Here's your sign...

It sounded like a dying camel. We could hear it from the front porch. My partner and I looked at each other with quizzical expressions on our faces.

The lady was rolling around on the ground in a t shirt, her underwear, and socks. The animal noises were coming from deep in her throat. Her family members were standing around in tears, looking bewildered.

"What happened?" I asked.

The family told us that the pt had been using a steamer machine to remove wallpaper when it began to leak. She knelt down to open the lid and it flew off, spewing hot water and steam everywhere. She ripped her jeans off and had been screaming in pain and agony ever since then.

"Let me look." I begged her. She continued to scream and hyperventilate. My partner finally grabbed her face with his hands and sternly to her to calm down. He made eye contact with her and told her that he knew she was hurting and in pain but we needed her to calm down a little bit so that we could help her.

Her leg was burned badly. There were several areas that were full thickness, the rest partial thickness burns. That's new terminology for 2nd and 3rd degree burns. The skin was peeling and sloughing off and you could tell that the one leg was already so much more swollen than the other.

"Ma'am, you have to calm down. Take slow deep breaths. Help us to help you", I said.

We helped her to the cot and got her prepared for transport. She couldn't sit still and I was worried about her tipping us off balance and potentially injuring one of the 3 of us.

"Medic xyz to dispatch"

"Go ahead, medic xyz"

"Dispatch, you're going to have to send us some help here"

"10-4 medic xyz, I'll get anytown fire department en route"

They should have been sent anyway, but that is beside the point. Sometimes we have glitches in the mutual aid agreement---that's the subject of another blog entirely.

So, we get the pt loaded in the back of the truck. My partner got her vitals, obtained IV access, and started to provide wound care.

The Anytown firefighters stuck their head in both doors and asked what we needed.

"I think we're ok back here, can you just drive us in?" I asked.

"Sure thing! Whatever you need."

I got her 10 mg of Morphine and told her to let me know if she started to feel sick to her stomach, I'd get her some phenergan too.

We wrapped her leg in a sterile burn sheet and began irrigating it. The relief was instantaneous---the cool sterile water combined with the morphine gave her some measure of distraction from the intense pain.

"You're an angel", she said to me. "And you're not too bad yourself", she said to my partner.

I notified the ED of her status by radio and we rigged up a continuous drip for irrigation with an IV bag and a 16 gauge catheter. Just before we got to the ED, I gave her another 10 mg of Morphine.

We got her inside and I gave report to the RN who would be taking care of her.

I called later to the ED and they said she had been sent home, to follow up in the morning with the local burn clinic.

Folks, please don't open a pressurized cap until it has cooled off. Serious injuries, burns, loss of life, and incredible pain can result. It is pressurized for a reason and the liquid inside is is generally very hot. This includes radiator caps, small household appliances, and other tools.

Happy Holidays.

A wonderful blog I found the other day. Those who are in the medical field will surely appreciate the descriptions about family members.

"I don't have any insurance"

The man was sitting in his car after just having falling in a public parking lot. The bones in his arm were obviously shattered and it was clear that he was in a severe amount of pain.

"Let us take you to the hospital", I pleaded.

"No I can't", said the man.

"Why not?" I asked.

"Because I don't have any insurance" he said.

The sad fact of life is that millions of Americans are uninsured and don't have any health insurance. Even worse is that they let that fact dictate whether or not the seek medical care and/or treatment.

In my career, I've run into multitudes of people who have no insurance and clearly are in need of medical care. Their problems run the gamut from injuries they've sustained in motor vehicle accidents, broken bones, heart attacks, diabetic problems, chronic pain, and various other ailments.

These folks my heart goes out to because I've walked miles in their shoes. And I beg them not to allow their financial situations dictate if they get care or not, especially if they truly need it. I tell them that we take payments and will work things out with them. I tell them that the hospitals will accept as little a $5 a month as long as they pay something. I appeal to their sense of gloom and doom and will just about do anything to encourage them to go.

Sometimes it works....Sometimes it doesn't.

Then there are the folks who are on state medical aid and think that their state medical card is like a taxi voucher. They think that every time they need to go to the doctor, it necessitates a trip via an ambulance to the local ED. I still work in a system that practices "you call, we haul". Whether or not the person truly needs ambulance transportation, we can not refuse to take them.

Stubbed toe? Hop in!

Nasty pimple on your face? Hop in!

Cut on your finger? Hop in!

Before I get more nasty emails, let me first say that we shouldn't be denying people medical care at all. However, there is a better way for utilizing emergency services so that a Paramedic staffed ambulance is available to the people that truly need it. I can't tell you how many times I've been on a call with someone who didn't need transport by ambulance and had alternate means to get a doctor's office or the ED and the standby unit has been called to an active MI or cardiac arrest, or a major traumatic incident and we couldn't leave the patient with a stubbed toe.

That is so frustrating to me. Knowing that we could potentially save someone's life, someone who truly needs medical care and we are tied up with someone who is too lazy to get their spouse to drive them to the hospital.

And to have someone refuse medical care or transportation simply because they don't have insurance is ludicris. If I'm having a heart attack, I'm getting care regardless of my insurance status. I'll worry about the bill later, when I'm healthy and back on my feet. I've walked down that path before. I was hospitalized a number of years ago for almost 9 days and I didn't have insurance. I wound up without a diagnosis AND nearly $75,000 in medical bills. Thank GOD for medi-cal. They paid retroactive for the month and my portion was $400. But you see, my health is more important. I'll get the care that I need and I'll worry about the finances later.

The man I had the above conversation with? He finally agreed to go, fractured arm and all. I'd like to say that my sweet nature and caring attitude convinced him to go. I'd love to take the credit for it. But I can't. No, the credit rests solely in the hands of my dear friend, Morphine Sulfate. It's a beautiful thing, those pain meds.

"Come with me, sir. We have pain medicine. I'll make sure you are comfortable."

After all, isn't that our job? Relieving suffering and treating pain? Tending to the souls of our patients?

Be safe out there. And please, get medical insurance if it's available to you. I don't like to beg so please don't make me.