Sometimes, we win.

I did an amazing thing, apparently.

Duty Night. Chillin' in the lounge chairs, watching a movie I've seen before and don't mind seeing again. Earlier that day, I had played in a kickball game with some other folks from the Firehouse. Good times. No beer for me as I was heading directly to the Firehouse afterwards.

Roswell pops his head into the lounge, "Hey, maddog, can I see you?" He tilts his head in a way that tells me he need to talk to me RIGHT NOW.

"Sure!" Off I go. He leads me back to one of the dorm rooms where his girlfriend, JLB, who's also a firefighter/EMT, is lying on the bed. They've been drinking steadily for the previous 7 hours (they started at the kickball game). She's lying on her side, breathing at a rate of 60 breaths per minute.

OoooooooKay! Pulse is 92, BP is 130/82 and her blood is 99% saturated with oxygen (SpO2=99). These are all good. Oh, yeah. She also smells boozy to the max!!! The thing is, I can't rouse her at all. I do exceedingly painful things to her but she doesn't respond. That is bad. However, considering her blood pressure and pulse are reasonably OK, I'm willing to adopt a "wait and see" attitude and see how long it takes her to sleep off her drunk. Roswell and I roll her onto her left side and make sure she's got a clear "vomit path" in case she barfs. We're trying to ensure she doesn't breathe in, or aspirate, anything she pukes up.

I'm standing next to the bed, discussing with Roswell what we should do. We were just deciding to check on her ever hour when her noisy breathing stops.

We look at each other.

We look at her.

We look at each other again.

This is the first time I've ever seen Roswell scared. Strangely enough, and totally out of context, I realize that, despite the ups and downs of their relationship over the past 2 years, Roswell really loves JLB!!

I roll JLB on her back. I move her head back to ensure her airway is open.

She's still not breathing.

I check her pulses on her neck (carotid) and her arm (radial). What had earlier been a steady "THUMPTHUMPTHUMP" is now a, "THumpthumpth...tu..th.......th......t...t....p....p................"

Everything is now bad.

"Hey, Roswell?" I say in my calmest voice, "I think we need to start a medic unit, OK?"

In a flash, he's gone.

I try again to get JLB's airway open and, again, try to rouse her with painful stimulus.

Still no breathing.

Check the pulse again. I can barely feel it. It's beginning to dawn on me that I may have to do CPR on a woman who I consider a family member. I guess I better get her off the bed and onto the floor!

I cradle her like a child and move her to the floor. She's as limp as a rag doll (or the newly dead). By this time RockSteady has shown up. He was a Paramedic back in "Joisey" before he came down here to be a financial planner. He runs at the Firehouse because, deep down inside, he misses it.

"What do you need?" he asks me. As calm as could be.

"AED, O2, BVM, a medic unit and wake everyone up." I reply in a tone that I hope sounds as calm as RockSteady.

Brooklyn shows up with the "Go" bag and the O2 Kit. This kid has learned much from the maddog. I drop a 22fr Nasopharengeal airway in JLB. Her jaw's pretty tightly clenched so I know I'm not getting anything in her mouth. At least I can help a bit with a flexible tube down her nose to help get oxygen into her lungs. I get out the Bag-Valve-Mask (BVM). This is a device that allows me to put a mask over your nose and mouth and squeeze air, via a specially built bag, into your lungs. I'm trying to breathe for JLB. By this time, Brooklyn has left to go get the stretcher. I check JLB's pulse again.

Nothing.

I check it AGAIN!

No, Really, I mean NOTHING!

"Crapcrapcrapcrapcrapcrap!" I'm saying to myself.

Weed has slid into the room at this time. She's still half asleep. I've never worked a bad patient with her but she and I work together as one.

"I got nothing" She says to me. She's feeling for a pulse too.

"Right!" I say. Weed hands me the scissors and In about 1 second, I've got JLB's shirt and bra cut off. Weed takes over the ventilations.

