Miracle on Ethiopia

No Comments

It was a dark and stormy night… No seriously, it was a typical cool Jerusalem night and I was on one of my first nights shifts on a MDA ambulance. At about midnight we were called to Ethiopia Street, which (as the name doesn’t suggest) is located in the Jewish Ultra-Orthodox center of the city. Control informed us that there was “Danger to Human Life;” in other words the health of a patient behind locked doors was in question. In such situations, all three services are called; The BLUES – to give authorization to knock the door down, REDS – to knock the door down, and EMS – to treat whoever lies behind the door.

Barreling down the street on the way to the call, the first thing I did was phone my cousin Rafe. He lived nearby and I knew that he would be eager to see me in my new uniform tearing down the street with lights and sirens. As expected, he was waiting for us when we arrived. I jumped out of the ambulance with much glamor and finesse. I’m pretty sure I saw him roll his eyes. Jealous lad.

As usual, we were on location before police or fire. We waited. And waited. The police finally showed up and started investigating. The address was an old Ethiopian church, as the street name would suggest. The patient in question was a priest, a generally unwell man who hadn’t been seen for a while. His friend assumed he was in his room in a small outbuilding connected to the church. Problem: He wasn’t answering his phone.

The first hurdle we had to overcome was the towering wall surrounding the church, locked from the inside. The wall was soon scaled by a fireman who had suddenly turned up, out of the blue red. He opened it for the rest of us who were not quite so adept at climbing 9 foot tall gates. We surrounded the little room, also locked from the inside, and began yelling the priest’s name, but to no avail. One of the nuns who had been awoken by our banging and screaming came running anxiously towards us, her habit slightly askew. We explained the goings-on and soon the whole compound was in an uproar. A superfluity of nuns appeared out of nowhere; Prayers were said, candles lit, incense offered – and I was chatting with Rafe.

Eventually Father Habtamu was seen through one of the windows, lying motionless on his bed. Now that we knew for certain that he was inside there were two options. Either he was in grave danger, clinging to life or worse. Alternatively, he was in a very deep sleep.

Blues, Reds, EMS and Nuns, screamed his name; still no answer. By now everyone was getting genuinely nervous. I quickly ran back to the ambulance to get the defibrillator, preparing for the worst. In tandem with me was a young fireman running to his truck. As I exited with the AED, he exited with a large sharp disk, designed to cut through (almost) anything. We ran back to the room where the nuns now stood chanting and swaying, holding hands. With a loud whirr, the firemen began cutting the bars of the window.

Sparks flew, tears fell, and amidst the chaos, Father Habtamu lifted his head and said, in a voice choked with emotion,

“What’s goin’ on out there? Ya crazy man, why are ya cuttin’ my window?”

All the nuns began shouting “It’s a miracle! It’s a miracle! He’s alive!” and, as if on cue, burst out into joyous gospel. The priest opened his front door, well and healthy, and asked that everyone tone it down a bit – he was tired.

We left the singing, clapping nuns + one slightly befuddled priest, and headed back towards the station, hoping to get a decent night’s sleep.

But alas, it wasn’t to be …

 

From Denial to Hypochondria

No Comments

I have begun to notice that many of the patients I treat, can be broadly split into two categories; The ‘Hypochondriac’ and the ‘Patient in Denial’. Both of these conditions are not only unhealthy, but cause unnecessary confusion to medical practitioners. This is particularly true for first responders in the pre-hospital setting, because our access to diagnostic tools is limited. In EMS we rely heavily on signs + symptoms and the patients’ vitals, to make an approximate diagnosis and initiate treatment. If the patient is lying about his symptoms, it can throw us off the mark.

Behold – two fascinating examples of these extremes, on the same day.

The first call was in an apartment in a high rise building, in the center of town, with no parking in the immediate vicinity. None of this bothered me, because I easily maneuvered my motorcycle between traffic, and found a perfect ‘parking spot’ on the sidewalk, immediately outside. The call was for a 60 year old – male – ‘Weakness’. Calls that come in as ‘weakness’ are, more often than not, absolutely nothing, or at least not life threatening. For heaven’s sake, I feel weak after an afternoon out with the kids!

As I rode the elevator to the 7th floor, it occurred to me that I might be alone with the patient for a while; the ambulance didn’t stand a chance in the mid-afternoon traffic. I began to think of conversation topics, because once I confirmed that there was nothing wrong with him, I would have to sit and make small talk till my colleagues arrived.

‘Weakness’ is normally a straightforward BLS call, and so I approached the apartment ever so casually. An elderly lady with few teeth and a big smile opened the door, and ushered me into the room where her husband was lying on his bed.

I asked him how he was feeling.

“Leave me alone” he said in heavily accented Hebrew.

“And a good day to you too, dear Sir,” I replied – “What’s bothering you?”

