Memories and More Memories 11


Memories and More Memories 11
By Joseph A. Moore

Well, the reason for the first memory today was actually a golf match that was shortened by a rain storm last night.  The former good friend and I were competing on opposing teams, and the memory of the first trip to a home on Donegal Bay hit me in the head and caused me to dream about the patient and the issues my friend and I had.
I can tell you that the primary responsibility for this 80 year old female fell on my shoulders as the call went out to Beaver Island EMS for this patient who was experiencing chest pain.  I had been to this home a few times before, and the patient was having chest pain on each of these previous occasions.  She had been transported to the hospital before by us, and this was probably not going to be too different, but I reminded myself, “Each and every call is different, and I need to be ready for anything.”
So, when the pager went off in my living room with the emergency response car parked in my driveway, I quickly put on my EMS jacket, calling on the radio, “Echo 4 is enroute to the scene.”
Central Dispatch stated, “The patient is alone at the residence, is complaining of chest pain, and says she has already taken a nitro with no relief in pain level.’
“Copy that,” I responded on the echo car radio.
It was about a half mile from my home to Donegal Bay Road and another mile to the home, and I was traveling about 40 mph with lights and siren going as I passed the ambulance barn that had no one yet ready to bring the ambulance.
This patient could code at any time, and I was not going to waste any time getting to that address!  Of course, you have to slow down going around the curves on the Donegal Bay Road by the campground, and you have to slow down when the roadway makes a 90 degree turn at the Lake Michigan access of Donegal Bay.  From there, the roadway is straight down along the beach, so along there I went a little faster than from the curve.  There were lots of cars, so I couldn’t go all out.  I was worried someone might walk out between a couple of cars.
Luckily, I had slowed down because a young boy, about five years old, did exactly that.  He walked out between the two cars nearest the volleyball net, and I had to slam on the brakes to stop from hitting him.  I scared the crap out of both of us, and I’m sure he didn’t make it to the outhouse before he wet his pants.  I know I was really upset, but I had to continue down the roadway to the house.
At the last minute, just as I was pulling in the driveway, I head the ambulance call enroute to the scene.
I grabbed my jump kit, the oxygen, and the cardiac monitor along with the cardiac drug box, and headed with both hands full to the front door.  It was unlocked, so I set one hand load down, opened the door, gave it an extra shove, and grabbed by equipment and in the house I went.
“Hello, it’s Joe from Beaver Island EMS,” I said as I walked to the patient sitting on the couch in the living room.
She said, “I’m……. having……… trouble……. Catching………. my ………breath,……. and my…… chest….. hurts.”
“Okay,” I said.  “I’m here to help with that.”
I began by first putting the pulse ox on her finger.  The reading was 84, so I immediately put on oxygen at 4 lpm by nasal canula.  I checked her pulse and she was having what I would suggest was atrial fibrillation with an irregular response.
She said, “I took……..nitro……but…….it didn’t…….help.”
I checked the nitro bottle on the coffee table, and, just as I thought, it was two and half years past the expiration date, and it was sitting there in the sunlight.
I did a quick set of vital signs, and wrote them down just as the ambulance arrived.  Her blood pressure was lower than her normal, the pulse rate was 112 and irregular, and her respiratory rate was 38 per minute even with the O2.
I said, “Judy, I’m going to have to get a little familiar with you and put on the pads for the cardiac monitor.  You remember, just like the last time I was here.”
“Go…….ahead……..and ……………………what……you…….need………to do,”  Judy said.
By the time, the three EMTs entered the room with the cot, I had a 12-lead EKG that verified that judy was having an episode of atrial fib, along with the chest pain, and difficult beathing.  I opened my drug box and said, “Judy, here is one of those pills that you took earlier.  Yours were expired by a couple years, so we’ll try this one, okay?”
I said this as I slowly put the pill under her tongue.  She didn’t respond, but just let the pill dissolve under her tongue.
“Okay, guys and gals,”  I said, “We need to get Judy to the airport as quickly as possible, so she can see her cardiologist.  I think we’ll be flying to Harbor Springs, so, John, can you check on the flight availability, please?”
We loaded Judy up onto the ambulance cot, rolled her out to the ambulance, and loaded her and the cot into the rig.  John stayed in the back with me, and he set up an IV for me to start.
Now, the important things, on the most remote inhabited island in the Great Lakes, are to provide immediate treatments quickly and get the patient on the way as quickly as possible.  As we pulled out of the driveway with John and me in the back of the ambulance, we heard the local flight service tell Central Dispatch over the radio that they were ready for the patient.
It took seven minutes to get to the airport with the lights flashing, about four minutes to load the patient off the ambulance cot, onto the plane’s cot, and loading Judy into the plane.  In that eleven minutes, I had the IV started with fluid running slowly to not overwork the heart, and I had given another nitro under the tongue.  We were in the air in less than two more minutes and on our way to Harbor Springs Airport.
I used the noise canceling microphone and my portable radio to call the Petoskey ER, and give my report.  “Northern Michigan Hospital, this is Beaver Island EMS on HEARN radio.   How do you copy” I said.
