No One Is Exempt from Needing EMS

No One is Exempt from Needing EMS by Joe Moore

In November, both the older members of an island family would need BIEMS.  On the sixteenth of the month, the 70 year old male was found sitting at his table with the PA and an RN from the medical center.  The patient was having difficulty being managed at his home.  His healthcare needs can no longer be met on Beaver Island.  This patient was to be admitted to Charlevoix Hospital for hospice care.  The patient had a urinary catheter in place.  The patient was assisted to by three EMS members to walk the six feet from his kitchen table to the BIEMS ambulance cot.  The patient’s vital signs were pulse 98 and irregular, respirations 28, blood pressure 78/48, with an oximeter reading of 94%.  The patient was loaded into the ambulance and driven a short distance to the aircraft where he was loaded for the flight to Charlevoix.  The patient rested comfortably during the flight and the trip to Charlevoix Hospital.  The patient would end up in a nursing home very close to the hospital.

Three days later, the 64 year old wife of one of our previous patients was going to walk from the house over to the detached garage.  She made it only one step outside her door, where BIEMS found her on the porch step, lying there covered with a blanket.  The patient said, “I tripped over my own feet when leaving the house and fell here on the step.” She denied any loss of consciousness before or after the fall.  She did not feel faint nor experience anything unusual.  She was complaining of pain in her left hip area.  It was painful to the touch.  The head to toe examination found no additional complaint of pain or deformity.  No additional injuries were found.  The patient denied any back or neck pain upon palpation.  She was alert an oriented.  The patient was placed on a backboard in her position of comfort, essentially in the position that she was found in.  We used pillows to support her in that position.  The patient had vital signs on her step with a pulse of 68 and respirations of 20.  The patient had so many clothes on that it was not possible to get a blood pressure, but her oximeter reading was 98%.  We loaded her onto the EMS cot and transported  her a short distance to the airport to load her into the aircraft.  She rested comfortably during the flight to Charlevoix where it was determined that she had a fractured hip.  She would end up spending some time in the same nursing home as her husband while getting her physical therapy.

It’s hard to imagine these wonderful people ill and injured.  I remember thirty-one years ago when my wife and I were managing the Beaver Lodge.  I had a waitress that was always late to work, and one night, with the snow blowing, I was afraid she had gotten into an accident, so I went looking for her.  She lived down the East Side Road so I decided to travel down that road.  I took a left turn at the Four Corners and proceeded down that road past the local airport and was on my way to the golf course when the road disappeared into a complete white-out.  This was my first winter on Beaver Island, and I did not know that the entire East Side Road was not plowed.  When my car came to rest in the snow bank created by the plow when it stopped, I had absolutely no idea what I was going to do to get out.  The entire car was completely covered with snow.  I had to roll down the window and tunnel my way out of the car.  It wasn’t that there was so much snow on top of the car, but the car had been lifted up off the driving surface by the snowbank.  I couldn’t get any traction because the wheels were not on the ground.  There was no one at the golf course, so my only choice was to walk back to the airport where I saw some lights.  I walked back with my dress shoes, my kitchen clothes, and my light coat because I was not planning on being outside my vehicle at all.  When I got to the airport owner’s house, I was shivering and quite wet.  Both the husband and wife invited me into their house.  She made me take off my wet socks and shoes and come in to warm up.  She found me dry pants, shirt, and socks.  After warming me up with some hot coffee, he handed me some carharts, fleece-lined gloves, and some fleece-lined boots, and said, “Well, let’s get the tractor and see if we can pull your car out of the snow bank.” 
We headed across the fields because there was less snow in the fields than in the roadway due to the drifting.  We got the tractor stuck a couple of times on our way, but with his skill at operating the tractor, we were out in no time flat. 
When we got to my car, he handed me a shovel and said, “You’ll have to dig out enough snow to be able to crawl under the back end of the car and attach this tow strap.  Dig all the way back to the gearbox on the rear axle.  It will keep you warm.  When you get done I’ll toss you the tow strap to loop around the rear axle.” 
About ten minutes later, he handed me the tow strap.  “Get in the car to steer.  I’ll pull you back far enough so you can actually turn the car around in the roadway.  Start it up, but be careful not to rev the engine up.  Once the wheels get traction, you will need to push on the brakes.  When I see the brake lights, I’ll know to stop pulling with the tractor.” 
It worked just like he suggested it would.  I climbed out and unhooked the tow strap.  He said, “Okay, now you be on your way back to the Lodge.  You can bring the carharts, boots, and gloves back tomorrow.  By then, my wife will have your coat, shoes and socks cleaned and dried.  See you tomorrow.” 
And off he went back through the blowing, drifting snow to put his tractor away.  Just one more good deed done for a stranger. 

