"One and Two and Three and Four and Five and Six and Seven...and Fifteen. Breathe!"

The call goes out as "trouble breathing" and I see on the printout that the patient has a stoma. That's a hole in their neck to breathe through. It's, basically, a permanent tracheotomy.

We hurtle around corners to the house. Run to the door. The wife is walking circles around the kitchen table.

"In there. Oh my god! Oh my God!" Her helplessness is expressed in her flapping arms and manic look.

Through the hall to the den. I see a man, 60-ish, in a chair. His chin is on his chest. I can't see his breathing hole in his neck. Also: He "looks like Sh*t," which, most people in EMS will tell you, means he's in trouble. Sometimes you can tell right away.

I'm at his side. I tilt his head back. Flaccid muscles. I check his pulse. Flat.

"No pulse. Let's go!"

Furniture is flying! We make room to work. (Have you ever THROWN a recliner? Wow!) We slide him from his chair to the floor and start right away.

"Um, Mask?"

He's got a hole in his neck. There's no use in ventilating him with a mask that covers his mouth!

Like Obi-Wan Kenobi's voice to Luke, during the trench run, a voice comes to me, "In the event you encounter a patient with a stoma, Use a pediatric mask over the stoma hole and invert the longitudinal orientation..." (Can you tell I was trained in the military?).

Pediatric mask is attached but we can't get a seal! Crap!

"Tick, tick, tick, tick, tick!" That's already going through my head. How long has he been down? How long has he been without oxygen? Why didn't his wife tilt his fu**ing head back?!

We can't get a seal with the mask and I improvise by putting the bag-valve mask (BVM) connector, directly into his stoma.

We get a little bit of air into his lungs. (I'm listening with a stethoscope), but most of it goes into his stomach. His belly's getting more and more distended and he's becoming a bright shade of purple.

"Crichoid pressure!" Says I!


"Push here!" I show where to push on the windpipe to close off the esophagus (on the Crichoid cartilage) and allow the air into the lungs.

A little better but the pressure in his stomach is restricting lung movement.

Dammit! Dammit! Dammit!

We're pumping and blowing (CPR) as best we can as we transfer him to our ambulance. The 'Medics arrive and pile into the back of "the Bus."

Intubation! A tube down the throat and he's suddenly pink again. It's amazing what you can do when you can get an air "pipe" directly to the lungs.

IV! A direct line into a vein to carry drugs to he heart will work wonders when you need to "restart a ticker."

Than we go into Transcutaneous Pacing. This is where an electrical shock is delivered via electrodes attached to the skin (transcutaneous) on a regular basis to coincide with a desirable heart rhythm(pacing).

Meanwhile, we're still bagging the patient (using a breathing bag to push air into his lungs).

"Check for a pulse." says the 'Medic.

"No pulse. Radial or carotid." Says I.

"Ok! Let's see what he does now!" The 'Medic increases the energy output of the pacer.

"Check for pulse." A bit later

"I have a pulse!" says I.

"No Sh*t?" says the 'Medic.

Not only that but his blood pressure has returned to 122/82. Without chest compressions!

"Right on!" says the 'Medic.

We continue ventilations until the patient begins to breathe on his own.

We transfer a patient, to the hospital, who has a spontaneous pulse and is breathing without assistance.

For weeks afterwards, the name "Lazarus" keeps coming into my head.

I did my job as a BLS provider. I fed oxygenated blood to the brain. Did that help the patient? Is he alive because of me? Did I see this patient for what he was and act in enough time to save his life?

I don't know. So much of what we did seemed to be ineffective. The more dramatic results did not manifest until the paramedics arrived. But still. Did I, somehow, make that possible?

Since then, I have found myself checking everyone's pulse who's close to me. On the subway, I'm watching everyone breathe. Those are the important things. ABC's, Airway, Breathing and Circulation.

It's reassuring to see it.




Desk as a drum....as inspired by Martin O'Donnell.

