Generally speaking, we are there to provide service, if needed, for the players, umpires and other on-field personnel. Service for fans is provided by First-Aid teams scattered around the stadium. We also assign one paramedic to standby in the First Aid room to  assist those teams as well.

The Twins have a  new ballpark, Target Field, and I can’t add anything to the superlatives that have all ready been written about this place – except to say that it is the nicest sports venue I’ve ever been in.

The move from the Metro Dome to the new facility has involved an awful lot of planning. But, as Robert Burns famously said,  “The best laid plans o’ mice an’ men gang afta-gley.”

The fans have to learn the best route to the ballpark, and where to park. The ballplayers have to learn “the hop” on infield grounders and the carom off the wall. Manager Ron Gardenhire has to figure out where to stand in the dugout. The concessionaires have a lot to think about, as do the ticket-takers. Police, security and the general operation people have to shoe-horn the old procedures into the new operational reality. In other words, a lot of people are running around and scratching their heads.

Most agree that it will take the entire season to get every thing figured out.

How does the new facility effect the Paramedics? Well, there are not a lot of jobs that put a guy in a situation where some body’s life could be on the line (in a worse-case scenario) and you are called to perform in front of 40,000 people, network cameras and You Tube.

To put it mildly, we have a lot of issues to think through.

I worked the first two exhibition games where the Twins played the Cardinals. We have been posted in the camera well adjacent to the Twins’ dugout. The first thing we noticed was that, once we entered the hallway leading to the camera well from the Clubhouse, the door locked behind us. This isn’t good – our equipment is on the other side. That problem was solved by getting us a key fob that opened every secure door in the stadium.This is good for the medics, but gives Twins security something else to think about.

This camera well was built for, well, those who produce video and those who are credentialed photographers. The hallway is also used by the grounds crew, a group of about 10 guys who run out about every 3 innings to tend to the field. Sports reporters are also in and out of there, as they also are trying to figure out the best way to cover the game.

Consequently, I frequently found myself moving around, saying “excuse me,” a lot and trying to keep my ugly mug off the big screen in center field (I failed in this regard). In other words, we are the least important guys in that area…until…

Something Bad Happens.

It is then that the situation changes and all focus is on the victim and the people who come to their aid.

That’s when my obsequiousness ends and command of the situation passes to me and my partner. It is the expectation that we will perform tasks and give orders and that all will run smoothly. Command and control of emergency medical scenes is what I do for a living. I’ll be the first to tell you that “we ain’t there yet” if an emergency would happen on the field.

But we are getting close. We have had nothing but the best relations with the Minnesota Twins. This is a first class operation that is doing its utmost to make sure that things go well in the case of a medical emergency.

Things will get ironed out. Its just going to take a little while.

They will also christen the newest ball park in Major League Baseball, Target Field.

I’m working both these games as a medic. While I missed our tours of the facility, Those who went told me it’s a terrific stadium.

There are undoubtedly going to be some operational “bugs”  to be worked out over the course of the season Our concern will be the logistics of how the field medics interact with the Twins medical team. Preliminary plans have been made, but things always seem to change as we all put our heads together and attempt to determine the best way to perform our various duties.

There will be some initial confusion but it all will work itself out – but I do hear that I had better bring the raincoat Friday night.

Wonder when the Twins last had a rain-out for a home game?

For the first time, we will also have a medic with the First Aid team that responds to calls in the stands. This will probably be less of a hassle due to the fact that this same team of volunteers are a carry-over from the MetroDome and have been busy practicing patient extrication from the stands for several weeks now. Historically, they have really done a nice job.

Additionally, I will also be working the TimberWolves game Saturday night and I would be remiss if I did not say that the Wolves and Target Center handle their public safety responsibilities better than any other organization I have been associated with.

My agitated response appeared in Ambulance Driver the same day as the Whistleblower report.

Whistleblower has a follow-up today in which Erica A. Brix, senior plant manager at the Post Office, refuses to throw away the shovel.

