How to beat a deputy- 101

It is fun working in emergency services. I get to work with other paramedics, emergency medical technicians, fire fighters, and all different departments of law enforcement. Now, in every profession, there are the good and the really good, and then there are the bad and the really stupid.

Some people just do not see the whole picture when they are involved in a situation. This is one story that involves a sheriff deputy and an inmate in lock-up. In defense of the deputy, he was truly attempting to help an inmate. The inmate was venting his anger on the kind deputy.

Everyday there are quite a few arrest made. In larger cities, they go to a processing center called a lock-up. There the “accused” are finger printed and photographed. They also sit for a very long time waiting to see a magistrate or a judge or moved to a jail. Sometimes they are bored or just looking for sympathy to their situation. Hoping to get their “get out of jail card”, they have any medical complaint that will land them in the emergency department. Some complain of asthma, but they do not know the name of their inhaler and their lung sounds are clear as a bell. Some complain of chest pain and they will answer yes to every question.

One afternoon an inmate’s complaint was seizures. Seizures are a common ailment. The seizure in many aspects is easy to fake, unless the one you are faking knows you are faking. Being fooled many a time, I have specific signs and symptoms to look for. Some are more medically based and some are more street smart based. This day it was just as simple as watching the patient when he seized.

This inmate, “guilty till proven innocent,” was down a narrow hall and through narrower doors in a five foot by ten foot holding area. Lying down on the floor, he was drooling from the mouth. The deputy stated that he was seizing every few minutes and then would wake up cursing at the deputies just a few seconds later. I looked for my signs of a seizure: urine in pants, mouth trauma, and the unresponsive time after a seizure. He did not have any.

I made a comment to him of how he needed to wake up and talk. I made it nicely. There was still no response. I used my back up, an ammonia cap. There is nothing like a nice burning in the nose to wake a person up. This did the trick until the burning went away.

What happened next was nothing less than hilarious. The patient took a quick, and purposeful, look around and began to “seize.” That is, he rolled his eyes back and balled up his fist and began punching the deputy. Everyone else was trying to help him, give him oxygen, hold him down, and protect him. I sat back and laughed, very loud.

I got some funny looks. I finally told the deputy what the patient was doing. Amazingly it stopped right then. Just pointing to the patient I said, “Got ya.”

To stay in lock-up, the hospital needed to evaluate the patient. At the time, there were several law suites of people in lock up dying of medical conditions, so every went out. To get him out of such a narrow spot we used a Reeves Stretcher. Lifting the patient off the floor, he would start to “seize." That was, to ball up his fist and hit any officer in sight, he never hit an EMS provider. Tired of this game I started an IV. With a syringe full of Valium, I began treating this poor patients’ multiple seizers. As the patient suddenly awoke after a short seizure, I was pushing the medicine. He did not have but five little milligrams of Valium but it took that big guy down. He soon began “seizing” again, but this time it was like slow motions of swatting flies.

On my report to the hospital, trying to keep it less than 30 seconds, I simple gave the patient age, the pick up location, and how I treated the patients’ pseudo-seizures (fake seizures.) There was quite a long pause and simple reply, “10-4.”

At the hospital, I turned the patient over to the doctor with the same simple report. She looked at me and laughed then signed my call sheet approving of the treatment and narcotics used.

The He-She-It

In big cities, and even small cities trying to be big, there are always groups that stay together. A few examples of these groups are the Latinos, Irish, Chinese, and then there are the He-She-Its. This is one of my embarrassing moments working in their world.

Working in a very violent town gives opportunity to run calls with variety. Many of these violent calls are just a means to the end (of life). People are very creative when they plan what and how they will enact their revenge. Some are barbaric, like men when they use a knife. Men when killing with a knife, in a moment of anger, they usually will strike upwards. If they are good, or lucky, men will knick a piece of intestine and then go to the thoracic cavity puncturing a lung or clipping the heart. Some are passionate, like women when they use a knife to kill. A woman in her wrath will use a knife over-head and come down multiple times. This action if in the chest could go between ribs, again puncturing a lung or clipping the heart or a major blood vessel.

Then there is the brainless use of a gun. This method is a no brainer. Point and shoot is the KISS method to gun use. That is what happened one night, but instead of death, I was the one who learned a lesson.