Have you ever banged on something with a rhythm and realized that it sounds good? I play a drum. Not drums. Just one.

I was just listening to Peril by Martin O'Donnell from the Halo 2 soundtrack (yeah, I got the mp3). It's full of rhythm and strings and generally sounds great! I suddenly found myself bangin' away on my desk. I have this hollow-core desk from Ikea with great acoustics and it sounded pretty dang good!

Who knew?



Maddog rides the fire engine! Unresponsive patients respond!

Well, the ambulance developed a pretty major fuel leak. I found out later that it blew a fuel hose and my chief could tell everywhere we drove that night by the trail of diesel fuel we left all over town. I wince at the thought of the sheen that is heading to the Atlantic Ocean as I write this.

Well, I go to bed with the thought that the ambulance is out of service and I'll sleep all night.


At 4am the bell rings and I'm up, dressed and in the vehicle bay before I realize we have no ambulance in service. I do hear:

"...Medic local: 402 _____ Road, Apartment 103, Unresponsive person, Engine XXX (our engine), Ambulance XXX (the ambulance from my old station), Medic XX (from earlier that night), respond on channel 2."

"There's no ambulance!" Complains I.

"C'mon, Maddog! Get on the engine, It's a medic call! We'll get there first!" says LT.

I'm on the engine!

"Get the suction unit and the AED off the Ambulance!" I shout.

"Right!" says another firefighter and, just like that, It's done.

In the engine, the Cap'n hands me the suction unit and the AED. Woodchuck is in the seat next to me. LT is driving and Jr. is riding officer.

"I'll carry the AED and the suction unit. Cap'n, you follow me with the aide bag and, Woodchuck, come up with the O2 kit. Ok?"

They nod. Once again, I'm in charge. I'm thinking, unresponsive at 4am means bad business. If they're truly unresponsive, they're either really dead or recently dead. AED, O2, Suction, I'm ready for the worst.

The address is right next to where my parents lived when they moved to this town in 1966. I'm not the first out of the engine but I'm the first to the door (runner, me). The door is opened by a worried looking woman in her 20's and I see a man of the same age sitting on the couch.

"Do you have any pets or dogs in this apartment?" I ask.

"No, No pets. Just another roommate." Says the woman with an accent. (German? Russian?)

"Where's the..." I start to ask, thinking the roommate is in a back bedroom, dead or barely breathing. The guy on the couch raises his hand.


I see he has a glucose meter on the coffee table in front of him. Things are starting to make sense. I move in to the apartment and situate myself near the "patient." By this time, the other 3 firefighters show up with the rest of my gear.

"I get like this sometimes when my sugar is low. My girlfriend, She got scared. I'm sorry you all came out." says the man on the couch. He knows exactly what's going on. His speech is clear and well-delivered. He too speaks with an accent. Definitely German. He uses articles. I've found that Russians don't often use possessives and articles in their speech.

"Cancel the Medic." I say to LT, who has the radio.

It's done. I take vitals. All normal. I check his lungs, eyes and look for nystagmus or other signs of inebriation which can also indicate a diabetic emergency. All come up negative. The guy smells of laundry detergent and spice deodorant. He does NOT smell like he's drunk or having a diabetic emergency.

His blood sugar is 36.

"Have you eaten?" I ask. I feel my eyebrows are in my hairline.

"Yes, I just had some cereal and milk." he says as the woman brings him an apple, oddly, on a plate. The patient takes a look around his living room. He's sitting on his couch in his pyjamas, surrounded by 4 emergency responders and a worried girlfriend (I know who called 911!).

"Ok. Your girlfriend is worried. That's why she called 911. I'm worried because your blood sugar is so low. If you want to go to the hospital, we will have an ambulance take you."

"No, No. I'm fine. This happens all the time. I eat something and my sugar comes back up. I'm fine, I assure you." He converses the way people do in books. A consequence of not being a native English speaker, I'm sure. I satisfy myself that he's of a good mental state and is doing something to address his hypoglycemic state. The apartment is clean and well ordered. The girlfriend is concerned and attentive. No signs of a dangerous or risky lifestyle. I also note the lack of tracks in his arms and the lack of "smell" in the apartment.