Silence

I persisted in my questioning, and he eventually admitted that he felt slightly weak. His wife confessed that she had been the one to call the ambulance, ignoring her husband’s protestations. I gave him a quick once-over. He looked OK – good color, not sweating; this still appeared to be the run of the mill ‘weakness’. Then I felt for his radial pulse, found it, and started counting heartbeats.

Uh Oh.

His pulse was 28. I thought I had made a mistake so I tried again. His pulse was still 28.

A Normal pulse rate ranges from 60-100; 50 being borderline Bradycardia. 28 is significant bradycardia and life-threatening. It was a miracle he was conscious at all.

As I reached for my phone to request a NATAN, an ALS crew headed by a doctor walked through the door.

“How did you know?” I asked incredulously.

“Know what?” they responded in unison.

Turns out that although this call came in as a CAT B, the NATAN was the closest available ambulance, and protocol dictated that they had to respond. This patient was very lucky to have a full paramedic team and a doctor land unsuspectingly on his doorstep. He needed them to survive.

“Do you feel alright?” the Doc asked.

“I feel fine,” he insisted again.

He was, however, much closer to death than he could’ve imagined as the ECG subsequently showed. He was suffering from a third degree AV block, also known as complete heart block.

A heart block is a disease in the electrical system of the heart, and can cause lightheadedness, syncope, and if left untreated, death.

Before we rushed him out of the house, a line was started and defibrillator pads attached to his chest – just in case. A cardiac emergency response team was waiting at the hospital, and this man eventually had an artificial pacemaker implanted.

Just your regular ‘patient in denial’ claiming perfect health, while his life hung in the balance. At least heaven ordained that he get the proper care he so desperately needed in time.

As I was leaving the first scene, another call came in as “Severe chest pains, suspected MI” at an address 1km away. Expecting the worst, I did an immediate U-turn and headed to the call.

I arrived at the bungalow style house, walked inside, and found a man strewn across the couch in the lounge.

“Hi, I’m from EMS; what’s wrong?” I asked.

“I have pain in my chest,” he grimaced.

“Can you show me exactly where the pain is?”

“Right here,” he moaned, pointing to his belly button.

Things now took a drastic turn to the bizarre.

Further questioning revealed that (a) he was in no pain right now and (b) the last belly button attack had occurred the previous week! The reason he decided to call now, was, in his own words, “because it was convenient.” I held back laughter / disgust and took his vitals; all within normal ranges. Ultimately, he decided against going to the hospital and remained at home.

Just to recap for those of you out there doing a mental differential diagnosis. We have;

  1. Pain near the belly button
  2. From last week
  3. Normal vitals

If you guessed hypochondriac in the first degree, you’re spot on.

Fireman Sam

No Comments

“Playground entrapment – child stuck between metal bars”.

Control got on the radio and had some more information about the call. “4 Year old – conscious & alert – not injured, just stuck”.

Although this didn’t seem like a medical emergency and thus probably best left to FIRE to deal with; I was around the corner, so I decided to respond.

Veteran EMS personnel have an innate ability to remain composed and come up with solutions in difficult and testing situations. I wasn’t a veteran though. Au contraire – I practically had novice printed all over my brand new, crisp, not even one speck of blood, still smelt of a Chinese factory, emergency vest. I certainly didn’t want to embarrass myself, but – “Nothing ventured, nothing gained”, my father says – so off I went.

Twenty seconds later, I found myself at the edge of the park. I was immediately surrounded by frightened mothers, all pointing to an even more terrified woman, in the left-hand corner of the playing area. I started to regret coming to this party. I was the first on scene, and clearly outside of my comfort zone. I took my red bag out, knowing full well that I wouldn’t be using it. Be that as it may, I like being fully prepared when responding to an emergency. “You never know”, my father says. Yes, my father has several important mantras, so WHAT!

I walked up the hill towards the play area, and found a child that was indeed very much stuck. His hysterical mother was not helping the situation whatsoever. She was crying and flailing her hands and it was making the child and me quite uncomfortable. “Please try and calm down”, I whispered, “you’re scaring the kid.”

I took a deep breath and said, “Ok, I’ll try to extricate your son but I must admit that I don’t have much experience with this.”

Her eyes bulged as she said in a shrill English accent, “I don’t believe it – Then why did they send you!?”

“What number did you call?” I asked.

“101”

“Well, that’s why they sent me. 101 is the ambulance service and I ‘work’ for them. Had you called 102 you would have got the Fire department, and they are far more experienced with these sorts of predicaments,” I said with more than a hint of sarcasm in my voice.

“So what should we do now?”

“First let me ascertain if FIRE is on their way.”

When our call-center gets calls such as these, they usually have the common sense to alert the correct department. I called Control and confirmed that both services were indeed en-route with an ETA of 5 minutes.

I was alone on this one for a while, so I got to work.

The way I see it; however the foot got in, it can come out, as long as the ‘stuck’ person is cool and collected. Problem is, he wasn’t; so I began my ‘treatment’ by handing the screeching child a pack of Winkies to calm him down.

