Tuesday, March 25, 2008

O2 and Transport

We received a call one night for a miscarriage. The addressed turned out to be a dilapidated rental house in a poor section of town. We found a sixteen-year-old girl lying in a huge pool of blood. A single bare light bulb illuminated the scene. She lay in this rectangle of harsh white light, her blood black in the light. It was as if someone had staged a stark black and white picture of the life that led up to this. A tiny fetus still attached to the umbilical cord that lay between her legs. She laid half in and half out of the tiny bathroom.

            She was only dimly conscious. Her pulse was barely discernable and I was only able to palpate a blood pressure. I immediately got on the radio. We were going to need orders if we were going to do any good for this girl. We needed orders to start any type of advanced life support and that is exactly what she needed. I talked to medical communications and they got me through to the hospital.

            “This is paramedic Huder number 104. We have a sixteen-year-old patient who aborted an approximately two-month fetus. She is conscious, cool and diaphoretic to the touch. The patient has lost approximately 1000cc’s of blood and is still bleeding frank blood from her vagina. The fetus is still attached to the umbilical cord appears to be attached to the uterus.

            Blood pressure is 50 palpable, her pulse is 120. We have her on six liters of O2. I would like permission to start 2 IV’s of lactated ringers before transport to your facility.”

            I waited for the hospital to reply. This was the type of call I had become a paramedic. We could help. We could make a difference. She needed fluid replacement. It would help stabilize her before we got her to the hospital. Every second counted.

            “Standby.” The voice on the radio said.

            Standby what in the hell do I need to standby for, just give me the order and lets get this show on the road.

            “ Rescue 1. Place your patient on O2 and transport immediately.”

            “ Repeat.” I couldn’t believe it.

            “Place your patient on O2 and transport immediately.”

            My partner and I just looked at each other. The wrong doctor was on duty. He never gave orders. We called him O2 and transport. Now he was pulling his shit on this little girl.

            What in the hell was I out here for? Why had I gone through all the training? Why was putting up with all the shit from the other firefighters. If we were not going to be able to do the job, then lets stop playing around with people’s lives. I never knew if or what kind of orders I would get when I called the hospital, but this…

            My partner and I carefully loaded her up as quickly as possible into the ambulance when it arrived. It was a silent ride into the hospital. All we could do was hold her hand and try to say a few comforting words and wonder why we were out on the street.

A few minutes later the ambulance pulled under the overhang at the hospital. We carefully unloaded her and rushed her into the room where the nurses directed us. We stood there alone with the girl for several minutes. We had not been guided into the trauma room, but instead we had been shown into a normal room. There was no team waiting for us.

A nurse finally walked in and took one look at our patient and us. She immediately turned and rushed off to find the doctor. Apparently they had not believed our radio report. After all we were just paramedics. When he arrived he immediately ordered two IV’s and called for the trauma team.

We could have given her those IV’s twenty minutes ago. I turned and walked out of the room without saying a word. I couldn’t watch. She needed those IV’s when I called for them. These were the early days and this was the game. You never, ever questioned a doctor. If you did there was a real chance that the next time you needed an order you wouldn’t get it. Even if you didn’t get one this time, you truly never knew what would happen the next time out. The nurses thought we were after their jobs and resented our pay which at the time was better than theirs. Many of the doctors did not trust us, we were too new. One call you would get the orders you needed. The next time there were no orders. So you kept your mouth shut and hoped for the best. Maybe next time. But it didn’t help the 

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