In December, we were paged to the home of one of my students, well actually the home of three of the Beaver Island Community School students.  At the time I only had the oldest in my classes.  Her father had fallen off a ladder approximately ten feet from the top of the ladder to the ground.  He was complaining of pain in his belly and back.  It also hurt to breathe.  He was alert and oriented.  There was guarding to his upper left abdomen, which is a muscle tightness over the organs to protect them.  He had pain on palpation to the left rib area and his left side by his hip.  He was able to move his extremities well.  He had the ability to flex and extend his feet against the resistance of my hand.  He was not nauseous.  He denied any loss of consciousness.  There was no shortness of breath, but it hurt to breathe, so his respirations were shallow.  He denied  any neck pain or spinal pain with palpation down his vertebrae.  His lungs were clear with good air movement on both sides.  His trachea was midline with neck veins normal.  There was no bruising to the abdomen.  The patient had vital signs within normal limits except his blood pressure was high at 180/102. 
We believed that we could temporarily rule out shock, but we fully immobilized the patient using a cervical collar and a backboard to protect his spine.  We started an IV of normal saline in his left forearm and gave him 2 liters per minute of oxygen by nasal cannula.  He was transported to the local airport on the BIEMS ambulance cot in the BIEMS ambulance.  We loaded him into the aircraft and he arrived at the Charlevoix Hospital by normal means.  The oldest daughter was to take the high school EMT class that I taught and become an excellent medical first responder.  She has now graduated from Central Michigan University with her medical field being Sports Medicine.  The next oldest daughter took the same EMT class a few years later, and now she works in the ER at Munson Hospital in Traverse City and is now a registered nurse.  It is interesting how one experience at a young age can have such an effect on your life.

Sometimes, even a short distance fall can cause a person problems.  We were paged to a local American Indian fishing dock for a 49 year old male who had fallen approximately six feet from the dock onto the fish tug.  He had slipped and when he fell, he hit the back of his head and his shoulders.  The bystander on the fish tug stated that he had been unconscious for about one minute prior to EMS arrival which had been the reason for the 911 call.  His physical exam revealed only the locations already mentioned as possible injury sites.  His pupils were equal in size and shape and reactive to light.  The patient was able to move his extremities quite well with extension and flexion of both feet against my hand.  He had pulse and sensation in all extremities as well.  Nonetheless, the patient was fully immobilized on the backboard using a cervical collar, head blocks, and straps.  His only medical history involved a heart attack about three years ago.  His vital signs were within normal limits except for his blood pressure which was 160/100.  We administered oxygen by nasal cannula at two liters per minute which brought his oximeter reading up to 99%.  The patient was handed up using four EMS people in the fish tug and four EMS people on the dock.  The backboarded patient was put on the ambulance cot and transported to the local airport.   He was transported to Charlevoix Hospital by normal means.

A fifty-three year old female was having a severe allergic reaction on Michigan Avenue at 9:20 in the morning.  The patient had a pulse rate of 100, respirations of 36, and a blood pressure of 90/60 upon EMS arrival.  The PA, who was also a paramedic, had arrived before any other EMS providers, had an IV started and had already given Benadryl 50 milligrams slow IV push prior to EMS arrival.  Within fifteen minutes of the original page, the patient vital signs were back to normal with a pulse of 80, blood pressure of 110/70, and respirations of 18.  Her oximeter reading was 100% on two liters of oxygen by nasal cannula.  Her lungs sounds were clear on both sides. 
The patient had taken one over-the-counter pain pill, and then she had become nauseous with itching all over her body.  She had very red skin and hives.  The patient was put on the cardiac monitor, and loaded onto the BIEMS cot for transport to Charlevoix Hospital.  This woman played violin and I played bass violin in the string program sponsored by the Crooked Tree Arts Council and the school.  No matter what the people do, no matter how much money they may have. no matter how lucky they have been in their lifetime, sooner or later I will get them all in the back of my ambulance.

I have had some amazing experiences with some amazing people in this twentieth year of my EMS career.  Why do we volunteer?  We volunteer to help our neighbors, our friends, our acquaintances.  We want to help out in our community.  We want to make a difference.  Please don’t legislate volunteer, rural EMS out of existence.  There is no company willing to provide the services here.  There is no money to be made in EMS in the rural areas.  There are just people helping people.