It took another two tries to get an answer, but finally, it was, “Go ahead, Beaver Island.”
“We are enroute to Harbor Springs Airport with an 80 year old female with atrial fibrillation on the monitor.  She is having chest pain, about seven out of ten after two nitro’s.  Her vital signs are stable after the nitro, oxygen at 4 lpm via nasal canula, and an IV running at 100 cc/hr.  Our estimated time of arrival at Harbor Springs Airport is fifteen minutes.  The patient is requesting that Doctor Canon, her cardiologist meet her at the ER upon her arrival.  We have a 12 lead EKG which we are unable to transmit from the airplane, but that verifies the chest pain cause.  The SPO2 was 85, but is now 94.  The CO2 was 40, but is now 32.  The patient will receive another nitro during the flight to ease her pain.  We request permission to give up to 10 milligrams of morphine IV as needed to control the pain.  Can we get that order, and do you request anything further?” I stated over the radio.
“Why are you bringing this patient to us instead of Munson in Charlevoix?” was the only response that I got right away.
“I believe that her cardiologist is in your hospital, and the patient requested this.  We are going to be landing in less than ten minutes, and Emmett County EMS will be bringing the patient to you.  Do I get the morphine order?  Do you need any further information?” I replied.
There was no response right away.  I figured that the person on the radio was providing the information to the nurse, who then would have to talk to the doctor to get the order.
Finally, the person on the other end of radio, this time a male, said, “You have permission for the morphine, up to ten mg IV,  and nitro every 5 to 7 minutes as needed.  We’ll contact the cardiologist after the patient arrives in the ER.”
“Roger, permission for up to 10 mg morphine IV and nitro every 5 to 7 minutes for pain, “  I replied.  “Any further information needed by your ER?”
“Negative, Northern Michigan, out,” the final communication ended.
“Central Dispatch, we are enroute to Harbor Springs Airport with a chest pain patient.  We need Emmett County EMS waiting there for us.  Do you copy?” I said after switch frequencies.
‘Beaver Island, we copied your transmission.  Emmett County will be awaiting your arrival.  Your ETA is six minutes.  Is that correct?” Central Dispatch asked.
“That is current, Central,” I finished the radio communication.
We were downwind at the airport as the radio traffic was over less than two minutes later.  It took less time, apparently due to a tailwind of about 15 to 20 mph.  The landing was a little rough, but we made it down, and our patient was sleeping comfortably during the landing and after we taxied up the runway to the ambulance that was waiting for us.
Now, there is not one person involved in EMS that wants to not follow their patient directly to the hospital, but most of us did and do not have that luxury here on Beaver Island.  You need to do what you can do for the patient while that patient is in your care, but you also need to get back to the island to be available for the next emergency.  So, this patient was turned over to the Emmett County EMS paramedics for further transport to the hospital.
The two of us that accompanied the patient in the airplane had to gather up our equipment and jump back into the airplane for our trip back to the island, and it’s a good thing that we did.
About six minutes before we landed back at the Welke Airport here on Beaver Island, the pager went off again.  Luckily, we had a back-up list of responders for just such situations.  There was, however, only one paramedic at this time, and I was not on the island to respond.
“Beaver Island EMS, Beaver Island EMS….Respond to the South End Road for a patient experiencing difficulty breathing.  The patient is a fifty year old female with a history of COPD and asthma,” the pager blared.
“Shit,” was the only word that came out of my mouth, but our wonderful pilot had heard the page too, and the plane moved forward faster than normal to get us back against the headwind.
You can talk about hustling to reorganize your equipment in the big city while you are running from the drop off of a patient to the next call, but I guarantee you that you don’t have the same issue as being in an airplane trying to get the equipment ready while you are belted into an airplane.  Both of us hustled to grab one piece of equipment each to wipe it down, reorganize the wires or whatever, and get the extra masks, etc. ready for this run before the plane landed.
As we landed, the pilot said, “You guys go.  We’ll have the plane ready for you for the next patient!”
Jumping out of the frying pan into the fire is what this seemed like.  The back-up ambulance was enroute to the scene with a first responder and a Basic EMT.  We jumped in the Echo car and called in to Central Dispatch.
“Central, fifty-seven echo four is enroute to the south end of Beaver Island,” I said on the vehicle radio, and off we went lights and siren down the East Side Road of the island.  We flew by the golf course and were going along quite well until a deer jumped out of the field and scared the crap out of me.  I didn’t hit the deer, but it made me realize that the adrenalin dump was causing me to drive with less safety than I normally would.
“Take it easy,” I said quietly to myself.
There was thankfully no answer of rebellion and the vehicle slowed a little bit to be more safe.
The ambulance was on scene.  The patient was on oxygen.  The patient was receiving a breathing treatment using the oxygen and our special drug box that was locked up in the Basic Life Support ambulance.  I knew that these responders were quite capable, but I had to remind myself that the whole system works just fine whenever the weather allowed us to complete the job.
I talked myself into listening to my logical part of the brain, and I drove 35 mph, the safe speed on the gravel roads. 
