Ambulance Driver

Since Gubernatorial candidate Mark Dayton’s revelation late last month in the Star-Tribune that he is a recovering alcoholic and has been suffering from mild depression all of his adult life, local media have struggled on how to properly report the issue – or whether to report it at all.

David Brauer of MinnPost had thoughts that were introspective and gleaned from painful experience:

….depression is the struggle of my life, from the insomnia and obsessiveness that has me up at 4 a.m. chewing over this topic, to bouts of withdrawing from my family and the physical world. Trust me, if I were running for governor, I’d regard my depression and the resulting stress-triggered struggles as something the public should know.

Others, such as Minnesota Public Radio’s Bob Collins, seem to think we should be careful:

It’s a slippery slope that the most influential news organization in Minnesota has decided to take us down, particularly when an alternative is a thorough examination of vision and ideas of candidates.

MPR has covered this story fairly extensively and in a seemingly even-handed manner. Kerri Miller’s Mid Morning show on 1/13/10 was particularly good.

There are, however, quite a few unanswered questions in my mind.

1. Mark Dayton’s mental illness has been known to me for 10 years. It is one of the poorest kept secrets in Minnesota politics. I refuse to believe that a significant number of Twin City journalists did not know of it. Why the current self-flagellation when it seems the media had already made a judgment on the issue’s  newsworthiness?
2. Dayton is the source of the disclosure and news reports state repeatedly that he will not be more specific about the circumstances of his illness. Many have praised his honesty in this admission but questions remain. How do we know what his diagnosis is? Verifying that he suffers only from “mild depression” would go a long way in putting the issue to rest.
3. Substance abuse and mental illness often go hand in hand due to the patient’s attempts to “self medicate.” When Dayton’s alcohol consumption ended up with an admission to a treatment program, had he been compliant with his medicine regimen? A simple question would be, “Has your history included periods where you were non-compliant with your medications?”
4. Another question that has been asked, but bears repeating, is whether or not Dayton’s mental illness has affected his job performance. Indications have been that the execution of his office as US Senator left something to be desired.

Mark Dayton’s illness does not make him a bad fellow and doesn’t necessarily disqualify him for public office. However, that is a question for an informed public to decide. The journalists in this town have quite a lot of follow-up to do before his fitness for duty can be determined.

An Automatic External Defibrillator (AED), pictured left,  is a life-saving tool that   is  becoming  common place in today’s society. They have a proven track record for delivering  definitive care for those who have suffered a cardiac arrest. They are light weight, very simple to use (they talk to you), and provide the treatment of choice in a large number of cardiac arrest states. These things save lives.

Unfortunately, the United States Postal Service can’t seem to get its bureaucracy to approve the installation of an AED that is going to be donated to its downtown Minneapolis facility.

As the Minneapolis Star Tribune reports today, it has been 7 months since a worker at the facility died as a result of a cardiac arrest. Since then, his co-workers have tried in vain to get the upper-echelon paper pushers to approve their request – even though one is being donated.

Sure, the Post Office spokesman had a myriad of excuses:

“We can’t just make a local decision,” Nowacki said. “There are processes and things like that within the Postal Service.”

That was spoken like a true Government worker, don’t you think?

The article goes on to say that the spokesman denied the urgency of the request, in part due to the 4 minute response time of the paramedics from Hennepin County Medical Center.

I’ve responded to the downtown post office numerous times. As the workers attest in the article, it is a vast space. Their assertion that it actually took 13 minutes for the medics to arrive at the side of the patient does not surprise me a bit. Having an AED at the patient’s side immediately is much preferable to having to wait for me to show up.

And the spokesman just couldn’t stop digging:

Nowacki said the Postal Service couldn’t move forward, however, until the facility first updated its CPR certification. That process was completed Dec. 1, so a formal request will go to regional headquarters in the next few days, he said.

Nowacki estimated the facility would need 15 defibrillators, and that any decision to employ them must fit in with the “overall safety program” for 14,000 local postal employees.

When you go to the airport, the malls, the skyways or hundreds of other places where you see AED’s, you are not going to see a sign which says “DO NOT USE UNLESS YOU ARE CERTIFIED IN CPR.” As stated before, these machines are fool-proof. As long as you get the lid open, you’re home free. It starts talking to you and gives very simple instructions. Any moron can use one of these things.