She essentially gives two reasons for denying the request. The first is the 3.5 minute reponse time for EMS to arrive at the scene. This is a bogus response time. She is referring to the average time it takes for an ambulance to pull up to the curb, after the call is received by the ambulance. It does not take into account the amount of time  to actually place the call to 911 after the patient collapses, for the call taker to process the call, for the call to be transferred to the ambulance dispatcher, for the dispatcher to determine where the closest ambulance is located and the amount of time for the medics to load their gear on the stretcher (after they pull up to the curb) and walk into this large facility and to the patient’s side.

Now don’t get me wrong – all this happens fairly quickly. But to assert that EMS can arrive at a patient’s side in 3.5 minutes after a person suffers cardiac arrest shows just how clueless Ms. Brix is about this issue – even after months of study.

Cost is the second factor, it is contended. They claim they are going to need 18 AED’s to adequately supply the facility. Now think of that. The Postal Workers asked to place ONE DONATED machine in a central location and the bureaucrats said, “Nope, we can’t afford 18.”  What does that tell us about bloated federal programs? Government thinking if I ever saw it.

Ms. Brix also indicates that the facility already has a CPR and First Aid program. As far as I know, any CPR training that I am aware of requires training for AED use.

I don’t know where the National Medical Director of the Postal Service came up with his numbers for cost, but if the device is donated, all you need is an extra set of batteries, which have a life expectancy of several years ($200 bucks) and an extra set of pads for $20 – which need replaced every two years.

They admit the training program is already in place,  they have at least one machine donated, and their understanding of response times is flawed.

Give these folks their AED, you look like a bunch of fools.

1. A female who was so short of breath she could barely speak to the 911 operator.

2. A patient with multiple medical problems was experiencing rectal bleeding. This illicited a chuckle from me because the medic on this call has a well known aversion to anything coming out of the rectum.

3. An elderly patient suffering from a seizure.

4. A nosebleed called in from a physician at a clinic. This is a rare call, doctors would usually have no problem with this complaint.

5. A nosebleed from an elderly man calling from home. This is a very common 911 cal.

6. A person in their 20’s found unconscious. The caller suspected a drug overdose.

7. A transfer from an emergency room to a hyperbaric chamber.

8. New confusion in a nursing home patient.

9. A patient of middle age having chest pain and shortness of breath.

10. A fall in a nursing home with a suspected fracture hip.

11. A call from a physician asking that police and ambulance respond to a  home to place a mentally ill patient on a transportation hold for evaluation.

The Daily Snapshot is intended to demonstrate the varied patient complaints that EMS personnel are called upon to care for.

We were called to a “Wet House” (which I will describe below) and found an intoxicated individual lying in his bed. There were stool and urine all over the floor and his bed clothes were soaked with the same. He was awake, spoke in a monotone and had just awful color. He gave us a history of pancreatitis and GI bleeds that were associated with his chronic alcoholism. His main complaint today was black stools (indicating the presence of blood) and abdominal pain probably caused by the pancreatitis.

He had been having pain, diarrhea stools and vomiting for several days. He admitted to a 2 week binge of drinking a liter of vodka a day, though it is likely the time frame was closer to 2 months.

We got him on the stretcher without getting “dirty” ourselves – which was quite the trick considering that he been rolling around in soiled bedding, fully clothed for quite some time.

We then asked him about any medicines and he pointed to a couple of bottles on a bed side table. On reentering the room, I found that it was going to be impossible to reach the bottles without stepping in stuff I’d rather leave behind. It was then that I noticed a few boxes, plastic garbage bags and paper sacks at my feet. Inside were found at least 200 prescription bottles, every one of which appeared to be full.

Now we frequently see folks that are non-compliant with their meds, but never have I seen so many medicines left untouched.

 My immediate thought was: “I don’t care what the Department policy is, I’m not going to write all these down.”

We were left with three options:

1. Declare a hazardous materials emergency and call in the Fire Department.

2. Pretend we didn’t see the bottles and just leave them behind.

3. Bag everything up and take them with us.

 I asked the staffer if she had a garbage bag – a Big garbage bag. She soon returned with a bag the size you would use to rake leaves into in the Fall. We filled it up beyond half-way. As my partner slung it over his shoulder, I swore he could’ve passed for Santa Clause, except Santa has more hair on his head.