“What are you doing?” There was that shrill whine again.

“Aren’t you going to get him out?” – “Why are you giving him candy?”

“I can hardly be expected to rescue a wriggling hysterical child!” “First let’s calm him down and then we’ll focus on a plan to remove his tiny foot out of the even tinier hole.”

My reasoning made sense and Mum took a step back.

With Winkies in hand, the child was a bit more composed and I started applying the basic tools for a foot extraction;

Apple juice from his Sippy cup, and Moisturizer from his Mum’s purse.

I applied them both (don’t try this at home), and after a little wiggling, lifting, pushing, and pulling the child was free, just in time for the ambulance and fire engine to turn up.

First attempted leg extraction: SUCCESS !

 

 

Beginnings

No Comments

בסד

“In the beginning G-d created” (Genesis 1:1) Can also be explained to read “First (ie. most importantly) – Good Health” – for in Hebrew, the root word of “to create” also means “to be healthy”. In laymen’s terms, good health is absolutely fundamental to our leading successful and productive lives.

Whilst somewhere in the back of my mind I knew this was probably true – 3000 ‘calls’ and 5 years later – I can swear it. I have seen, and bear witness to some of the most indescribable tragedies imaginable. From treating victims of terrorist attacks, to performing CPR on infants, I have ‘been there and done that’, and my appreciation for life has increased exponentially. Jerusalem has an exceptionally low crime rate and so GSW and Stabbings are rare. But there is also a high birth rate and so emergencies involving children are common and very distressing. Pediatric emergencies are the worst type of call and affect me deeply. Every once in a while I come home and tell my wife that the time is ripe for early retirement. But then I’ll wake up the next morning, switch on my beeper, and start all over again. I love what I do, and I do what I love. But let’s get back to the beginning…

In the beginning So every EMT has their very first call. It’s not something you mentally prepare for; it’s just something that kind of happens. You complete the course, get your certification, and all of a sudden, you are thrown into a real emergency and there is someone totally relying on you to save their life. And that person is not normally alone. In most instances there is a room full of people, glaring at you, hoping, praying, that you know what to do. Did I know what to do on day one? – Not really! Please understand that the EMT course is loads of fun. We get to practice on dummies, and we sometimes even stop in the middle of an intense CPR, to take an ice-cream break. Not so in real-life. Our patients are not dummies, and there is no stopping a CPR unless the patient returns to a spontaneous pulse, or is declared dead.

Bottom line: the classroom leaves you ill prepared for the real world, and once you get out there, the learning curve is sharp. Whilst probably true of most professions, in emergency medicine it’s truer. You’ve learnt that if a person has difficulty breathing, you move them from supine to sitting position, put on a non-rebreather mask and start the flow of oxygen at a rate of 10-15 LPM. Cool – I’ve saved a life, and maybe there will still be time for that ice cream after all.

How about this though; how about the patient is barely breathing, sweating profusely, with pink froth coming from his mouth. You’re alone. Now what. Can’t sit him up; he keeps on slipping out of my hands. What to do first – take his vitals, tear open the O2 mask, but I need to sit him up, he is drowning in his own fluids. Help!! – Aaargh, Where is my ALS backup? Every EMT reading this knows what I’m talking about, and everyone else wants to know what pink froth is – well; it’s a symptom of PE. But let’s get back to the beginning…

In the beginning Sometimes it’s unremarkable – sometimes it’s unsightly – and sometimes it’s petty. Unit #28 first call was to a “Serious Injury – Male Crushed in Elevator Shaft”! – I kid you not. His very first call was to an “X”, where there was nothing to do except find the nearest toilet, and vomit. If his was unsightly, then my first was petty. Actually it was the absolute paltriest call I have ever responded to.

I had just graduated as an EMT-B and had purchased some supplies online, even before I was officially accepted to any of the local EMS organizations. Big mistake for three reasons. First is that you don’t yet actually know what you’ll really need and what is just ‘extra’. Second is that the pre-prepared kits you buy online are garbage. And third because the organization you will volunteer for will give you a first-responder kit.

I had just finished packing up my bright red bag, when I get a phone call on my cell. It was from a neighbor across the street, and he told me in the most condescending voice he could muster, that his daughter had gotten a splinter, please could I come around. Really, a splinter, on day one. I didn’t even know what to do with a splinter; it’s not in the textbook! But I was way too macho to admit that, so I went over, red bag in tow. I get there to find a 3 year old screaming hysterically. It was then and there that I learnt lesson number one of my career. When treating screaming kids, have a distraction, like a candy, at hand. Cut a long story short, I calmed her down, extricated the splinter, and waved the cute kid and pompous father goodbye. “A job well done”, I thought as I schlepped the 15kg bag back home. “It has to get more difficult than this though”, I mumbled. Trust me – It did.