"Imagine running a 1/4 mile sprint, as fast as you can, while breathing through a drinking straw"

The call went out as a severe asthma attack. We arrive on scene to find the patient sitting on a couch in the lobby in the "tripod position" and struggling mightily to breathe. The tripod position is where a person is sitting, leaning forward and their two arms are extended down and in front of them so their body and arms make a tripod. This is a common position that people take when they're having trouble breathing.

That night, Shannon drove and Sonja rode in the back. They're both experienced EMTs. Shannon works for a transport company as an EMT-B. The patient responds to my voice but can't do much else. Her initial blood oxygen perfusion is at 72% and her pulse is 124. Yikes! We get O2 at 25 lpm via a Non-Rebreather Mask. I listen for lung sounds as she's breathing and I hear nothing. No air moving at all.

The boyfriend states that she had just taken her inhaler and she takes steroids for her asthma too. Last dose on the steroids was that morning. I call for Shannon to get the stretcher and start putting a BP cuff on her (knowing full well her blood pressure's going to be very low) when the medics arrive. Phew!

We move her to the stretcher, They give her an injection of Epinephrine and we keep the O2 going. Her blood oxygen is now up to 82%. At this point the patient is starting to look like she's having seizures. She's got some frothy blood at her lips and she's thrashing around a bit. Sonja is trying to get information from the boyfriend but he's on the phone walking next to the stretcher. I look at him and say. "Sir, you need to hang up the phone and talk to my partner."

"But I'm talking to her mother." he says, pointing to the patient.

"Your girlfriend needs you to talk to my partner right now. That's more important that talking to her mom."

This guy's an off duty police officer. He's doing his best to stay calm and the presence of 5 people in uniform is helping. He gets it. His focus goes from over my shoulder to my face. He says, "I'll call you back," snaps the phone shut and goes over to Sonja.

We load the patient into the back of the medic unit. Shannon's going to drive their unit, Sonja's going to be an extra pair of hands and I'm left with an ambulance and no driver. I call the station and they send someone out.

The medic unit hasn't rolled yet so I hop in the back to see if I can help. The boyfriend has been installed in the front of the ambulance where he can't get in the way. I see the patient's condition has deteriorated quite a bit. One of the medics is trying to run an intubation tube through her nose and keeps getting her stomach. The other one is trying to get an IV started. Sonja is bagging the patient to assist her respirations and the patient is starting to thrash around. They need a bit of help.

I start the suction unit and get it to the Medic working the intubation. He thanks me and uses it to clear her airway that has now become a bit gunky. I then help the other medic secure the IV he finally started on the patient's ever-swinging arm. I then notice that Sonja's bagging the patient pretty fast. I remembered an entry by MedicMom where thinking about her blog made her re-assess her respiration rates. I told Sonja to slow it down a bit and her focus shifted from trying to get a mask seal to paying attention to the patient's breathing effort. At this point, the patient's blood oxygen level is down to 52% but I'm not sure if it's accurate as the patient keeps knocking off the sensor.

They decide to roll. I hop off and put my ambulance back together as I wait for my driver. In about 5 minutes the utility truck shows up with Thumper (previously referred to as "H"). I call her Thumper because she reminds me of all the good spirit in thumper in the movie Bambi. She's about 5 feet tall, qualified to do just about everything at the firehouse, finished her Undergrad in 3.5 years and is going to veterinary school in the Fall. Pretty awesome.

We get to the hospital in time to meet the medics on their way out. Sonja told me that the patient was doing a lot better. The paramedics spent a good 5 minutes going over the whole thing with us. As I was riding to the hospital with Thumper, I realized I should have put her on the stretcher right away, put a nasopharageal airway in and bagged her to assist respirations. I brought this up to the medics and they agreed that it would have been a good idea if I had the time. They were only 3 minutes behind us.

One of them said I should have hit her with an Epi-pen auto-injector. We just recently started carrying them on our BLS ambulances and It didn't even occur to me. Of course, after the fact, it made perfect sense. We talked a bit about asthma. It was amazing how easily it could have killed this woman. One of the medics said, "Imagine running a 1/4 sprint, as fast as you can, while breathing through a drinking straw." Ugh! I asked the medic a few questions about his airway management, the Nasal intubation and about what he did after I left the ambulance. It was pretty cool. I'm pretty excited about begin a medic. I gotta watch the "Hero worship" thing, though. Pretty soon I'll be asking for autographs. Heh heh.