They also assert that they need 15 devices. Well, knock yourself out. Go ahead, if you think you must. But that does not preclude placing ONE in a central location where everyone could know where it is.  I bet you could even get a couple of employees to mount it on the wall for you free of charge – except I’m sure there are regulations about that as well.

Well, anyway, I suppose the Postal Service employees can expect to see their new AED sometime in the next couple of years. Meanwhile let’s salute a group of federal workers who are trying like hell to do the right thing.

I Blame Bush

We had 70 runs today during my shift. Ambulance Driver was assigned 7 of them.

• Call #1 was for a non-English speaking patient with back pain that resulted from a chronic condition. A friend was present that spoke passable English and was able to translate. Patient was given pain medication and transported. The funny thing about this call was the friend. He was an amiable sort and was very helpful. As we lifted the patient from the floor, the guy was giving us directions. His last bit of help was a lusty, “one, two, three,” followed by a grunt. We got a kick out of it. We told him that he was going to assimilate well into this culture.
• Call #2 was for a young patient with abdominal pain that had been persistent for a couple of weeks. Had not had nausea, change of stools, fever or recent history of trauma.
• Call #3 involved a foreign visitor to this country with a fever and hypotension. Also nausea, vomiting and diarrhea. Very pale and weak as well. Sad thing about this was the patient had no insurance but had to go by ambulance. Ouch.
• Call #4 was for a very elderly patient who stumbled getting on a city bus. No obvious injury but was aphasic and could not write. The patient seemed to understand what was being said but had a very hard time communicating. This condition was obviously chronic. The patient provided a phone number but no one was home. We transported to the nearest hospital to let them sort it out.
• Call #5 was for a seizure patient housed in a shelter for those with chemical dependency issues.
• Call # 6 found us in the home of an elderly patient who had fallen in the home and discovered by “Meals on Wheels.” Patient had been lying there for several hours.
• Call #7 was for a patient who had gall bladder problems and had been putting off surgery for several months. Now had very severe upper right quadrant abdominal pain.

It was a busy enough day to keep us interested and the time went by fairly quickly. See you tomorrow.

Let’s say you went to get an oil change for your car. Upon driving in, you asked the attendant what the price would be for the service. “I don’t know,” he replies.

He hands you a telephone number to call for pricing information. You find yourself on hold for several minutes but finally discover that the oil change will cost $50.

“Wait a minute,” you tell the attendant. “That is way more than I’m prepared to pay.”

“Too late,” you’re told. “The job is already done.”

Outrageous? Sure it is. But that is what reportedly happened to to a Hopkins, MN couple during an emergency room visit at a Twin Cities’ hospital.

Stories such as these are always difficult to unravel. One always questions whether the story is true and/or complete. The public is woefully ignorant on the subject of health care delivery and providers have a history of not being terribly forthcoming in explaining things. On top of that, news reporters are notorious for inaccuracy when writing about health care.

Nevertheless, this story has the ring of truth to it, in my opinion.

First of all, why couldn’t the hospital give pricing information when requested? Answer – there is no good reason, expect for the fact that no one in health care knows (or seemingly cares) what anything costs. To simply give the customer a phone number so he can investigate the matter himself is ridiculous.

Secondly, there was no reason that the scan could not have waited until the customer’s questions were answered to their satisfaction. No emergency existed. For the hospital to rush this procedure in the manner reported and not allowing the customer to make an informed decision is just a poor business practice.

If this situation occurred as reported, then I’m afraid that the hospital in question is way out of bounds.

The service responded to 83 911 calls during my 12 hour shift today. Ambulance Driver was assigned 6 of them.

• Call #1 was for a man who had subtle complaints of “just not feeling well.” He was hypertensive with a pulse rate too fast for me to count. EKG showed him to be in a supraventricular tachycardia with a rate of 200 beats per minute. The administration of 6 mg of Adenosine broke the rhythm and he settled into a atrial fibrillation with a rate of 90.
• Call #2 was for an elderly man in a nursing home who suddenly developed a fever. He was weak as a kitten, had a decreased level of consciousness, fever of 102 and with a low blood pressure.
• Call#3 involved an elderly male with a history of drug seeking behavior. Appeared to be shopping for a new hospital/physician since he had been recently dropped by the last doctor.
• Call #4 was for a nursing home patient who experienced a simple partial seizure that lasted 2-3 minutes. This was apparently a first time event.
• Call #5 was to a chronic inebriate who had fallen and fractured several ribs in recent days. The patient had been to the hospital twice already and now was treating the pain with Vicodin and several bottles of mouthwash.
• Call #6 saw us walk into a scene that reminded us of the set of the Jerry Springer Show. Several women had gotten into a shouting match that had deteriorated into a knife fight. The result was minor cuts and bruises. No one wanted treatment – which was just fine by me.