At this point, part of my mind is remembering how many times JLB and I have joked about getting "Trauma Naked" by cutting someone's clothes off. We say that this is a real possibility when someone dates a paramedic. Now, here she is, "trauma naked."

I start shoving on her chest with all my weight. I'm forcibly and mechanically taking over for her heart. I'm slamming it flat to force the blood in it to go out to her body and lungs and then springing up suddenly to allow it to fill up with blood to, again, be forced out to her body by the next compression of my body weight on her chest. It's not elegant but it IS effective.

I do about 2 rounds of 30 compressions when the AED arrives with Brooklyn, Ninja and RockSteady. We slap the pads on her and stop CPR long enough to have the machine tell me that no shock is advised. I go right back to CPR.

Here's the freaky bit:

I finish my 3rd or 4th cycle of chest compressions when JLB's eyes snap open and she takes a deep, ragged breath.

Woah!

Did I just do that?

"Hey, darlin'! Glad you've decided to come back and join us!" I say in a voice I hope sounds lighthearted and calm. Her eyes orient towards me and she makes eye contact. Well! This is Very Good!!!

She fades in and out. Her respiratory rate never gets above about 6-8 per minute so, I keep assisting her ventilations with the BVM and a full dose of Oxygen.

Brooklyn, Ninja, Weed, RockSteady and I get JLB moved out on a Reeves stretcher. This is a nice tool for getting people out of tight spots without jerking them around too much. As we load her onto the stretcher/cot in the engine bay, we hear the Medic unit pulling up out front.

Smooth and easy we move her into the medic unit. Weed and I stay in the back to help out and Ninja jumps in the driver's seat. Off we go. The medics hook JLB up to the EKG, check her Carbon Dioxide output (Capnography), her blood pressure and other vitals as well as starting an IV in her left arm (after an attempt in her right arm and her external jugular vein with no success). All the while, JLB is alternating between lucid periods where she's looking at me and asking where Roswell is and complete unconsciousness with a respiratory rate of around 4-6 breaths per minute.

The two medics, Weed and I work together like we were cogs made for the same machine. Medic #1 calls the hospital on her cellpone and gives them a good, solid report so they know exactly what's coming in the door when we arrive. It pays off too. We roll right into a critical care resuscitation room and are swamped by nurses, techs and doctors.

As soon as we arrive at the hospital, we're swarmed by other firefighters, JLB's family and a few cops too. It's a circus. I hand off ventilations to a tech and clear out of there. I wash my hands and find a spot out of the way to wait and see what happens.

20 minutes and 2 liters of intravenous fluid later, JLB is answering questions and completely alert. 1 Hour later, all of the people involved are having a CISM debrief in a conference room in the hospital. 2 hours later, JLB is going through a battery of tests, EKG, 12 lead, Blood work, etc., etc.. I'm back at the station, filling out my reports and restocking my gear.

They keep JLB at the hospital for a while to do a full workup. By the time she slides into CAT scan, I'm dead to the world asleep.

I did everything as I should and made no mistakes. Clinically, I'm pleased and satisfied. 14 hours later, telling the story to someone who's not a firefighter, I can't stop myself from crying. No sobbing of loss of control. I simply cannot stop the tears from flowing out of my eyes.

She woke up. Her eyes opened and she looked right at me. I'm beating on her little body hoping to push enough blood around to keep her brain from dying and she opens her eyes and looks AT ME.

Somehow, this is the part the overwhelms me.

-'Medic

Indy 500.

Yes, I was there.

Every year, my brothers and I go somewhere awesome with our father for Father's day. Though it was a bit early, we went to the Indy 500 this year.

This pretty much sums it up:



Brreeeeeoooowwwwww!!!!

-maddog

Nothin' Doin'

It's a fill-in night at the firehouse. I've asked Helga to cover for me in the past and I'm paying her back now.

There's this kid. Her mom and my Mom went to Nursing school together. Her older sister is a doctor and she's thinking the same thing.