 To make a long story short, we got him to the hospital.

 ”Wet Houses” are facilities for the destitute chronic inebriates who have failed time and again to dry out. The purpose is to give them a safe place to drink. In fact, this place has a sign posted by the elevator that reads, “Drink if you want to. Stay sober if you have to.” 

They are assigned to a space about the size of a college dorm room. There is no meals provided. There is a staff that oversees the operation. If memory serves, the cost to state government is about $1300/mon. They are also provided a type of bank card in which the state deposits about $150 a month for food. In addition, they are provided a little over $200 in a monthly payment.

But the $20,000 a year described above does not yet cover their expenses. Folks like this are huge consumers of health care services. The program that this patient and the one described in the last posting has over 30,000 enrollees that have incomes of less than $7500 a year. They incur health care costs to the state of over $1000 per month per person. But that still isn’t the whole story. The reimbursements the state pays to the providers of this care is significantly less than the total cost of the service.

So how does the provider make up the difference? They charge everybody else more. That’s you and me folks. Our insurance premiums are higher and our out of pocket expenses are higher due to care given to those who cannot pay and depend on government.

 I’m not claiming that every one of those 30,000 people are drunks and beyond help. But I will assert that a significant percentage of them are and it is costing a fortune. In this instance there were several thousands of dollars of medicines in that bag which will be simply thrown away – paid for with taxpayer money.

The cost of this particular program is rising at a rate of 18% a year. Simple math tells us that the cost will double every 4 years with that level of yearly increases – and it already is a $1 billion item in the state budget.

What we are doing here is not working. The sad part is that society has tried every reasonable (and unreasonable) way to try to help people like this and none of it works. We simply end up enabling behavior and calling it compassion.

I want to talk about the Hall of Famers, the chronic inebriates, those who have not seen a sober moment in years and attempt, if they have found themselves sober, to do everything they can to remedy the situation.

Two patients in recent weeks stand out in the annals of drunkedness and merit some discussion. The first will be dealt with in this posting

This was a fellow that was found unconscious lying on a sidewalk.  He reeked of alcohol. His best response to hard pain stimulus was to raise his head and grunt. Despite this, his blood pressure, pulse, ventilations and oxygen saturation were normal. He had no sign of trauma and the blood sugar was normal. Given that my partner and I have over 70 years experience, we were able to quickly diagnose the patient’s problem.

He was drunk.

Now I know what you’re thinking – “Those medics are sharp as tacks.”

Well, its not quite that simple. Yes, he was drunk, but this is where a little discernment is required. This patient is not one of those who can just be taken to a facility where he can sleep it off. His level of consciousness was so decreased that he was in a potentially dangerous situation. It is also possible that my partner and I had completely missed something obvious – although we try not to let that happen, as a rule.  At any rate this patient needed to be taken to an emergency room where he would be monitored closely.

And I’m not talking about just any emergency room. Patients such as these need a place where the personnel are used to dealing with those deeply intoxicated and understand the need for close monitoring. Not all ER’s can be trusted with this in my opinion.

A lot of things can happen as they detoxify. They could vomit and aspirate at any time. They are in danger of hypoventilation, where they are so neurologically depressed that their breathing becomes so inadequate that they stop altogether. They can awake in a 2-3 hours and not fully appreciate why they are lying on a hospital bed and start throwing things around – like nurses.

So what we did was to initiate our protocols for an unconscious patient of unknown origin and transported to an appropriate ER. Once there we were asked if the patient could go to the area where the less intoxicated go to sleep it off.

Our answer was “no”, not until he is evaluated by a physician. The Doctor soon appeared and agreed that the patient was too “down” and needed admission to the main ER.

Up to this point, all of this is fairly routine. It’s what we found out next that makes this a little more interesting.

I don’t know how many of you have seen how a breathalyzer works but here is what they look like:

What you need to do in order to get an accurate reading is to blow HARD into that little plastic tube until the operator tells you to stop.

Well, for this patient, having him to blow hard was not going to happen, so they merely stuck the tube in his mouth and obtained a “passive BAC.”