"Cancel the ambulance." Again, It's done.

"I need you to sign this form. It says that you do not wish to go to the hospital right now."

"Ok. No problem."

"Now, I want you to understand that this does not mean you cannot call 911 two minutes after we leave. If you need an ambulance or medical attention, you call 911. I'll come here 20 times tonight if I have to. Ok?"

"Yes, Yes. I'm sorry to put you all through so much trouble."

"It's no trouble. I'm only concerned if you are OK. Are you sure you don't need to go to the hospital?"

"Yes, I am sure. Thank you." All of his dialogue is delivered appropriately and clearly.

I get up to leave. I look around to find all my gear has already been gathered up and put away. Deferential looks from the Firefighters. Walking back to the engine, clearly the domain of the firefighters, I'm struck by the strangeness of it all. I'm surrounded by people I greatly value, respect and look up to yet, here they are, looking at me like I'm in charge.

Back at the station: "G'night, Maddog. Thanks"

Thanks? Me? No, No! Thank YOU! Wow!

I write a loooong report and go to bed.




"... Medic Local. 125 _____ Road, The Step Club, Chest pain, Trouble breathing. Ambulance XXX, Medic XX, Respond on Channel two."

I know exactly where the address is (I've lived here my whole life) and I know the Step Club is a meeting place and hangout for recovering substance abusers. It's right next to the grocery store and in the basement of the barber shop.

I'm assuming it's a heart attack but I'm also ready to be greeted by someone who's fallen off the wagon and making a scene (it's happened before).

We roll and, this time, my LT is driving. He's also in charge of the EMS side of things at my station so, I'm kinda glad he's along. I'll get to "strut my stuff."

We arrive on scene in 2 minutes and find a man being walked out to our ambulance by a friend. He looks like crap but he's walking, alert, oriented and answers my questions appropriately. I ask him if he can climb into my ambulance and he says yes. I'm prepared to help him up but he has no trouble. Good.

In the ambulance we get him situated and get his complaint:

"My heart's racing and I have a funny feeling in my chest."

"Does your chest hurt at all?"

"No, it just feels funny

I give the guy a full check out. The pulse oximeter(PulseOx) is showing he's got a pule of 114 and saturating at 99% on room air (no oxygen supply) and talking. I check his pulse manually and it feels strong but irregular. I look over at the PulseOx and compare what it's rhythm says to what my fingers tell me. The PulseOx clips onto a finger tip and reads the electrical impulses of a heart rate along with how saturated the blood's hemoglobin is. These are great things to know but they don't mean anything by themselves.

I notice that his wrist doesn't always pulse when the PulseOx is saying he should. He's dropping beats, or, his heart's not beating all the time. That would explain a "funny feeling" in his chest!

Otherwise, this guy is unremarkable. He's 49, healthy-looking, sober and has a good mental status. He says it all started when he was on the treadmill earlier that day. The rest of my exam reveals clear lungs, eyes: PERL (Pupils Equally Reactive to Light), skin: warm, pink and dry, no edema at the lower extremities and his carotid and distal pulses match in all 4 extemities. I take a careful listen to his heart in 4 places and it's giving me an unusual "harrumph" at the apical point that's faintly echoed at S2. Hmmmm.....

I look across the cot at LT. "Medic Status?"

He checks via radio and I hear they're about 3 minutes out.

"Medics? What's wrong with me?" asks the patient. He's worried.

"I don't know." I say honestly. "There's definitely something funny going on with your heart. The paramedics have much better equipment for looking at your heart and more advanced interventions if you need them. I'd be a lot more comfortable with them here."

"Oh, man. This is bad. I don't know what's wrong with me. I work out every day...."

He's worried and it's making him more anxious which is making his heart rate go up again.