In the interim, she's decided that being an EMT-B is a good idea as a start on her road to her MD. An application, background check and a physical exam (Ironic?) later, she's a member.

Now, she's my problem.

The only time we roll the ambulance tonight is to go get ice cream at 11:00 at night.

Exciting times, no?

She fits in so well that I feel she's been here all along. This is one of those cases where someone is well suited to be here contrary to all assumptions.

I don't have a blog-name for her yet. She plays it too close to the vest for that at this point. For now, we shall call her, "Sis." She is more like a sister to me than anyone I've ever known at the firehouse. She's beautiful, confident and capable.

I have great hopes for her.

Tonight, she joked with us, commented on bad movies with us, made a senior member blush and was first on the engine when it got toned out for a fire. I watch this person for 4 hours and realize that nothing will stop her and she will do well in all she puts her mind to.

That's some powerful stuff.

'Go, Sis, GO!'

--maddog

Sunny Day

It's the first beautiful day of Spring. temperatures creeping into the 80s. Lovely.

Around 11 am, he puts his favorite lawn chair in a sunny spot, grabs a cup of coffee and has a seat in the sun. He's 93 years old.

It's a beautiful day.

Nine and a half hours later, we find him. Still sitting in the char, still holding his (now empty) coffee cup. From a distance, it looks like he just rested his chin on his chest and went to sleep. Up close, I see the signs.

For him, I think this beautiful day never ended.

For us on the engine and ambulance crews, we smile quietly and look inward. Passing is sad but, somehow, this one seems to fit.

Not a bad way to go.

-maddog

There are smells...

I am driving south on a major highway. An interstate, in fact.

There are smells leaking in to the confines of the vehicle I drive. They are smells like any other.

It all comes down to context.

There is a smell I call "vaporized rubber." Its the smell of locked wheels sliding across tar pavement. Some of that black tire material becomes a vapor and gets into my nose. I have smelled the remnants of this as I pull up and survey the scene of someone's bad decisions

"Diesel urgency" is a smell that exists in many areas. Chemically, it's the smell of insufficiently burned diesel fuel. This can happen when a diesel engine is accelerating excessively (Go faster! She's fading fast!)or when one is desperately trying do decelerate(Oh Crap! Oh Crap! Oh Crap! *BANG*). It is also the smell equated with spilt diesel fuel hitting a hot surface (Get 'em out now!!).

This, too, is a smell I equate with highway calamity.

I, however, am not driving an ambulance tonight. I'm merely driving home from work. These smells leach into my nose and brain via the ventilation system of my car.

Around me, the day to day catastrophe of an interstate occurs. I am just another commuter.

The smells remind me.

--maddog

Testing, testing, 1, 2, 3...

Yes, I have an iPhone. I'm testing to see how well blogger works with it. So far, I'm having a bit of difficulty getting blogger and Safari to play nice. The only way I can enter text is via the HTML only window.

Ugh!

--maddog

Death and I...

I'm dead asleep and it's the address coming over the dispatch radio that wakes me before the bell rings. Somehow I'm attuned to the addresses and street names in my home town. 

"One not breathing" is an ominous call for early in the morning. 

During our run to the scene, dispatch updates us that CPR is in progress. I've got 2 trainees, Babygirl and Fireplug. They wear stern faces and follow my instructions with immediacy and exactitude. Babygirl is about to go into the military and Fireplug has been active duty army for about 12 years. 

We roll into the house to see the daughter doing chest compressions on her father in a hospital bed in the living room. Grizzly is my partner on this one and, in his 30 years at the firehouse, he's seen enough of this. We work without speaking. No pulse, no breathing, nothing. 

We grab the top and bottom of the sheet and move the patient to the floor. Stiff. 

"Cot and backboard, into the house." I say. Without looking, I know that Babygirl and Fireplug are on it. 

Grizzly gets the monitor ready as I try to secure the airway. I can't even open the jaw to get a oral airway in. The chest is crunched in from the CPR and the stomach is distended. We slap the pads on his chest as the Medic unit arrives. 