Dispatched to a call in some row houses, we met the police outside of a house. The area was full of by-standers and upset friends and family. The gathering of people, from infants to senior citizens, was common when there was a shooting – which this was. The police, needless to say, did not secure the area. Escorted into the basement apartment and in the back bedroom, I found a very scantily dressed female. She was speaking very course and it was difficult to understand her. She was holding her throat and complained of pain to her throat.

This was a shooting, why was this woman complaining of her throat hurting? As requested, she moved her hand away. Dead center of her neck was a puncture wound. In the pre-hospital setting, we do not classify un-natural holes. They are not stab wounds nor are they gun shot wounds they are simply puncture wounds. Doctors and the forensic specialists go to court and debate the nature or cause of said wounds. (By they way this was a gun shot wound.)

How do I know it was a gun shot wound? The woman told me. She gave a very brief account. A man took out a gun and pointed it towards her. He was only feet away when he pulled the trigger. In a single shot missed her head, which is normal around my city, and shot her once in the throat.

There was minor external bleeding but she had a large hematoma and tenderness that run down the front side of her neck. I quickly removed her upper clothing to examine the chest and listen to her lung sounds. She had wet lung sounds on the right side, which happened to be the side of the pain. During all of this, she was screaming, kind of. Many times the only way I could calm her was to say, “You need to calm down now sweet-heart.” It seemed to work well, so I stuck with it.

She was now complaining of difficulty breathing. The closest trauma center was only fifteen blocks away. We did all the treatments quickly and to the hospital we went.

To help calm her I would say “Sweet-heart” at the beginning of everything from treatments to movements to what to expect once she got to the hospital. All of the “sweet hearts” seemed to work and served the purpose well.

We arrived at the hospital about 15 minutes from patient contact, which is not a bad time for contact to ED door. I had to give the report several times: over the radio, to the nurse, to the surgeon. Each time was the same. She was shot at close range signal shot to the throat. She had difficulty breathing. She was developing a hemo/pneumo-thorax, this means she was collecting blood and air where it did not belong.

Where is the KILL twist? Here it is!

I sat in the trauma room doing paperwork answering questions as they came up. During my call-sheet writing, I heard an order for a Foley to be placed. A Foley is a simple tube placed in the urethra to drain the bladder.

For obvious reasons, there are different techniques to place a Foley for a male verses a female. A female placement usually requires the knees drawn up and out. On the other hand, the male placement is swoop and jab. Both sound like a lot of fun. NOT!

I began to notice that there were no knees in the air but there was a little swooping going on.

THAT IS RIGHT!

She was a HE!

He-She-It was going through hormone therapy, which gave her/him breasts. This was one of the transgender stages before the permanent surgery. I quickly went back through my paperwork and changed the females to males.

If you do not want any more details stop now. I know you do or you would not have read to this point.

Per the police officers on scene and the officer investigating, it is expensive to do the life changing choice s/he was about to under go, so s/he supplemented her/his income by working one NIGHT. When her /his client found out SHE was a HE. The S/HE’s client shot HER. I mean He shot HIM. More details anyone?

When males try to hide their “identity,” they tie it back and hide it from the public. Yes, that means what you think it means.

YES, I went to court for this one, not the blog article, but the shooting.

Happy dreams!

Question for EMS providers

DOA's (Dead On Arrival), also known as DRT's (Dead Right There), many times have a common thread... So to other EMS providers, answer me this question...

WHY ARE DOA's ALWAYS NAKED AND FAT?

I am just throwing the question out there for consideration. It may just be where I work!

The Patient That Wishes He Were Still Dead

Each paramedic, at different stages of their career, has a favorite type of call (i.e. cardiac arrests, pregnancies, traumas). During my cardiac arrest stage, I had a save, but the story behind the life just prior to the patients’ cardiac arrest is far more entertaining.

Roaming around the city in our area was the only thing we have to do at times. This time it made my unit only a mile, at most, from a call sent out for a cardiac arrest. Dispatch assigned the call to my unit and we were off. We were able to find it quickly. I was the first in to find a female, about 40 or so, crying and pointing to the back.