Which resulted in a measurement of 0.419%.  This is the mark of a true professional.

But that’s not the end of it. A nurse walked in and shook her head stating, “He was in here 2 days ago with a blood-drawn BAC of 0.80%.”

Now over the years I’ve found that 0.50 isn’t all that rare. I’ve had several patients over 0.60 and even one who measured 0.65 who was standing erect, swinging his arms around and loudly telling everyone he was going to kick my ass.

I’ve heard of 0.75% at my hospital – but I’ve never heard of 0.80% BAC.

Think of it. First of all this guy had to drink enough to get to 0.80, which is quite an accomplishment in and of itself, but then he had to live through it. In addition to that, he had to sober up in the hospital, (and I’m sure that was an all-day thing)  gather his wits, get discharged from the hospital, get outside and say, ” Ya know, that was fun. I think I’ll do it again.”

Now, my readers not in the medical profession may chuckle and shake their heads. My colleagues may shrug their shoulders. What we all need to think about, however, is the impact of folks like this on our health care system and the costs incurred in taking care of this patient over a course of years.

It ain’t a pretty scenario. It is also something that no one wants to talk about.

My next posting will drive this point home.

As a native born Hoosier I was very pleased to watch Butler’s win over Kansas State yesterday. It was not an upset.

Butler entered the ranks of top-notch college programs years ago due to its performance against teams from the major conferences. Having Butler on your non-conference schedule has generally  proven to be a losing proposition.

Butler also has the honor of playing in what I consider to be the finest basketball arena in the world. Hinkle Fieldhouse was built in 1928 and its large size helped transform basketball in the late 1920’s and 1930’s. It is the oldest of the major college basketball fieldhouses and still the largest at a private institution.

In my youth I was a frequent visitor. I saw Pete Maravich play there and saw Adolph Rupp and Hank Ida coach there. Last summer, my youngest son and I walked in the door. It was my first visit in over 30 years. While some renovations had been made, it was the same old place.

1) An elderly gentleman fell in his apartment resulting in some vague pain in pelvis area. No obvious fracture.

Since it was obvious that today was going to be very slow, at 1030am I jotted down the runs my department was responding to at that moment:

1) A person who slipped and fell in a church parking lot.

2) A baby vomiting and coughing

3) Chest pain in a person with  a history of a heart attack

4) Child who had a seizure

5) An elderly patient who fell in the home

6) A pregnant woman with vaginal bleeding after trauma the night before.

That will do it. We will see if tomorrow is any busier.

Kinda like how Medicaid is and how ObamaCare would be.

I urge you to follow the link Mitch provides to the NPR story (where you can read the transcript or listen to the playback) and then read his thoughts.

1) The first call of the day was for a toothache, which is not as unusual as one may think. This was also the second call for this patient in the last 8 hours. Had gotten pennicillin and a pain medication on the first visit. The tooth still hurt. But, you can hardly blame the patient for running up several thousand dollars in medical bills, they are on Medical Assistance and those folks don’t pay a cent for the care they receive.

2) This patient fell on the ice this morning. Poor English. Has a history of  liver disease and is a diabetic. The fall resulted in back pain with the severity of the injury unknown, but not thought to be serious. This patient is on General Assistance Medical Care.

3) This patient was intoxicated, lying on the sidewalk not able to walk. Has a history of mental health problems. On Medical Assistance.

4) This patient fell on the ice and had pelvic pain with no obvious fractures. This patient had private insurance with premiums that are made more expensive due to patients like 1), 2) and 3).

5) Was a seizure patient at one of the shelters. He recovered quickly said he lived out of state and his ID showed that. HE was on General Assistance Medical Care.

6) Was an elderly lady with diabetes and whose feet were so bad she finally couldn’t get around. Grandson had tried to transport, but just couldn’t manage it.

7) False medical alarm, cancelled upon arrival.

Was for an auto accident with no injuries.

Yep, it was a rainy, icy windy day and the Ambulance Driver arrived home in a grumpy mood.

Go Vikings

For some reason my 8’s show as a smiley face. I’m too stupid to know why and too lazy to find out. Read nothing into it.