"When did you last see your dad?" I ask the daughter. 

"Last night, when I gave him his morphine."

We logroll her dad and see the dark purple blotches of pooled blood on his back. This is called "dependent lividity." He also moves like a board. I can't unbend his arm to look for a vein, nor can I move his head at all. Rigor Mortis. The Stiffness of Death. 

The two other medics bustle in the front door, just ahead of the cot and backboard. I give the lead medic "the eyebrow" and say, 

"Lividity and rigor."

The medic hands me the leads for the EKG and plugs my pads into his monitor. We see a flat line (asystole) on all leads. 

Dad is cold. 

"He's dead, isn't he?" says the daughter. She works for the recreation department and is CPR certified. She's been all business since we walked in the door but this is the first time I've heard a quaver in her voice. 

"I'll call it." says the medic. 

"I'll talk to her." I tell him. 

"You sure?" he asks. He's looking me in the eye. I look him back. 

"Yeah, She's a neighbor." He nods and pats my shoulder and calls in for the police and coroner. 

She's already on the phone with her sister in California. 

"He's dead, isn't he?" She's got her hand over the phone receiver. 

"Yes he is. He seems to have been for a while." I look right at her. I will not shy away from this. Her eyes now start to fill up. 

"Here, tell my sister, will you?" She hands me the phone and sobs. 

"Hello? This is "maddog", I'm with the Fire department."

"Is my father dead?" says a scared voice from 2800 miles away. 

"Yes he is. He died last night, it seems. I'm sorry." This is the point where it hits me. I was expecting this but it always hits hard. My face is getting hot and I feel the welling of tears in my eyes. "Your father is dead."

"Thank you so much for being there. Thank you so much for what you do" She says. That's the hammer-blow. My cheeks are now wet. "May I speak to my sister now?"

"Sure." I croak as I hand the phone back. The daughter sees my tears as she takes the phone. I will not shy away from this. This is what I do.  She mourns with her sister on the phone. 

As we put away our gear and my eyes dry up I see the leering face of the full moon as it dips behind the trees to the West. It looks like the skull of death to me this night. I can imagine it nodding at me as if I've done my job and been in the place I'm meant to be for this one life. 

This is what I do. 

--maddog

I can't FEEL anything!!!

I'm now a Sergeant at my volunteer Firehouse and, this particular duty night, I'm in charge. 

1900, Assign housework, apparatus checks and get dinner ordered. We eat, run some training and then get ready for a long night. 

You see, the moon is full and the night is one of the warmer ones as spring starts to seep its way into our area. I'm ready for stabbings, shootings, fights, drunken silliness and more. 

First call: car vs. car at an intersection. I have the most cooperative and mellow patient in the world. She's in the driver's seat and got t-boned (side impact) she's got no complaints other than a painful hand and head. The arriving crew before us has already put a collar on her and we arrive in time to extricate her. 

Both cars are sitting where they stopped and I have to crawl over the hood of one car to get into the passenger door of the one my patient is in. The plan is to pull her out, feet first, from the driver's side door onto a long backboard. My job is to guide her head and shoulders down into the passenger seat and to keep her head in line with the rest of her spine. It's not as elegant as it would seem. Cars these days are built in a way that they seem to wrap around a person and make it difficult to just turn them 90 degrees and lay them down. I have to negotiate the parking brake, gearshift, armrest/console and the bucket seats. All the while we're bouncing this girl around a bit. She's not complaining, wincing, or crying at all. 

This is not normal. 

We get her onto the backboard, into the ambulance and YoungJim and I work her up. Rapid trauma assessment reveals no obvious injuries or pain other than her left hand. Ok. I ask her if she hurts anywhere other than her hand (NO) and if she feels different or funny. 

"I can't feel anything." She says calmly. 

UH OH! I'm thinking she can't FEEL anything!!! Quickly, I check that she has motor, sensory and a pulse in each of her legs and hands. I pinch the top of each foot, "Wiggle the toes of this foot."

