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.

WRONG! HA!

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.

--maddog

ALS-a-go-go!

"... 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.

"Sure!"

"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!

--maddog

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?"

"Nope."

Great.

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?"

Wow!

--maddog

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!!

--maddog

One year Blog-a-versary

I started my blog a year ago.

Wow!

--maddog

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. ;)

--maddog

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.

--maddog

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.

Ahhh.....

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

--maddog

Helpless....

I've been looking at the pictures of the devastated towns and thinking of where I would put my command post. I've closely examined the faces and bodies of the injured in the photos and video and found myself thinking of treatment procedures. I've seen the hundreds of bodies floating in the water amid debris and am thinking of cleanup methods.

I've responded to disasters, I've treated the sick, I've distributed food and supplies and I've recovered bloated bodies of the dead from the water. I CAN help. I've done it before. I, and many of my brothers and sisters in the Coast Guard can help. We're really good at it. History has shown that to be true.

If my commanding officer called me right now, "Maddog, be ready to hop at 0800, we're heading East." I'd be turned out and ready to deploy by 0730.

We have the a collection of the best military organizations in the world. We are all volunteers and do this because we feel it's right. Why are we not on the ground in Indonesia, India, Sri Lanka?

Why do Coast Guardsmen get injured and die in Iraq protecting oil platforms when there is the biggest humanitarian need right around the corner? That's what we do, Dammit! Coasties save lives! Set us loose to do our job!!

We are a fat, rich country. We have a force of men and women who are smart, flexible, competent and compassionate. I can think of no shipmate of mine, past or present, who would not drop everything and run to aid if the Commandant just said so.

We're helpless. We don't have to be.

Dammit! Dammit! Dammit!

--maddog

Hindsight, Foresight and why I suck at school...

I'm looking back upon my last academic semester and I am not pleased. I felt that the entire semester was a struggle to keep up. I finished with 4 B's and and A. I passed, yes. Where I feel I did poorly is that I did not finish with the level of understanding I should have had.

Cardiology, for example: I'm still don't have a clear grasp of how the drugs we administer for cardiac emergencies work. That is to say, I don't understand them enough to be able to figure out which one goes for which arrhythmia. I only know them from rote memorization and some great memorization tricks. I ended the semester feeling lucky that I passed rather than feeling that I passed because I learned what I was supposed to.

In a field where knowledge and understanding affect other's lives, I'm shaken to realize that I may care for patients based on rote memorization. Is that fair to the people I treat?

I have felt that I've spent the entire semester trying to keep up with what I have to know to pass the tests and not spending any time learning the material. Miserable, I know. College is supposed to be a time where I'm full of excitement and wonder at all the cool things I'm learning. I've experienced that in the previous semesters. I know how to enjoy the wonder of learning and still have the discipline to get my assignments turned in on time. I'm an adult. That's what I do.

I know, I know. I've had some "acceptable" distractions: Non-stop school since last January, soon-to-be-adopted twins, dead soon-to-be-adopted twins, my uncle dies, my beloved mother-in-law dies and I moved twice.

It's enough to make Socrates stop asking questions! I know!

It is not an excuse. I HATE excuses.

All this self-recrimination aside, what I really need to look at is my attitude towards learning. In the 13 years between the first and second semesters of my Freshman year, I attended a lot of classes. These were classes that were given on a work related basis. Military training, law enforcement academy, technical schools, and much more. They were all driven by learning a bunch of specific, ordered objectives and were easy to map out. I had a clear list of what I was expected to regurgitate or know and I performed within those parameters in order to pass the course. Not a whole lot of actual thinking was required

Often times, the real learning did not occur until I went out to apply those skills in "the world." Working with another officer, another engineer, another crewman (or woman) gave me the necessary experience to apply what I had learned and give me the opportunity to screw up without causing too much harm.

I'm sure there are those of you out there who have met 'Medics who don't think too much and do everything by rote. That is, most emphatically, not my goal. I can be a basic EMT and do everything that way but I want to be a Paramedic. The more I learn about this profession, the more I learn that I must be thinking, diagnosing and analyzing, all the time. I must take nothing for granted and always be ready to change.