Slept in at the firehouse last night. Not a single ambulance call. Phooey!

I'm going to implement a new naming system for people in my blog. I realize I have about 5 people at the firehouse who's names begin with J. J1, J2, J3, and so on gets confusing.

The two J's who I primarily work with shall now be referred to as "Hotrod," (the one who drives awesomely and is my favorite partner on the ambulance) and "Volume Control" (the one with no sense of humor who cannot shut her mouth). I'll fill in more as I go. I feel that nicknames that reflect their persona may work better an keep them more memorable.

Not much went on besides Volume Control having a hissy because the chief wouldn't take the ambulance out of service. Apparently she felt the stair chair was broken and when we carried Big McV (300lbs) around in the chair she got even more upset.

The only other thing is that Big McV got his ears burnt in a fire the night before because he's too fat (or lazy) to get low to the ground. He spent the night hanging around the firehouse, getting drunk and causing trouble. Keep in mind that this kid is 17 years old, over 300lbs and has a good case of "poor impulse control." Suffice it to say there were a few frightening moments involving buckets of water, ropes and the roof of the firehouse. Most the rest of the time was wearisome scenes of a fat, pimply kid roaring through the station chasing people with his penis out.

He didn't assault me very much. He gives me a wide berth since our last encounter.

I had duty one night and brought my digital camera with me. Big McV and another kid were wrestling on the floor of the lounge and were presenting the amusing scene of two men groping and gripping each other with lots of grunting in a posture that elicited comments on their sexual preferences. I'm watching this from a corner of the lounge where I'm working on my homework and, of course, I whip out my digital camera and take some video!

After the "love in" is over and we all have a laugh, Big McV comes roaring at me,

"Gimme that camera, I'm gonna smash it!"

Of course, I sort of don't think he will but he's got a look in his eye that tells me he just might. It's a $400 camera, I'm not taking any chances. As he thunders towards me, I hop up out of my chair and say "No." He proceeds to chase me a bit repeating he's going to smash my camera. He's kinda glassy eyed and looking back he might have been drunk again. Who knows.

Finally I get tired of this and I stop, turn towards him and say "Cut it out, man." Onward he charges. I drop into a defensive stance, put my guard up, lock eyes with him and give him a "GET BACK!" in a tone of voice that says. "I'm not fucking with you, your going to die if you touch me."

We lock eyes, the whole lounge is silent. For 15 extremely tense seconds, I'm ready to go with this kid. I care about nothing but bringing him down. I can see the brain whirring behind his eyes and realization fills his face. "You're wierd." he says and lumbers away.

I exhale.

This kid's got me by about 50 to 75 pounds so, I was a bit worried. It wasn't about the camera, it was about respecting my space. I then deleted the video and told him so. Big McV thanked me and has been nice or wary around me ever since.

Hotrod is having a party tonight and most of the firehouse will be there. I'm sure I'll have a lot more blogworthy material after that.


Thanks for all your comments of support for finals. Yes, Professor, I've been getting a lot of sleep.

Last Thursday was a double header for me. Two tough exams, Organic Chemistry and Statistics for Research. I had been studying and preparing for them for about a week. The night before the exams, I went to bed at 9pm, asleep by 10. Exam morning, I was up at 5am to take my parents to the airport. The airport is right by the school so I was on campus by 7:15. As my first exam wasn't until 10:30, I had a bit of time to kill.

There is a large, beautiful state forest adjacent to school and it is full of well marked, well maintained trails. I ran about 6 miles of beautiful woods and hills before the weather got hot for the day. Back at campus, I showered up, met some classmates for coffee and a review and then sat for my exams.

Let me tell ya, it worked! I fairly breezed through those exams with confidence and comfort. I knew the answers, I felt no panic and I still remember most of the stuff I learned!

Now I have a 1000 word take home final for Spanish and a Sociology exam on Tuesday and I'm done! Until I start my summer session on June 1!.



