% when she was taken off oxygen to move her to the Charlevoix EMS cot, but immediately went back up to 100% upon readministration of oxygen back hooked up and given by non-rebreather mask.  The patient was accompanied to Charlevoix Hospital by the BIEMS paramedic, report was given, and the patient turned over to the RN in ER.  Diversion due to weather is nothing unusual for the experienced EMTs on Beaver Island.  Sometimes we never know where we will end up with the patient when we leave the island.  We have a few times taken off in the aircraft from Beaver Island with an intention to go to Charlevoix, and we have ended up taking the patient down south to Traverse City because the weather did not allow us to land in Charlevoix or Harbor Springs.

Working to help one of my former students is not an unusual situation to find myself in, but sometimes it is much harder than others.  The family of this 28 year old male has had more than its share of tragedy and hardship over the years.  Two of this man’s brothers had drowned early in the morning of school day while going out to set or lift fishing nets.  Another of this man’s brothers died in an aircraft accident right here on Beaver Island.  We found out just a couple of weeks ago that his sister has a brain tumor.  What a difficult situation for a family this has been!  I’m not sure that I could handle all of this type of misfortune.  Back to the 28 year old male who had been riding on a four-wheeler, all terrain vehicle (ATV) out near Donegal Bay at a little before one in the morning.  He was the passenger on the back seat when the ATV rolled over out on the Donegal Bay beach area.  Upon EMS arrival he had neck pain and pain in his right shoulder.  He also complained that his fingers on the right hand were “tingling.”
Our head to toe patient assessment revealed pulse, sensation, and movement in all extremities.  His pupils were equal and reactive to light.  The patient had no pain on palpation during the entire head to toe exam.  His abdomen was soft with no guarding by the abdominal muscles.  He had no incontinence.  We provided complete spinal immobilization for this patient due to the mechanism of his injury.  He was placed on eight liters of oxygen by non-rebreather mask, and an IV was started to keep the vein open.  The immobilized patient was placed on the ambulance cot and loaded into the ambulance.  As we were preparing for transport the patient became nauseous and began to vomit.  The immobilized position is one in which the patient is on his back secured to a backboard. 
Vomiting while in this position can cause serious airway and lung difficulties.  We quickly, (It may be described as furiously), moved the patient’s backboard, so that he was able to maintain his own airway, at a forty-five degree angle by propping up one side with pillows.  The patient vomited three times while enroute to the local airport.  We used our portable suction machine to keep his airway clear.  Describing the vomit may see quite unusual to the every day type reader, but this was an important finding for our EMS people.  The patient’s vomit looked somewhat like “coffee grounds” which pretty much means that he has a bleeding ulcer or something like that.  We can’t diagnose this in the field, but the quantity of “coffee grounds” was more than you would find in a very large commercial coffeemaker.  We made a decision to turn up his IV to about 300 milliliters per hour even though his vital signs were within the normal range.  Our goal was to keep the vital signs within the normal range by adding a little extra fluid to his circulatory system.  There was no doubt that alcohol played some part in this accident, but it was not our job to judge anyone.  Our job was to get this patient to the hospital with as little further damage as possible.  The patient was transported to Charlevoix Hospital along with his wife and two BIEMS personnel.  We EMS people were all back on the Island and in bed by a little after three in the morning with our patient in capable hands at the hospital.