It's just about time for me to think about heading home and, yes, the alarm goes off again. 33 y/o male c/o (complaining of) breathing difficulty and chest pains. This one is over in the next jurisdiction too.

I head for the ambulance and find that Zach, my neighbor's son, is my driver. Cool. This time out the door, I give my old ambulance number on the radio as I report us responding. Our radios have a transponder signal that are unique for each unit. I realize this and I imagine the dispatcher seeing one number on the CAD system and hearing another over the radio. I quickly repeat my transmission with the corrected unit number and I can hear the smirk in the voice of dispatch as they confirm.

It was bound to happen.

The station who's area this call is in has sent an engine and a Medic unit is on the way. I walk into the house to find a guy my age sitting on the stairs holding his chest and looking pained. Pretty clear signs. One of the EMTs from the engine has taken vitals already and they're all within norms. Skin is warm and dry, pulse is 94 and strong (little high) and respirations are about 24 and regular. The guy has no previous history of chest pain or trouble breathing and he's answering my questions perfectly without having to pause between words for breath. His color looks good too. Shit! This guy's no older than me! I resolve, at that moment, to boost my weekly running distance to 30 miles.

Pain is 5 on a scale of 1 to 10, does not move or radiate and locates mostly in the right side of his chest. Equal pupil action, clear lungs, all lobes, normal digestive noises and both eyes orient and track equally to voice. This last bit I picked up busting drunk and high boaters. I'll ask him a question on one side and then move over to the other side of the patient to check a BP cuff or something innocuous and then ask him another question to see how he tracks. Bouncy eyes or unequal movement will give me a clue there may be something going on in the brain pain and help guide my questions and examination.

The FF/EMT from the Engine looks at me, "Cancel the Medic unit?"

As much as I hate to (I believe in all ALS, all the time), I say "Sure." and she does so via her handheld radio. The hospital is about 3 minutes away and this guy is presenting no other signs or symptoms.

SIDE NOTE: How many of you out there are comfortable with BLS providers making a decision whether a patient need ALS care or not? email me or use the comments link at the bottom of the entry.

There are 2 teenagers home and nobody else. I ask the patient if he wants them to come. I tell him I can take one of them and his 15 year old daughter opts to come. The patient walks well and without assistance to the door and we put him on the stretcher for the 25 yards to the Ambulance.

We install the stretcher and I get the daughter to belt in. I see the daughter's anxiety rising and she starts unconsciously sucking her thumb. I start asking her about school and keep her talking as I retake dad's vitals and work on paperwork.

Transfer is smooth and courteous. The triage nurse is bigger and taller than me but he pauses to talk to the daughter for a second and then guides her to a waiting room while he orders a 12 lead and blood work. As I step out I hear him tell an orderly to get her a soda. I look back and the expression on his face mirrors how I'm feeling. Compassion. This is her dad. This is scary stuff for her.

I clear my paperwork as Zach sets up the stretcher and ambulance for the next run. I take a minute to go to the waiting room to talk to the daughter. She looks small and alone but she's got a brave face. I take a minute to tell her what's going on in her dad's room and to assure her they're not hurting him. I also tell her that it probably means a lot to her dad that she's there and to show her how to get a line out to call her brother.

She thanks me as I head out. I apologize to Zach for taking so long and tell him why. He says, "No problem. That's what you're good at."

Music to my ears.

--maddog