Finals started today.

Don't expect to hear from me much in the next week and a half.

What noise? Oh, that's just the sound of my head repeatedly hitting my desk.

I'll be fine.



Jeezus, I'm crying here!

I know I'm way off topic but, Damn! I get an email from a fellow Coastie about DC3 Brukenthal's funeral. The sender's in the middle of nowhere, was classmates with Nathan, and is pumping me for details of the funeral.

I, of course, oblige him as best I can. Then I read it over again. I'm never struck by the death of others. I'm always affected by the grief of the living.

Shipmates, War, Family, Widows and Death. These are the reasons I'm not sleeping tonight.

Dammit, dammit, dammit, dammit, dammit!

Gonna go break something now.


Shipmates and loss:

I got this on my comments link and I have to share:

"Hey maddog,

this is my first time on your site DC3 bruckenthal was a DC A-school class mate of mine. he was a wonderful person and a great friend. his sudden death really caught me off guard. we havn't kept in touch since i guess we just figured that the guard is small enough we'll run into each other someday... I didnt have the privlege to go to his burrial I would have if the CG wasnt sending me to cuba for 6 months. can you give me more details of that day I would really appreiciate it. thank you


Well, here's what I wrote back:

"It was hot and sunny. I left the house in my bravos because It was the uniform to wear on a day like this. When I got to work, I even took the time to be sure I was in proper uniform (medals in order, Irish pennants, tape down the jacket for the 100th time). I paid more attention to my uniform than I have for any inspection or review.

We had buses to take us to Arlington and I was preoccupied with the "boot" 3rd class who was with me. He was, I thought, too jovial and excited to be out of the workplace on a workday. He ceased to exist when we arrived at the burial site. Over 400 USCG enlisted, officer, active duty and reservists were in attendance. Blue uniforms and white combo covers dominated the landscape of the small dale of his gravesite. Without direction and without a leader, we all "formed up." I got the feeling that formality was part of what we felt DC3 deserved. I "Dressed right" to a CWO4 and an IT3 did the same to me. We didn't care about precedence or who was more important. We all knew who was important.

Soon, a member of the honor guard told us that the family wished us to not be in formation. "Nathan would have been uncomfortable with all the ceremony." We fell out and gathered 'round.

When the casket came, We snapped to attention, and the whip of salutes were heard all along the line. Salutes came from members of the US Coast Guard, the US border Patrol and uniforms of police, firefighters and EMTs from his hometown. I've never met him but I knew right then that he is missed.

As many uniforms were in attendance, there were at least as many civilians. DC3 Bruckenthal was clearly loved and admired by many. 21 guns in 3 salvos of 7 were sounded for him. Taps was played and the sweating, suffering Honor Guard did their duty well by our shipmate. The flag from his casket went to Commandant Collins and then to DC3's Widow.

We fell out. Nobody laughed, nobody slapped backs. We were all aware of the loss of a shipate.

I had a conversation with an Army PFC two days before. His point was that the USCG didn't know loss because we had lost only one where the Army had lost many. I set him straight. We are so small and so close that we cannot afford to lose anyone. We all feel the loss of one. "

--MK2 maddog

Friday was scratchy wool, hot sunlight and heartfelt tears.

I went to the funeral of a man I've never met. I've never met him but he's by brother. Damage Controlman Third Class, Nathan Bruckenthal was laid to rest at Arlington Cemetery on Friday, May 7th, 2004 at 11:15am. In attendance were his family, representatives of the US Border Patrol, New York State Police officers, firefighters and EMTs from his hometown and over 400 members of the United States Coast Guard.

I met shipmates from the past that knew him. They wiped the tears from their eyes to greet me. I saw his wife and family wearing faces of sadness that won't leave them for years.

Semper Paratus, DC3 Bruckenthal. We shall forever work to honor your memory.



Ok, meatheads! I've had over 50 hits since my last post and not one of you has commented. Democracy is born of dissent! Silence means appoval!! Sound off, Dammit!

Really, though, I'm always nervous when I don't hear from my readers. Have I pissed off everyone? Am I unbearably boring? C'mon! If you have a complaint, let me hear it!!!