"Look, you're about to be in an ambulance with 2 EMTs and 2 paramedics. If anything is going to go wrong, this is the best time for it, okay?"

"Okay." He's calming down again. I watch his pulse go from 105 to 88.

The paramedics arrive and climb in. I give my report to the lead medic. I tell him about the guy's pulse and the pulseOx reading on room air, the patient's family history of heart disease (brother and mother had heart attacks) and exercise intolerance(the symptoms appear when he exerts himself. I also tell him of the "Pertinent negatives:" No unusual lung sounds, No briuts in his carotid, no edema in the extremities, skin condition, etc..

The medic leans his head over to look over my right shoulder. I follow his gaze thinking someone got in the cab of the ambulance.

"Hm, I was looking for a paramedic patch on your shoulder but all you're wearing is a Basic patch. You don't sound like a typical EMT-B."

"Oh! Uh..thanks. I'm going to 'medic school" (I'm actually BLUSHING!!!)

"Really? Where?"

"Up at _______."

"Yeah, I've talked with ______ (My advisor) a couple times. I'm thinking of taking the management program there."

We turn our attention back to the patient.

"You remember your 12-Lead placement?" he asks me.


"Great! there's the kit. Go to it!"

He directs his partner to start an IV line and, as I'm setting up the leads for the EKG, I notice she must be new at this. She doesn't warn the patient that she's going to stick him, she has a hard time finding the vein (She went for one she could see easily and it kept rolling away.) and once she's got the vein, the guy's bleeding all over the place because she forgot to take off the tourniquet.

Fortunately, she's paired up with a pretty squared away medic. He decides that we're taking the patient to a cardiac specialty center that's a longer drive than 3 other local hospitals. He's clearly more concerned about the patient than getting back to his dinner or TV show (There IS hope!). He also decides to ride in the back of my ambulance with me helping while his partner follows us in the medic unit.

On the way he takes a good 12 lead and 3 lead strips. He hands them to me for interpretation prior to saying anything and we discuss how it could or could not be a Type 2 Mobitz II AV heart block. He then asks me what drugs I would give this patient and the only one I can think of that was appropriate would be Aspirin. He's not in obvious need of Nitroglycerine (no chest pain), His pain and blood pressure don't indicate Morphine and I'd already started him on 15 liters per minute of O2.

"The aspirin is in the top of the drug box next to you. Go ahead."

He quizzes me some more. We talk some more. At the hospital, we hand off the patient, re-stock our rigs and he wishes me luck.

All in all, a very enjoyable call.

Up next:

Maddog rides the fire engine! Unresponsive patients respond!

Stay tuned!



Am I an angel?

The bell rings. One long bell. My eyes go to the scrolling LED display high on the wall and I see it's an ambulance call. I also see that it's a personal injury after an assault and it's 2 jurisdictions away. It's been a busy night and we've been called into this one because the ambulances in the neighboring areas are all occupied.

I grab the printout to be sure of the address and am deep in the map book for that area by the time Helga hoists herself into the driver's seat. It's a long drive but we don't get lost. Once we get close, the lights of the fire trucks and police cars act as beacons, guiding us in.

As I'm grabbing my bags, I ask the nearest cop what happened.

"She and her boyfriend were arguing and he stabbed her. She ran to a neighbor's house, in there."

"You got the boyfriend in custody?"



One of these days it's going to be me vs. assailant. I'm not looking forward to that but I'm sure it will end badly for the assailant. (Let's see, I'm 6'4" (2 meters) and 245 lbs (110Kilos), yep, bad day)

In the house I find a crying 35 year old woman from El Salvador sitting in a chair and being attended to by 3 firefighters. She is being administered oxygen by an infant non-rebreather mask(NRB) (about the size of her nose) and has a wad of trauma sponges on her neck. Hoo boy!

To the firefighters: "Hey, fellas. What do we got?" as I pull an adult NRB out of my oxygen mask.

"We didn't have any adults in our aide bag on the engine." says one of them apologetically.

"No worries. What happened?"

"We don't know, we don't speak Spanish."