This amusing story comes to us from a co-worker.

He responded to a 911 call to find a man unconscious on the floor. His friend reported that he had found him there minutes before.

“Does he take medicines? asked the medic.

“Yeah, he does. What was that? – Oh, I remember, ‘Peanut Butter Balls’,” he said. “That’s it.”

“Huh?” the medic replied. “Where’s the pill bottle?”

The victim’s friend handed over a bottle labeled, “Phenobarbital.”

Today was an 8 hour shift during which our service responded to 48 calls to 911. We snagged 6 of them.

• Call #1 was for a patient who was suffering an apparent allergic reaction to a prepackaged nutritional supplement. Skin was flushed with no other symptoms. Benadryl was administered.
• Call #2 involved a drunk sitting on a sidewalk and was unable to walk away. He was amiable enough and taken to Detox.
• Call #3 concerned a nursing home patient with profound hypotension. While he was mentating and sitting up when we arrived, he had no palpable pulses. Very sick individual
• Call #4 was for an apparent cellulitis that had caused a leg to swell about three times the normal size. It occurred over night. Patient could not bear weight. Luckily, they were not heavy.
• Call #5 was a young person who was either very anxious because their pulse was 140/min or had a fast pulse because they were anxious. We didn’t know which, but weren’t overly concerned either way.
• Call #6 was in response to a diabetic who knew their blood sugar was low. Turned out they were correct, the reading was less than 15. An IV bolus of Dextrose made everything better.

That’s it. Ambulance Driver is going to be a soccer dad this weekend out on the East Coast. Blogging will be minimal.

Over the past few days Ambulance Driver has had several conversations with the ambulance department operations manager concerning this blog’s 911 Update series. On my initiative alone, and not at the urging of my employer, the following changes have been made – in addition to those policies referenced here.

• My bio, which only appeared for a very few days, has been removed.
• My employer is not named on the blog
• In the 911 Update series, the reader cannot trust the day of service, the patient’s age, sex, or location. The order in which the runs occurred also cannot be trusted.

What remains could be described as a “fictionalized” account of a typical day in the life of an urban Paramedic. Were the runs actually made and was the “essence” of the calls preserved?  The answer is “yes.”  Will the reader be able to track a specific call to a specific patient?  My answer to that is, “I don’t see how anyone could.”

In addition to all of this, it has come to the Ambulance Driver’s attention that many of his co-workers are using MySpace, Facebook and Twitter in a manner that has not been as circumspect as this writer has attempted to be

Be forewarned.

Sorry, but Ambulance Driver is a couple of days behind in the Update. On March 9th our Department had 98 calls in my 12 hour shift. Busy day, but we only handled 6 of them.

• Call #1  was for a elderly lady in a nursing home that was mildly hypotensive, weak and thought to be suffering from dehydration.
• Call #2 was for a young man with a chronic disease who had stopped taking his meds and hadn’t seen a doctor for while. Ended up at a clinic wondering why he felt so bad.
• Call #3 was for a middle age man who broke his ankle running down the basement stairs. He really like the morphine.
• Call #4 was for a nursing home patient with a sudden allergic reaction that threatened to close the airway. Epinephrine and Benadryl came in very handy.
• Call # 5 involved an elderly lady with non-traumatic hip pain. Previous hip replacement
• Call #6 was for a jaywalker who got run over by a car that was exiting a parking lot. The tires ran over the paitent’s legs, at least one of which was fractured. No other injury.

A patient said something funny today and it generated an idea for a new category of posts. It will be titled, “You Can’t Make This Stuff Up.”

Under this category Ambulance Driver will relate funny things that have happened over the years either to me or my co-workers.

The first will be about a patient encounter Ambulance Driver had many years ago:

“Lord, help me,” the patient said as we arrived, “I’m having contraptions.”

“You mean contractions?” I asked, trying to be helpful.

“Yes sir, I hurt from my Eucharist all the way to my vagina bone.”