PART II: Two days with the Dorchester County Emergency Medical Service

  • Thursday, August 15, 2013

Austin Mandeville cares for a patient en route to Summerville Medical Center. A.M. SHEEHAN/JOURNAL SCENE

(Editor’s Note: Continued from August 14.)
Day 2, 8:36 a.m. – difficulty breathing
Medic 2, on Trolley Road at Summerville Fire Station 3, is toned out for a difficulty breathing call. Today’s crew are Paramedic Austin Mandeville, 29, of Ladson and Paramedic Emily Alber, 23, of Summerville.
Arriving on scene, they are greeted by the patient’s husband. He wants her to go and get checked out. She has been ill for two days. The patient doesn’t want to go. She is running a fever and is nauseous. She doesn’t answer questions such as “what is your last name” and “when is your birthday,” and “where do you live.” These questions serve dual purposes. They not only give the medics needed information but they also help them ascertain how oriented a patient is. In this case, however, they feel the lack of response is not neurological but patient refusal because she does not want to go to the hospital. Eventually they convince her to get on the stretcher.
On every call, medics get vitals – heart, pulse, respiratory, blood oxygen levels, blood pressure. They call these into the hospital they will transport to. In this case, Summerville Medical Center. They will regularly take blood for lab work and start an IV port.
Back at Station 3 they fill out paperwork. Paperwork alone can take quite a bit of the medic’s time.
10:20 a.m. -- MVA
Medic 2 is toned out for a Motor Vehicle Accident. Another unit was initially dispatched but there are two patients. Medic 2 is dispatched for the less injured of the two. It arrives on scene. There is an SUV that has t-boned (hit broadside) a small sedan. The driver’s and passenger’s doors on the sedan are crushed. The SUV has sustained little damage. Medics always check the vehicle damage at an MVA because they can get an idea of the type of injuries a patient may have sustained based on the damage to the vehicle.
The driver of the SUV is the patient. However, she refuses to leave the vehicle – which she uses for her business – until she can get someone to come and remove “sensitive information” contained in the vehicle. Further, North Charleston Police, who are the responding agency, won’t let her leave until she had made arrangements for someone to come and collect the gun she has in the vehicle.
Her medical complaint is muscular chest pain. This could be from the seatbelt during impact. Medic 2 waits, but informs her she really needs to hurry these arrangements along because while they are waiting for her to let them transport her to the hospital, they are not available for other emergencies.
She finally gets a hold of someone to come get the private papers, her husband to come collect the gun and a towing company that agrees to take the vehicle to her home. She climbs aboard the ambulance, still on her cell phone.
The phone stays pretty much at her ear as she calls various people to inform them of her accident.
Medic 2 manages to get her vitals and get her ready for the ER. As they leave her in the exam room, the ER nurse is suggesting she get off the phone.
11:30 a.m. – lunch/muscle pain
Medic 2 pulls into Subway. Everyone orders. The sandwiches just arrive then the tones go off for a muscle pain call. Sandwiches are grabbed and deposited in the ambulance. “Our food is only hot when we order it,” says Mandeville. Just as he is ready to pull out to respond, dispatch cancels Medic 2 saying that Medic 8, which is at SMC, will take the call. The patient is right across the street from the hospital.
The air conditioning in the rig “doesn’t work so well,” says Mandeville. This is an understatement. It is about 84 degrees in the box and 98 degrees outside. The sandwiches stay somewhat warm…and are taken back to the station where they are consumed.
12:55 p.m. – abdominal pain
Medic 2 is toned out for a call in Medic 1’s district because Medic 1 is out on another call, as is Medic 8, the floating ambulance. This call is for abdominal pain. Arriving at the scene, paramedics find the patient writhing on the couch in obvious pain. Between gasping breaths, she describes her pain, its type (stabbing) and location (lower right abdomen and lower right back). They get a quick history.
This patient is quiet but clearly suffering, her knuckles white and her body arching when the pain hits, and tears are running silently down her face.
She is quickly loaded into the ambulance. Paramedic Mandeville gets her vitals then contacts the SMC ER requesting permission to give Fentanyl for her pain. He explains Morphine gives her migraines.
The ER attending physician gives permission and the Fentanyl is administered through the IV he has inserted. He also gives her an anti-nausea drug to help combat her waves of nausea.
The ER staff is waiting for her at SMC.
But that’s not the end of it for Mandeville. Now he must take the partially used vial of Fentanyl, a controlled narcotic analgesic, and empty the remainder of the dosage in front of a ER nurse witness who then signs a form stating that he has done so.
In the meantime Alber cleans up the ambulance and empties the trash.
Back at Station 3, Mandeville begins his paperwork. He empties his pockets where he had put the Fentanyl vial, looking for the green tag that accompanies narcotics and bears a specific serial number. He needs this as part of the accountability process. It is not in his pocket. He looks everywhere in the rig. Nothing. Back to the ER, he looks inside, where he took the vial out to dispose of it, in case the tag fell out then. No. He pulls out the bag of trash, emptied from the rig. Nothing. The tag has disappeared. Now he will need to do even more paperwork, documenting the loss of the tag.
“Better than losing the actual drug,” he says.
He calls his supervisor to report the missing tag. He fills out the paperwork, after which he lies down hoping to get a quick nap.
This is, he explains, a “night-rig.” This means that the bulk of the calls Medic 2 responds to are at night. Consequently, the paramedics try and take advantage of any downtime they might have during the day because the odds are, they will get no sleep at night. Other stations may experience busy times during the day. Some are not as busy as others depending on where they are located.
Alber turns on the TV to the Discovery Channel, which is broadcasting a day, long viewing of its series Shark Attack.
3:10 p.m. – chest pain
Mandeville has barely had 20 minutes when the tones go off again. Chest pains. Arriving on scene, they greet a 48 year old female with non-radiating chest pain. She has had the pain for about a month but today, she says, it is worse. She is quite loquacious, chatting away during the trip. They transport her to SMC.
4:08 p.m. – unconscious, barely breathing
Dispatch tones Medic 2 for a patient unconscious, barely breathing, however the call is then cancelled. No explanation.
5 p.m. – Lift assist
Medic 2 responds for a lift assist. Sometimes other ambulances are called and sometimes fire department personnel are called when a patient is exceptionally heavy. Even with Striker “stretchers” – battery operated hydraulic lift stretchers that enable the stretcher to do the work of getting a patient up off the ground and into an ambulance, heavier patients tax the hydraulics’ ability to get the stretcher high enough to get the wheels into the ambulance. It needs to be lifted a few inches.
To Be Continued…

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