"Hola, Señorita. Me llamo Maddog. Me voy a ayudarte. Digame que pasó."
"Hello, Miss. My Name is Maddog. I'm going to help you. Tell me what happened"

She cries and, through the tears tells me that her boyfriend is not happy that she's renting a room in a house that is populated by men. He stabbed her with a knife.

"¿Un cuchillo de cocina?"
"A kitchen knife?", I ask.

"Sí, sí. Al primero vez, un grande pero yo lo luchó. Él tiró de mi pelo y me lanzó en el suelo."
"Yes, at first a big one but I fought him. He pulled my hair and threw me on the ground."

I see that chunks of her long, black hair are missing.

"¿Con qué tipo de cuchillo él le apuñaló?"
"What kind of knife did he stab you with?"

"Un pequeño, para las frutas."
"A small one, A fruit knife."

I gingerly pull away the dressing from her neck to find a small incision at the angle of her jaw. right to the bone of her mandible. Two inches further back, and I'd be bagging a corpse. Wow!

She's upset. She's crying. She's scared.

"¡Oye! A mí, hay seguridad. Yo, y las policia, vamos a protectarte. ¿Me intenedes? En mí ambulancia, es un espacio seguro. Es importante que usted va al hospital. Voy a tomarle allí. ¿Bien?"
"Listen! With me, you're safe. I and the police are going to protect you. Understand? My ambulance is a safe place. It's important that you go to the hospital, I'll take you there. OK?"

"¡Sí, sí gracias, gracias, gracias!"
"Yes, yes, thank you, thank you, thank you!"

In the ambulance, I take the time to explain everything that is happening. The neighbors have gotten her a change of clothes to replace her blood-soaked dress. I'm gentle with her. She's scared and fragile.

"¿Porqué eres bueno?¿Es usted un ángel?"
"Why are you so good? Are you an angel?"




Chicken suit? I don't THINK so!

I just got off the phone with Peaches.

I beat him, again, by one grade in one class.

Looks like HE'll be wearing the chicken suit the first day of class!

Woo hoooo!

There'll be pictures, I promise!!




That sexy bald one...

For information concerning the title, please see the previous post.

Here's a picture of the maddog himself. I no longer have the beard.

I look really good in a doctored photo. ;)



The joys of working in your home town...

Chewbacca and I run a call to the house of a former neighbor of mine. His daughter went to grade school with my older brother. She shows up as Chewbacca and I are getting our gear ready to move the patient. I've run into her from time to time around town. She's pretty and has a good sense of humor.

"It's Ok," says her friend, "The guys from the ambulance are here."

"Yeah, Especially that sexy bald one!" Says the daughter.

Chewbacca almost drops the cot.

I think I'll have a hard time living this one down.



Happy New Year!..zzzzzzzzz......

Not a single call. Not one. I suppose the residents of my town can count themselves lucky that not a single one of them required EMS or Fires services for the last few hours of 2004 and the first few hours of 2005.

I went in last night all excited about running calls involving drunk revelers, automobile wrecks and more. I had planned well. I arrived at the station at 7pm, checked out, stocked and cleaned the ambulance, had dinner and was in bed by 9pm. I woke up at midnight and got dressed. I figured that's where the action would be. I stayed up until 4am alternately reading my book and watching crappy movies on tv. No bell, no calls, nothing...

At 8am, I got up and got dressed. I had programmed my coffee maker to go off at 8 and when I walked into the lounge I found Old Jr on the couch looking bleary.

"You drink coffee?" I ask him.

"Yeah, you wanna run to the gas station and get some? I don't think they're open yet."

"No, man, I make the best coffee in the world and it's right around the corner." says I. We hop in the ambulance, leave the firehouse and make 2 left turns. Old Jr. Sits in the ambulance, idling our front while I run in for a couple travel mugs of locally roasted, organic french roast that will put a smile on a corpse's face.


Ok, so the ambulance only left the bay once but it was for a "rescue" call.