"Ow! Ok." she says. 

Same with the other foot and both hands. Good. Apparently she meant that she didn't feel ANYTHING as in she wasn't hurting anywhere. YoungJim and I take the tension down a few notches and calm down. 

Grandma's going to ride with us. 

"Do you mind if I take your grandma for a drive?" I ask the patient. 

"Please do." She replies. "She needs to get out more." I install Grandma in the front passenger seat and drive easy and smooth to the hospital. 

--maddog

...Smells like burning rubber and EtOH!

Car accidents. If you run from the cops in your car. You'll be arrested. Especially after you drunkenly wreck your car into the woods. 

If your girlfriend does a lot of heroin before the vodka shots. She gets to ride with me. She was wearing a goosedown coat. We almost had a catastrophe in the back of the ambulance when the rookie medic started cutting the jacket off of her. Fortunately we stopped him before he filled up the ambulance with a cloud of goose feathers!! 

The rest of the night was quiet for us but nobody else. The radio was hopping for everyone else in the county besides us. 

The next morning RT and I head out for coffee. We're getting waves from the employees as we pull in front of the coffee house. As I'm getting out we get called for an auto accident about 2 blocks away at a nearby high school. 

We arrive on scene and I see a couple cars pulled into a parking lot and nobody really hurt. Out of the ambulance with gear bags and gloves. I see a woman sitting in the back seat of her own car with the door open and a man standing by his van. I ask what happened. It's a good way to get a story and see if anyone's hurt. 

"She was pulling out and didn't stop..."

"He was driving too fast..."

"She didn't even look..."

"He was supposed to stop...."

"I was honking my horn..."

"He tried to kill me...."

"woah" says I. 

"He doesn't know how to drive...."

"woah!"

"She doesn't know how to drive!...."

"Woah!"

"He thinks he owns the road...."

"SHUT UP!" I finally holler. They both clamp their mouths shut. 

"I'm not the police and I don't care who's fault it is! All I care about is if someone's hurt."

They look at each other as if this is a foreign concept. 

"Is anyone hurt?" I ask again. 

"Look at my car!" Says the woman. I do. I see some scraping on the driver's side but no real damage. 

"How fast were you going?" I ask the van driver. 

"About 20, 25 miles an hour." The street is congested enough that I believe he couldn't have gotten much faster than that. 

I look at the woman. "Are you hurt?"

"My car!"

"Lady, I'm a paramedic, not a mechanic. I couldn't care less about your car. Are YOU hurt?" (keep in mind, I haven't had coffee yet. I'm a bit cranky)

She looks at her shoes. "No." She says sheepishly. 

"Good. Because I need me some coffee!"

They sign refusals and I'm out of there!

--maddog

...What's that smell?

Duty tonight at the ol' Firehouse. I've got a feeling that something's going to happen!!

Stay tuned!

--maddog

Face lift?

I've started a fancy new blog over there at The Running Medic. It's really pretty!

This one, on the other hand, was started with the old blogger setup. I haven't converted it over to the new one as it's a bit of a hassle to re-load all the stuff I added, Blogroll, Haloscan comments, etc. 

Now, I'm thinking that it might be a good idea to do that. It's looking pretty tired. 

When I get time. 

--maddog

Runrunrunrun

I'm running again.

I've even made a blog about it. Since this one is for EMS-related stuff, I've made another blog to track my efforts to prepare for the JFK 50 Mile Ultramarathon!!

Yeah, I'm crazy.

--maddog

"Man, this is what it's all about!"

Rain moves through the area, bringing a flurry of accidents. We're dispatched to one after another. Often times, perhaps due to the construction of cars these days, there are no injuries. We arrive on scene, look around at busted cars and get legal signatures from people who don't want to go to the hospital (and probably shouldn't.).

We clear one accident and are on our way back to the station when we get called back to another one not far from the first. We're in stopped traffic on a two lane road. I pop on the sirens and lights. execute a 3-point turn and we're off to the races again!! Wheeee!