Therein lies the fear from my last semester. I fear I haven't learned enough. I've passed the tests but, standing next to my classmates, I feel profoundly stupid.

Well, I'm a "can-do" kind of person. I would not be me if I wasn't thinking of how to fix this problem. Here's my approach: I will take advantage of the next 4 weeks of break to enjoy the "learning" part that I missed last semester. I'll throw myself into the world of cardiology, pharmacology and more with the enthusiasm of a true maven. In the next (Spring) semester, I resolve to enjoy and learn. I will not bog myself down with the worries of trying to meet specific criteria. They'll come easily if I know the material. I'll know the material if I'm enthusiastic about it and, finally, I'll be enthusiastic about it if I take the time to enjoy it.

Lao Tzu talks a lot about the "Art of Non-doing." Now, I'm no ancient sage but it sounds good to me. I'll just do my best to emulate my "Study Monkey":




I love that smile!!

--maddog

Santa Was Good To Me!

Right after finals, I was hurled into the holidays and have been catching up on all the parties and shopping I had been neglecting in order to study.

Fortunately Santa was very kind to me:




My mother says I was born in the year of the monkey and when she saw this, she shrieked aloud.

I love it.

I'll be posting a ton this week, I promise. I have much to tell and more questions to answer from my querilous reader from Japan.

Thanks for your patience and Happy Holidays.

--maddog

Finals, Haiku, Rockin' Irish music and Guinness...

I'm in the throes of final exams for the semester right now. They end on Monday.

So far I've only killed 3 patients during my practical exams...

A haiku for you:

Finals Loom
Tension-twisted guts
Must Not Fail!

I did take a break last night to go see these guys:

http://www.gaelicstorm.com/

The last time I saw them I was brought on stage to race a few chaps to the bottom of a couple pints of stout.

I won.

--maddog

"Personal Injury after an assault, Police on scene."

I love calls that are dispatched like that. They NEVER are boring.

Romeo and I hop in the bus. Before we've gone 100 yards, we're talking about what we need on the call. Romeo has decided to leave behind his idyllic lifestyle as a twenty-something heartbreaker and become a medic in the Army Rangers. He's got an appointment with "Pre-Ranger indoctrination" and he's excited about both being a medic and being a Ranger.

"O2 bag, Aide Bag (our usual "all around" kit) and the suction unit." says I.

"Suction?" asks Romeo.

"You ever been popped in the mouth?" I ask him.

"Oh yeah!" He says. We understand each other.

What this means to me is that he takes EMS as seriously as I do. We arrive at the restaurant/watering hole to see the usual scene of 2-3 police cars and a crowd of bystanders. I'm ready for a belligerent, bloody drunk who's going to alternately complain of life-threatening injuries and swear he'll kill anyone who comes near him.

A person approaches me as I step down from the ambulance. The cops don't even look my way. ...Odd!

"Hey." Says the approacher

"Who's hurt?" I ask. (Simple questions work best sometimes.)

"Me."

"You called the ambulance?"

"Yeah, I'm hurt."

Mind you, all of this dialogue is delivered clearly and without slurring by a person who has walked up to me with no apparent difficulty. I look around. Nobody else cares that there's an ambulance in front of the bar/restaurant. I guess this is it.

My patient is about 20-30 years old, black and of an indeterminate gender. Complains of head pain 8 on a scale of 1 to 10 after a police officer shoved him/her into a brick wall during a scuffle. A quick examination with my flashlight shows no swelling, bleeding or deformity on the site of pain.

"Let's go into my ambulance where the light's better."

"Ok."

In my ambulance, I discover she's female, oriented and alert and exhibits no signs of being drunk or even drinking. I conduct a physical examination of her head, palpate her cervical spine (feel her neck bones) and assess her eyes for pupil response along with horizontal and vertical nystagmus (shaky eyes that indicate either inebriation or brain damage). She comes up negative on all tests. Physically she's fine.

"Ok. Listen. I'm not a cop and I don't care what happened or why. All I care about is you. You wanna tell me what happened?"