These Boots:

Tom has written an entry about his boots. Medicmom has done the same thing. They are both very good entries. I, too, often reflect on my memories and past through the gear I have worn during those experiences. I value quality gear and keep it for a long time. I can look back on what my boots have been through. Somehow that's easier than reflecting on what I've been through.

So, here goes.

These boots:

    Have stepped on the decks of ships from foreign nations.
    Have carried me at full sprint down a marina dock, chasing a boat thief.
    Have stood on the neck of a man who was being handcuffed to keep him from beating his girlfriend any further.
    Have been puked on by drunks
    Have been puked on by patients.
    Have been bled on by many (including me!).
    Have climbed old wooden piers at 2 am.
    Have been awash in bilge water of many strange boats.
    Have been awash in spent shell casings.
    Have been thrown at my alarm clock
    Have been completely submerged in river mud
    Have been frozen while still on my feet.
    Have given me a good foothold to help push a broken rescue squad.
    Are a size 13
    Have kicked a soccer ball with kids who haven't learned English yet.
    Used to hide a knife, now hide an extra set of trauma shears.
    Have used 3 cans of Kiwi Black polish so far.
    Have been put on in the dark many times.
    Have braced me as I've pulled many people from the water.
    Don't slip in blood
    Don't slip in oil
    Don't slip in oily blood.
    Have been cleaned with bleach many times.
    Have been stared at by surly drunks as I read them their rights.
    Have been stared at by a mother as I tell her her son is dead.
    Are polished weekly (at least).
    Have waded through trash in patient's homes.
    Are excellent defense against an attacking dog.
    Cost me $129
    Are terrible to dance in.



I'm always struck by how fragile people are. Does it make me love the ones I love even more? It does. I'm with friends for our usual Sunday night dinner. Each an individual. Each a separate entity. Each as fragile and breakable as every patient I've ever seen. I look at them and watch them as if I am savoring their life and vitality with my eyes.

I truly believe that working in EMS has made me cherish everyone so much more. I rejoice in every sign of life I see in every person. Children, adults, family, friends and strangers. I find myself watching people breathe. I check brachial pulses on children when I hold them. I listen to their breaths. I marvel at how delicate things like humans remain so vital and live so long.

The images that stay with me are not the eviscerations, the 2 month-old waterlogged corpses or the flat-eyed stares of the recently dead. The images that really stay are the pulse in the neck, the smiles and flushed faces of the happy, the belly laughs and the clear signs of life among the living.

In the car, on the way home, I thanked her for marrying me and said, "I love you."

She acted surprised. She doesn't know how deeply I am grateful and how deeply I love her.

The whole night was a blur.

Not much in the evening hours. We cleaned the ambulance and made assignments.

Got a call for an unresponsive male on a bus in the next jurisdiction over. Coincidentally, about 2 blocks from my house. By the the time we got there (I didn't need the map book to find it) dispatch stood us down. The local ambulance had finally arrived. One of the firefighters on the scene comes up to my side of the ambulance.

"What's up?" I ask.

"Last passenger off the bus tells the driver there's some dude in the back asleep. Driver goes back there and the dude is KTFO!" He laughs.

"KTFO?" J asks me as we drive away.

"Knocked The F**k Out."

We laugh for 1/2 mile.

No sooner do we get back then we're called to an accident on the highway with bad directions. By the time we get on scene, we're stood down again. Apparently one of the drivers kept driving after the impact for a while. The other driver is walking away from his overturned vehicle followed by 2 firefighters, an EMT and a cop. We roll on.

Return to the station. Get out of the ambulance. Fill my water bottle and the bell rings again. Auto accident, Engine from another station on scene.

I get out of the ambulance to find a person on the grass of the shoulder surrounded by Firefighters. They've got C-spine immobilization on him manually and are cutting off his clothes. They make room for me as I slide right in. Their turnout gear smells of old fires and fresh sweat. They're all looking at me. I'm EMS. Nothing's on fire and they seem a little lost.

"Light, I need light." I say.

Blank stares.

"C'mon, you all have flashlights hanging from your jackets. I can't see in the dark!"

Oh, yeah! Suddenly the patient is fully illuminated.