To get into position, we've got to go past the accident on the opposite side of the divided highway and turn around at the next exit. Some clown, on their cellphone while driving, almost takes me out with a 3 lane swerve. I suppose he couldn't see the 16,000lb, 9 foot tall, rolling ambulance with flashing strobes, wailing sirens and an air horn that's beating out a rhythm that sounds oddly like the cowbell in the beginning of "Honky Tonk Woman" by the Rolling Stones. Yes, I'm weird like that.

I start wading our way through the traffic to find the Medic unit in front of us and a trail of bashed, wrecked cars on the shoulders as we proceed. None of them appear to have injured people and we diligently report each one to the dispatch center as we go along.

Traffic is backed up because there is an SUV in one of the travel lanes. It's surrounded by police vehicles from the nearby military base, the state and the particular federal agency that patrols this stretch of highway. (Odd, I know but that's how things go sometimes). The patient is on the shoulder, out of the car already. RT immediately dives in with the medics doing patient care so I take the opportunity have a look at the vehicle.

It's got only 3 wheels. The front, passenger side wheel has only an axle stump where the wheel should be. Somehow, this driver has lost the entirety of the front wheel assembly. Tire, rim, brake caliper, ball joint...the whole mess. Both front fenders look like crumpled aluminum foil and there's not a single piece of intact glass or plastic on the vehicle from the doors forward. The busted grill of the SUV makes it look like a hapless boxer after a bad night.

Inside the car is another story. The patient is already out of the car and on the ground. The side windows have been broken and there is glass on the seat inside. This means that something broke the side windows from the outside. Rescuer? cop? rock? Errant Bird? I don't know. File that away for later.

Both airbags have been deployed. (significant) I can't tell if the driver (who is now being wrestled by the medics and RT) was wearing her seatbelt but the windshield has been broken from the outside and there is no evidence that a head hit it from the inside (hair, blood, brains or skin embedded in the glass). The seats are still bolted to the floor there is no blood or other evidence of trauma inside the car. The dashboard, steering wheel and other interior components are not deformed. This is good. It appears that nobody bounced around too much inside this vehicle.

Our patient has been living a life that is in no way deficient in calories. I dive in to help getting her to a backboard and then to the stretcher. During all this, I notice that her collar has slipped up her face. I go in to correct it and she wiggles her head around to get it out of the collar. She's already got a pretty short neck and her "upper body development" is not making it any easier. We improvise something useful and get her immobilized to the backboard, onto the stretcher and into the waiting medic unit.

While RT and the medics wrangle with the patient, I take a moment to query all the police as to how she got here. Broken windows and a busted windshield: Did she roll over? "No we had to break out the windows to get her out of the car."

Where's the missing wheel? "About 3 miles back. After she hit the 3rd car, she kept driving, on the road and in the median, with only 3 wheels and up to about 75 miles per hour!" I look at the police car that stopped her and see that it's covered in mud on the front of the car from the bumper to the lightbar. Woooh!

How long were you chasing her? "About 3 miles. Once we stopped her, she said that she was not allowed to stop for any police as she's the daughter of the top colonel of the army." Oooookaaayy.

"We pulled her out of the car and cuffed her. She immediately started to complain that her chest hurt. I put her on her side and then she started shaking."

Right-O! I hop into the medic unit and pass all this information onto them. RT is going to drive their unit and I'll follow in mine to take RT home once we get to the hospital. We get rolling onto the nearest trauma center. Halfway there, our dispatch starts calling the medic unit asking for their status. That's when I realize they haven't called with their patient information and destination yet.

After a few calls from dispatch to no avail, I hear RT mark up on the radio and advise them that we're all en-route to a particular trauma hospital and we'll advise upon arrival. Mind you, I'm driving an empty ambulance behind the medic unit and don't have a full appreciation of what's going on inside.