She gives me a detailed, coherently delivered narrative of some silliness of her sister's boyfriend being drunk, the manager, an unpaid bill and a tussle involving drunks, girlfriends and cops. Apparently in the scuffle, she got shoved back and hit her head on a wall. She denies any dizziness or loss of consciousness and only complains of pain.

I tell her that I'll take her to the hospital if she wants. I also tell her that if she was my kid, I wouldn't be worried. She says she doesn't want to go to a hospital but wanted to be seen. I'm seeing that my role is an emotionally supportive one at this point and I'm OK with not transporting her to the local ED. After assuring her that she can call 911 at any time if her condition worsens and getting a signature from her, Romeo and I roll out.

"Dude! So, was he hurt?"

"SHE was fine, man." says the maddog

"Wow! I was feeling kinda weird. I thought she was pretty good looking for a guy."

"Well, Romeo, you are pretty hot, yourself, you know."

"Shut up, man!"

I'm still laughing.

--maddog

Question From a Reader, Part Four (Continued)

In a previous post, our querulous reader asked, "Have you ever answered a call and found someone had begun first-aid that was helpful (or not)?" I put out the request to my other readers for their stories but have received none. Alas. I suppose an anecdote or two of mine would be appropriate.

I ran a call for a personal injury at a local bar. It seemed that the bass player of the band had stepped on broken class from a stage light and it went right through her sandal and into her foot. From the eyewitness reports there was a copious amount of blood involved and it was quite dramatic.

When I arrived, I found an alert, oriented and somewhat attractive woman sitting in a chair sipping orange juice. Her foot was elevated on another chair and had been dressed perfectly with cloth napkins. there was 2 of them folded perfectly as a trauma pad and 2 more rolled into cravats holding them onto the wounded part of her foot.

It seems that there were 2 trauma nurses and an EMT in the audience along with a bar manager willing to give up some linens. The bandage looked very good, wasn't soaking through and her toes were showing that it was not on too tight. She told me that the nurses and the EMT cleaned out the wound with a pitcher of ice water, dressed it with the napkins and gave her some orange juice because she was feeling woozy.

At this point, considering the quality of the foot dressing, the patient's mental status (good), level of pain (low) and proximity to a hospital (almost next door), there wasn't much for me to do but load her up. We did have a large audience and many of them taxpayers in our jurisdiction. Well, I love to do my job so I methodically checked her vital signs, got a good assessment of her foot further down from the injury to check for pulse, motor ability and sensation then we loaded her up and took her to the hospital.

I think the only thing we really provided above what she got from the bystanders was a stretcher! That's a case of good first aid.

The most frequent cases of inappropriate first aid that I see are when bystanders pull people from badly deformed cars in auto accidents. This presents a real danger of aggravating a life-threatening injury that requires immobilization before moving the patient. Many times, the patients remove themselves from the automobile.

Another frequent case of inappropriate first aid that I see comes, unfortunately, from the firefighter first responders that get to the scene before me. None of them are particularly egregious but they seem to indicate either a lack of skill or care. For example:

-A 35 year old female assault victim being administered oxygen via an infant rebreather mask. I changed that one out for an adult mask from my bag to the surprised and somewhat shamefaced looks from the firefighters.

-A firefighter attempting to move a patient with abdominal evisceration by pulling on his arms over his head. A clear and authoritative, "STOP!" put an end to that attempt.

-A patient having trouble breathing being administered 6 liters per minute of Oxygen via a Nasal Cannula and the nasal ports are not even pointing into the patient's nose. A nasal cannula is a tube with 2 holes in it that sits under the nostrils to supply oxygen. Useless for a patient that's breathing through their mouth and completely useless for a patient that's having trouble breathing.

-A hypothermic patient being treated with blankets and hot packs. What's wrong with that, you ask? They were being placed on TOP of the patient's wet, cold, cotton clothing. ("Hypothermia = Naked, no exceptions!" says I to the firefighters as I'm pulling off the patient's wet socks and shoes)

I don't have any particularly funny stories of inappropriate first aid. Voodoo and Santoria are not common in my area. I can imagine all kinds of stories of strange home remedies and odd poultices but, alas, I have none to tell myself.

How about my readers? Got any to share? Email me or drop it in the comments below.

--maddog