“Echo four, this is 5778.  Do you copy?” I heard on the radio.
“Copy, 78,” I replied.
“We are currently head north on the East Side Road.  We’ll meet you, so I can turn the patient over to you.  She is doing just fine, is finishing her breathing treatment, and her vital signs are within normal limits.  She is no longer gasping for breath and her pulse oximeter is coming up from 84 to now at 89.  We are doing fine.  See you in a few minutes?” my favorite EMT stated.
“Roger, we’ll meet you.  I’ll jump in and help in any way I can,” I responded.
It wasn’t but a couple more minutes after the radio traffic when the ambulance came in view, so I pulled over to the side of the road.  I didn’t need to tell my partner from the first run anything.  He knew to jump out grabbing the advanced equipment from the echo car, and load it and me into the ambulance.  He went back to drive the echo car, and I climbed into the ambulance.
“Well, hello there,” I said to the patient and my favorite EMT.  “What can I do to help?”
“I don’t know, Joe,” he said.  “I think we’re doing fine.  I did get into the drug box to give the breathing treatment, and I started the IV.  It’s running at the keep vein open rate, so you have access for anything you might need to do.  She’s your patient now, so you take over, and I’ll help in any way I can.”
The ambulance was already moving down the road headed to Welke Airport, and I went ahead and placed a four lead EKG, the pulse oximeter from the cardiac monitor and the CO2 monitor on the patient.  The patient was stable based upon the automatic BP on the monitor, and I said, “Well, John, I’d say that you did everything right.  The vitals including the pulse ox reading are within normal limits.  What have you and the patient discussed as a destination?”
“She wants to go to Munson in Traverse City without a stop in Charlevoix,” John said.  “She has family down there, and her pulmonologist is there too.”
“Okay, that’s sound like a plan.  Will you fly with me down to TC?” I asked.
“Of course, and I can give the report with all but the advanced things,” John said.
Well, we didn’t have any problems getting the patient into the airplane and the trip to Traverse City was uneventful.  Actually, this patient was “fixed” by the EMT John, and I didn’t need to do anything more at the advanced level, although I did give the patient some steroids, which could have waited until we got to the hospital.  We turned the patient over to the paramedics at Northflight Ground at the TC airport, and flew back to the island.
We had such a good crew of people in this volunteer EMS that everything was sterilized, stocked and ready to go in both of the ambulances, so we only needed to  decontaminate the equipment that went with the last patient.  Now, I had two patient reports to do on the computer and a couple of items to restock in my echo car, but everything else was done.  Thank you to all those who volunteered on this day, and special thanks to my favorite EMT for his excellent treatments and his skill in helping the last patient of the day.
So, as I have already stated in a lot of these stories, being prepared for the thing that you are never ready for is the most important part of being in the rural EMS arena.  For example, what do you do in the beginning of a pandemic when the items for infection control are not used or not available?
I’m not saying that this occurred on Beaver Island, but, as a retired paramedic, I worry about the EMS people nowadays not being prepared for a car rollover with five patients.  The questions that come up are many.  What do you have for a backup crew?  Where do you get the extra equipment needed for the five patients?  Do you have a plan for doing this?  Where do you transport these patients?  Can you wait an hour for a plane from the UP or from Traverse City?  Do you have a plan for taking care of this many patients at one time?
Well, enough on my concerns.  Let’s talk about another patient from the list of memories of this retired paramedic. 
“Beaver Island EMS, respond to the public yacht dock for seven patients in the water after a dock collapse,” dispatch paged.
The echo car was in the school driveway because I was teaching an EMT class, it was just after dinner time, and there were lots of volunteers listening to the Beaver Island Fire frequency.  On top of that there were four people in my EMT class.  We all jumped into the echo car and headed down the hill and less than a city block to the public yacht dock.
The seven people in the water had fallen in due to the dock alongside the boat collapsing from the weight of seven people on it at one time.  They all went into the water at one time.  The fire chief and several firemen were on the scene already, and we helped all seven get out of the water. 
Luckily very few were injured.  One had a cut over his eye from hitting something on the way down, and another had a twisted ankle with it being quite swollen.  This could have been a true disaster, but luckily it was not.  We had more people down at that scene than you could count.  Three people for every single one who was in the water.  More than twenty people responded, that’s fifteen more than my class members and me. 
I assessed every single one of those patients, making sure that they all did not have serious injuries.  They got tired of seeing me and of me checking back on them more than once.  Most of them were glad that we had come to check on them.  Some were embarrassed and some were quite angry, but they did not take out their anger on the EMS people. 

This time they were very lucky and so were we.  There was not one patient that needed to be transported to the hospital.  Two needed to be checked out and seen at the local medical center.  There were four EMT students and their instructor on the scene along with six other EMS licensees, and eleven firemen including the fire chief, who was also a medical first responder.  These seven people were lucky and the plan for the disaster did kick in with all of these responders working to help out in any way that they could help.
We were prepared for this, and I’m so glad that we had the help to handle this many potential patients.  That was not the first time, nor the last time that we needed the extra hands and the extra help.