26 June 2007

Stretcher ballet

Sometimes, you just can't share the humor in moments with the people involved. On a call where so much had gone wrong, we all needed a good laugh, but I think I'm the only one who got one.

Dispatched to the home of a frequent flier for 'cardiac arrest', on arrival he's not in arrest but is unresponsive, breathing inadequately and not protecting his airway. The firefighters on scene are performing the near-miraculous patient care technique known as 'folded arm observation'. Especially powerful tonight because there are four of them instead of the usual three. I give them credit for actually putting the pulse oximeter on the patient to make sure he wasn't in cardiac arrest before resorting to the FAO, but it is never encouraging to walk into a scene like that. They know this patient well, they've run full codes on him more than once and true to Murphy's law, not only does he have a full array of medical problems, he is a NOT small man.

BP was crap, SpO2 was low, no gag reflex. MC is after an intubation, sends me in for IV access. No go on IV. Second try at the tube gets us a fantastic vomit fountain of pink slurry due to esophageal placement. Two more tries for a ET tube leaves us pushing a combitube and making good use of the little plastic elbow attachment known locally as the vomit diverter. We finally decide to get moving, so the firefighters pick up the patient and head towards the stretcher. As they reach the hallway, they realize that the new guy had brought the stretcher in head-first while the patient is heading out head-first, meaning his head will be at the foot of the stretcher. We were loading him onto a backboard anyway in case we needed to do chest compressions, so I suggested that perhaps rather than attempting to deal with the issue in the hallway, they should load the patient as-is and we would move him when we had a little more room.

Out we go into the dark parking lot, throw open the doors to get the rear scene lights on, and now we have room to maneuver. The firefighters had done a good job of getting him out, loaded, and outside, so I decide to stay out of the way and let them reorient the backboard the proper direction on the stretcher and hop in the back to get some other equipment ready. This gives me the best seat in the house for the show. They do remember to unbuckle the stretcher straps and leave the backboard straps attached. The do lift him sufficiently to clear the railings of the stretcher. But somehow, in the large array of protective clothing, big pockets, and the assortment of equipment they each carry, they got hooked. They are pivoting clockwise with the backboard and the stretcher is pivoting gently beneath them. Keeping time with their every movement, defying their best efforts to fix the positioning.

Finally, the officer grabs the stretcher and yanks it 180 degrees releasing it from whatever was keeping them hooked. All of them look into the back of the truck where I quickly busy myself with something other than directly laughing at them. I know they heard me earlier and I know they heard me then. I did share a laugh with them about it at the hospital (MC took 2 with him in the back of the truck), so I know no feelings were hurt.

Oh, and in case you're wondering, patient was awake, tube removed and whining at the docs by the time we cleared the hospital. A little Narcan is good like that.

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