Earmuffs

I worked an OT shift on the ambulance last night and I had NO idea that Monday nights were that busy. I got to finish a dinner I started at 2030 at 2330 and slept a little from 0200-0430. Many places here are flooded out, roads washed away, etc. but not in the city, in the city we have the usual suspects.

"BEEP-BEEP-BEEP Ambulance meet the PD for an assault in the alley behind [local scummy bar]."

I had just finished about 10 bites of dinner with K, just enough to make me realize how hungry I was and not enough to actually do anything about it. Calls had been coming in just fast enough that Code 10 (my partner for the night) and I had been next out pretty much all night. We'd finish one call, hop in the ambulance to leave the hospital, maybe get parked at the station and then head right back out. Calls at the local scummy bar are generally not fun. This is a place that opens at 0700 and has customers all day - a steady flow of people with nothing better to do and no better place to do it. Many of the patrons are homeless, alcoholic, psychiatric, in ill health or all of the above.

We missed the turn to the alley, but did get enough of a glimpse to see PD already on scene. Rolling to a stop out front, the flashing lights attract only a limited amount of attention. Folks around here see us come and go so often that we aren't even interesting. Code 10 hops out of the truck and heads towards PD without waiting for me to grab the first-in bag, leaving me hustling to catch up while trying to take a good enough look around to decide if we really should be heading down this dark alley, PD or not.

We find the patient sitting on the ground, hunched over his knees, none too happy about the situation. He's covered in blood and the area below his right eye has seen some better days. When PD shines the flashlight on the patient, I'm surprised at the size of the swelling and the lacerations given that the patient isn't complaining about any of the injuries to his head. He's understandably annoyed with having been assaulted, but he's not showing signs of internal head injury, he's cooperating with the police, stands up when offered a hand and walks to the ambulance where we actually have enough light to see what is going on. As we're walking back, Code 10 asks him about living in the south city our company covers (because he works mostly down there). "Nahw man, I live in this city." "But you told the police south city." "Yeah."

We get him on the stretcher, start in with vital signs, and trauma assessment. NH has a protocol for being able to NOT use a cervical collar and backboard on patients, but it involves the patient being "reliable" and drunk=unreliable. The patient reports 4 beers and despite Code 10 giving him a hard time about it, will not admit to any more. Mid-twenties male, around 5'10", 160-175 lbs, admitting to 4 beers in 4 hours, probably a little borderline on the reliability. Patient denies head, neck, back pain beyond the obvious injuries and is complaining about pain in his ribs where he was kicked. We decide not to do the board/collar, start an IV and get rolling to the ED.

En route, the patient continues to be upset about being assaulted and his associate (who's had way more than 4 beers) in the front seat isn't really helping by turning around and shouting "helpful" advice every couple of minutes. "Yeah man, let them help you." "Dude, don't fight with them, they're just trying to help." I'm not sure what convinced this fellow that his assistance was needed because I wasn't having any problems with the patient at all. No drunken belligerence, no theatrical threats to the life of his attacker, no macho bravado. A rather pleasant change from the usual assault victim who seems to be determined to convince us that this was entirely undeserved, totally shocking and calls for an immediate retaliation.

The patient was having 7/10 pain in his ribs, with a notable contusion and a small amount of crepitus on his right side. He has some diminished lung sounds in the bases of his lungs, but he's also not taking full deep breaths, so I don't think he's really passing air that deeply. The crepitus seems to me more like a broken bone than any air trapped under the skin, so that is a good sign for his lung function. He doesn't want any pain medication and keeps fidgeting to try and find a comfortable spot. I try to reassure him that there is NO comfortable place on a stretcher so that maybe he'll hold still long enough to get a little pain relief. He's groaning about the pain, but actually manages to keep his language decent, although once asking me if I would do earmuffs so he could scream and curse a bit. He laughs a little when I tell him he's not going to top anything I hear around the station, but decides maybe he doesn't need to curse after all.

Neither of us heard what happened to him. Code 10 was convinced he was going to be transferred to a bigger hospital for surgical repair of a broken bone under his eye. I was guessing short observation and discharge from the ED because I don't think it was broken and there isn't much they do for broken ribs if they aren't causing any problems. The doc had him collared and x-rayed for spinal injury after we arrived but didn't really give us a hard time about not having done it on scene. He was gone by the next time we were in that ED long enough to check and nobody in our company transferred him anywhere, so I hope he's home recovering and maybe finding some new associates.