He's 15, thinks George Washington is the president, that it's 4 days earlier than it is and today, "starts with a 'T', Tuesday?" (It's Friday night). One of the firefighters is already doing a full body patient assessment. He's checking abdominal area for tenderness and ribs for flail chest. Good. I check pupils for equal response and it's there. Pain in neck, shoulder where the seatbelt was, knee where he hit the door and his head. It's 1:30 in the morning and he was riding in a car on the highway with his father about 30 miles away from where he lives.

"Were you wearing your seatbelt?"


"Were you in the front or back?"


"Were you the driver or passenger?"


"Did you hit your head?"


"Did you lose consciousness?"


"Why does your head hurt?"

"I bumped it on the window and then I closed my eyes."

"Do you know were you are."

"I'm [a location 60 miles south of where we are]."

No crepitation or deformity anywhere in the areas of complaint. Just some pain and the altered mental status. J asks me if we should go to the local ER and I say no. I call for us to go to the local trauma center and nobody bats an eye. Apparently, I'm in charge!

We execute a perfect log roll to get him on the board. I choose to use the spider straps because we have a ways to walk and, since I figured out how to use them, they're great for securing someone to a backboard. I've almost never seen them used by BLS units in my area. I have to spend a bit of time educating a few of the assisting Firefighters on how to set them up but we get the patient packaged very well.

"Is the father coming?" I ask. The policeman standing next to the father gives me "the look." OK. dad's going to jail. I find out from J later that standing downwind from dad would get anyone drunk.

All the way to Trauma, he's complaining about his shirt and his shoes. I feel bad for him. It was a nice sports jersey and we cut it right off of him. His shoes? Well, we left them for his father to take but I realized the kid's going to have to get them from evidence or property if he wants them back.

At Trauma, we're greeted by the sight of the driver of the earlier accident, fully immobilized to a backboard, being read his rights by an angry looking police officer in the ER. HA! We slide right into trauma and the team takes over. I pass as much information as I can and help to transfer him to a bed. The doc and the nurses seem surprised at a volunteer EMT giving them tons of info, chief complaint, the fact that he got out of the car himself, his altered mental status, his initial vitals and his condition during transport. I'm pleased to see social services is there and he gets the patient's address and guardian name from me.

Back at the station, I manage to get a shower and actually into bed when the bell rings again. 14 y/o male with severe leg pain. Can't move. The call goes out as a leg injury.

On scene, the mother tells us he has a history of sickle cell anemia and asthma. J and I gingerly, and compassionately move this kid to the ambulance. He's hurting. He's so skinny that at first, I think his leg is broken. The bones showing through his skin make his legs look deformed. He's a good looking kid and he has a sense of humor through the obvious pain. Other kids his age are "running ball" or goofing off. He's feeling more pain at 14 than most people feel in their entire life. I don't cry but it takes work.

Mom rides with us and in the ambulance, I tell him that I'm not going to do anything to hurt him but if he hurts, to tell me. I do my best to make him comfortable. I give him a full exam to make sure I haven't missed anything and to keep my mind on my work.

We get to a quiet ER and, surprisingly, have to wait. Apparently, dispatch did not call us in to the ER and they had no bed ready. Mom's frustrated and the triage nurse, after hearing what we have, takes off. My cynical side is grumbling when I look down the ER, over the heads of various nurses and techs that are sitting around, to find the triage nurse cleaning a room and changing the linens herself. Awesome!

She signals us down and we transfer the kid to the bed. I apologize to mom that they had to wait and then I go out to talk to the triage nurse. Nobody's around but us and I sincerely apologize that she wasn't notified and thank her for her effort. She's staring at me, open-mouthed, as I tell her the patient's SAMPLE history, last vitals and chief complaint. Before she goes to his room she grabs my arm, looks me in the eye and says, "Thanks." I swear, I must be the most atypical EMT-B in the state!

Back at the station, it's 4:35. I hit the bunk and sleep.

I dream of twins, thunderstorms and little girls saying, "Look, Daddy, Look!"



Busy night last night.

Yeah, I want to blog and fart around online but the sun is shining and the grass is very long.....

Stay tuned!!