We arrive. Once we do, I park in a convenient spot and pop over to help unload. The doors to the unit are still closed and RT is still up front. What's going on? I pop the back doors open to see two medics looking frazzled and each trying desperately to hold down the patient. She's thrown off her collar. and thrashed around quite a bit. In the confines of the ambulance, the medics are holding her down to keep from getting hit. The looks on their faces are pleas for help. Apparently she's been fighting them for the whole drive and has even tried to fake a seizure or two. The medics have been so busy trying to hold her down and not get hurt themselves, they haven't had time to call anyone on the radio.

"RT! Come open up and get us out of here!" I say as I hop up to the head of the patient to help out. I try to put the collar back on her. Just as she snaps at me with her teeth, one of the medics says, "Watch out! She bites!"

I jack both of my thumbs into the space behind the angle of her jaw and below her ears. This is called the infra-orbital pressure point for law enforcement types and causes a LOT of pain without any tissue damage. I look her in the eye (both of which are very open right now).

"You bite me, I'm going to knock you out!"

Her whole body relaxes enough for us to get her out of the ambulance and into the loving arms of a waiting trauma team. I don't put the collar back on her but I do hold her head to keep it from moving. I also have my fingers placed in the same spot I "zapped" her before as a reminder that if she gets frisky, she's going to pay for it.

The trauma team is ready and, really, not very impressed with her antics. If you thought I was cruel. the trauma doctor is an absolute sadist.

As we clean our gear, one of the medics says to me:

"Man, this is what it's all about!"

The stress of the call sloughs off of us and we laugh and laugh.

--maddog

Kids, kids and More kids!!

We get dispatched as the 2nd ambulance on a car accident.

On our way to the scene, the incident commander (the chief of the neighboring station) asks us if we have a problem taking 3 stable kids in car seats.

RT and I look at each other. He knows he can "tap out" and drive, leaving me in "the back" to handle things if he's over his head.

"Ambulance XXX, We're direct. No worries" I reply.

Here's the deal on scene:

Mom's driving the minivan with two 11 month-old twins and a 22 month-old son in car seats. The minivan gets rear-ended. Kids are fine (that's what car seats are for) but mom's neck and back hurt. RT and I work on mom. We get her extricated to a long board & immobilized to our stretcher. Into the ambulance we go and start doing our trauma assessment to be sure we haven't missed anything.

While we're doing this, firefighters start loading car seats and kids into our ambulance. By the time we're on the road, we have a 38 year old woman in full spinal immobilization as a precaution, 3 screaming children in car seats and RT being a stuffed-toy-laden octopus who's spending equal time entertaining toddlers and treating his patient.

At the hospital, I have to go in and get help from one of the waiting ambulance crews. We roll in. One EMT with a kid in a car seat and two others pulling a stretcher containing a woman on a backboard while holding identical boys on their hips.

At the nursing triage station, it's wait wait wait.

The oldest boy is content to play with his toy while still strapped into his car seat. No escape there. RT has one twin with a biblical name. Biblical name #2 is on my hip.

As I shift Biblical name #2 from hip to hip, I notice a particular smell.

Now, RT has a son but his ex left before the boy was born. Even though RT is very much involved in his son's life now, he's never dealt with toddler management. Mind you, we're already a spectacle in the emergency room with one patient on a cot and three little kids being wrangled and corralled by two harried-looking EMTs.

I catch a nurse's eye.

"Can u get me diapers and wipes?"

Her eyes widen in recognition. I look significantly at the toddler on my hip and nod at her with a knowing look.

"I'll be right back!" She drops what she's doing and dashes off.

Five minutes later, I've got this little man on his back on an exam table and am fighting him to get his onesie off.

Clearly he has a healthy diet! Bleah!

Another 3 minutes pass and he's clean, changed and dressed.

I walk out of the exam room and mom puts a hand out to touch her baby. Her hand finds my arm.

"Thank you."

The nurse from before comes bustling by.

"They teach you that in Paramedic school?"

I smile.

--maddog