I turned the corner into the bedroom and found the patient about 40 lying on the floor… naked. Not really, someone had been kind and laid a pair of boxers on top of him. I began following protocol: A, B, C’s. I did not do mouth to mouth. The first heart rhythms got the standard stack shocks (old school medicine). On television, it looks more violent than in real life. Waiting for my partner, I began doing chest compressions. My partner came in with the fire department and the rest of the equipment. I turned over the compressions to a fire fighter and began getting my IV and airway secured. Active in a new drug algorithm study I followed our protocols. Slowly the patients’ heart began to respond.

Speaking to patients whether alive or dead, I warned the patient each time prior to a defibrillation or a painful event. I call them by name and if I transport the patient to the hospital play their favorite radio station. I do not transport dead people. Soon I asked the female to come in to the bedroom. I began asking the usual questions: name, age, and birthday. Having a hard time answering the questions, I attempted to calm, reassure, and redirect her to help us. I saw her wedding band. With the missionary in me attempted to reference helping family. That was when she cried that the patient was not her husband. Ooops!

Curious, nosey, or just the real need to know, you pick one, I asked what happened prior to the patient passing out. The patient took a little pill, the one that is needed sometimes by men who are naked in the bedroom. Just prior to the act of, well you know, he literally dropped dead. Many people do not know that pharmaceutical companies discovered by accident that some high blood pressure medications had an unusual side effect that could treat erectile disfunction. Dropping dead is usually not a well-advertised side effect.

In order to expedite transport I asked the female just to meet us down at the hospital and the staff there would get the rest of the story. With the patient in the back of the unit, we went on to the hospital with a patient that had his own pulse and at times breathing on his own.

We arrived at a hospital that has hypothermic treatment study. Walking in the code room and began turn over two females were brought to the room. One I recognized as the female from the house, the other I did not. While I was writing my call-sheet, I sat in the room. Finally, with the adulterer on one side of the patient she introduces the other female on the other side of the patient as the patients’ wife.
The doctors began getting the past medical history from the wife and the current history from the adulterer. There is the story of the patient who wished he were still dead.

Nearly Headless

The best calls happen at night. There is the dark, the unknown, and the scary. This call was a combination of all those types of calls.

Sitting on a street corner, which is where we wait for calls, dispatch assigned my unit to a hemorrhage call. Nothing special, usually, about bleeding. It is actually one of the easier calls to work. Someone bleeds we give a band aide. The more they bleed the bigger the band aide. There is nothing like the KISS method in medicine. Keep it stupid simple.

While responding to the call, the only information we would get from dispatch was the address and that the calls’ girlfriend was bleeding, that was all the information call would give. We arrived on the street and in the block of the call; there were several houses dark, no front porch lights, and no one waving us down. My partner and I begin to do our search of the area. The boyfriend made the call from a payphone a few blocks away, so we began there. Hoping to find someone that would show us which house, we found nothing.

We drove back to the block. Two police cruisers pulled up to a house in the middle of the block. We asked the officers if they knew anything and one pointed out the house. One of the officers advised he was just there not an hour before for a domestic violence call.

The house was a small two-bedroom home like most on that block. Everything was dark. We knocked but no answer. The officers led the way into the house. They have the guns, not me, and they would not be in my way if I have to run. The two officers began searching the house and my partner and I followed. Being young and stupid, when the officer I was following went to the first bedroom, I went to the second.

I opened the door cautiously and began looking around. My eyes caught a glimpse of something shiny. Paramedics love shiny things. It was the hemorrhage. The blood was still dripping from her neck. Much slower that it was originally, I presume. With only a few pieces of flesh holding her head to her shoulders I did not even check for a pulse, I pronounced her dead. My partner scared that somehow she still had a pulse checked, guess what, she still did not have pulse.

This was one of my creepier calls and one I share a lot with patients of domestic violence, both male and female.

And the rest of the story… The police officer who state he was just there, gave the story that the female (now dead) was struck to the head with a coke bottle. When the officers began to arrest her boyfriend the female (now dead) refused to press charges or to testify. Frustrated that the female would not testify the officer did not want to waste time arresting the assailant. The got their word that they would behave that night and left without the arrest. The state where this happed has a law on the books that, even if the victim does not want to press charges, the police are to arrest the assailant of domestic violence calls. This time it could have changed a life.