“They were
animal-like, high-pitched screams
and
were as loud and
disturbing
as
I had ever heard
a scream to be.”
The
Silver Sage was on fire on a hot, dry day outside Reno, near Pyramid
Lake on the Paiute Indian Reservation. A strong wind was driving it
at about twenty to thirty miles per hour and preventing containment.
It
was now mid-morning, and my partner and I still hadn’t had a
chance to eat or time to use the bathroom. We were far from the
emergency location but were the closest unit, so the call was ours. One
of the firefighters had been burned when the fire circled back
and trapped him within its flames. It was unknown just how badly he
had been burned.
It
would take a long time to arrive, even driving with lights and
sirens. If the patient had any significant burns to his body, he
would continue to suffer the whole time we were on the way. And, as
it turned out, The Firefighter had many significant burns.
It
took us about fifteen minutes to arrive. A long time when a person
is in severe pain. As we pulled up and stopped, I could hear
screams. They were animal-like, high-pitched screams and were as
loud and disturbing as I had ever heard a scream to be. He had
probably been doing it the whole time we were on our way.
As
we drove up, we saw a small bunch of Firefighters gathered around
him. All of them were waving frantically with their arms straight up
over their heads. As they waved, their arms crossed over each other
to form an “X.”
Earlier
this morning, the man waiting for us outside the breakfast cafe had
been doing the same thing. Many people did the same in an emergency. It
was so common we came to call it the “X” wave.
They
had been with this man, and his screams, the whole time we were
responding. I’m sure their anxiety and psychological trauma
must have been intense. The only option they had for helping was to
keep him wet with their fire hoses, which had done nothing to stop
the screaming.
We
knew he was still alive, awake, and breathing because we could hear
his screams as we arrived. These were good things. However, we also
knew he was in severe pain, which was not good.
After
coming to a stop, we jumped out, ran to the back of the ambulance,
and grabbed the gurney. We didn’t bring any other equipment
with us, only the gurney.
We
knew this would be a “scoop and run” case with all our
treatments done in the ambulance. By doing this, The Firefighter
would receive definitive care in the hospital much sooner.
Because
he was in extremely critical condition with his life in danger, I was
required to ride with him in the patient compartment while my EMT
partner drove. One other Firefighter came along to be with his
friend and partner.
The
Firefighter’s screams continued while we drove and were
amplified in the small patient compartment of our van-type ambulance.
It was very disturbing. So were the smells. They were horrible,
and they assaulted my senses. With them and the high-pitched,
animal-like screams, it was almost impossible to concentrate on the
problems at hand, let alone to breathe.
The
exhaust fans were on and set on high, but they were overwhelmed and
could not clear the air. My partner opened the front windows despite
having the air conditioner running at max. This, too, made no
difference.
I
started The Firefighter on oxygen using a nose cannula at six liters
per minute. That setting is the maximum flow rate for a cannula. Then I
applied an oxygen mask on top of the cannula and set this for
fifteen liters a minute, the maximum rate for a mask. That was a lot
of oxygen, but dying tissue needs a lot. The first task to be done.
The
second was to begin a Normal Saline, medical water, IV, and get the
1000cc volume into him as fast as possible. When I finished
attaching the tubing, I handed it to the friend ride-along.
“Take
this and squeeze it until it is empty,” I told him. Then I put
another one together and handed that one to him, also.
“Sit
on this one until it’s empty,” I told him.
Before
we had arrived at the ER, the Firefighter ride-along buddy had
squeezed three and a half liters of medical water into our patient.
This is about twenty-five percent of the total circulating fluids
within the veins and arteries. Those fluids probably kept him alive
until we arrived at the ER.
When
tissue is burned, human or otherwise, the cells are either cooked,
partially cooked, or burst their walls when their inside fluid boils.
The amount of fluid lost depends on the extent of the burns and
their severity. This man’s burns covered about half his body
and were mostly third-degree.
A
first-degree burn is a sunburn; second-degree burns have big,
water-filled blisters. For a burn to be third-degree, the skin is
gone, and the muscle is cooked. A fourth-degree burn is when the
muscle is burned away, and the bone becomes charred.
Along
with the third-degree burns on the outside of our patient’s
body, I had to consider the almost certain possibility that the fire
had also burned his lungs when he inhaled the hot air to scream. He
also had to be losing fluid in his lungs. This man was in big
trouble.
Once
the oxygen and the two IVs were running, I contacted the emergency
room to give a report. Every EMT or Paramedic must do this to
validate the treatments already administered and to receive orders
for any further treatments the doctor might want to add. In this
case, however, I didn’t wait for the doctor to order treatment.
Instead, I immediately asked permission to give our patient Morphine
for his pain.
Each
emergency room doctor deals with the EMTs and Paramedics in the field
according to their style. This doctor was well known to have a
“Doctor-God” attitude where-in only he could correctly
treat the patient.
Usually,
he did not give orders for advanced treatments in the field, and
Morphine was an advanced treatment. He was the doctor and would
initiate any advanced treatments in the emergency room.
He
denied my request and would not allow me to give this man anything
for his pain, and I knew this was a bad decision. This patient
needed Morphine now. So, I did something I’d never done
before. While the doctor was still talking, I keyed the microphone
and cut into whatever he was saying.
Then
for fifteen to twenty seconds, I held that microphone about two
inches from the patient’s mouth while he was screaming his
animal-like screams. I just held it there, and held it there, and
held it there until I was fairly sure the doctor thoroughly
understood the severity of the situation.
Right
after I closed the microphone, the doctor began talking again. It
seemed he had realized the error of his ways and immediately gave
orders for the Morphine.
I
gave it to the patient through one of his IVs, and in about thirty
seconds, the screaming reduced in volume and intensity. Then, in a
few seconds more, he stopped screaming altogether. The moaning
continued, and he was still in critical condition and shock, but he
had stopped screaming. However, it did nothing for the smells.
Morphine
doesn’t remove the pain so much as it allows a person to not
care about it. At the same time, it reduces anxiety and, to a point,
acts as a tranquilizer. It is classified as a hypnotic class drug
and works well to alter the level of consciousness and anesthetize
the patient.
Those
effects allow patients to relax, and by doing that, it lowers the
potential for shock. When given directly into the blood flow via the
IV, as I had done, it works quickly, and this guy needed it to work
quickly.
The
Morphine lasted until we arrived at the emergency room and turned our
patient over to the doctor and the staff. I reported to the nurse
and ignored the doctor. All I needed from him was a signature on the
ambulance medical report signifying he had authorized the Morphine.
I
presented the medical report form to him, and he signed it. Then he
walked away without saying a word. Again, this doctor was known by
everyone in the emergency room to do this sort of thing regularly
with the Paramedics and the nursing staff.
As
I left with our gurney, one of the emergency room nurses I knew well
came up, smiled, and moved close to my ear.
“Nice
touch with the microphone,” she whispered.” I turned
toward her, smiled, nodded silently, and continued pushing the
gurney.
“I
was hoping it would work,” I responded.
“Well,
it did,” she added, “but what’s that terrible
smell?”
Again
I said, “We are having a busy morning and had a bad call
earlier. I haven’t had time to change.”
She
responded, “Sure hope you can before you return. That’s
a terrible smell.”
“Thanks,”
I replied. “I know,” and continued toward the door and
the fresh outside air.
That
doctor never again refused to give me what I asked for, and The
Firefighter received the medicine he needed when he needed it.
Outside
the emergency room, the firefighter ride-along, who had been watching
and listening to everything happening to his friend in the ambulance,
was waiting for his buddies to give him a ride back to his station. As
I pushed the gurney into the ambulance, he walked up and stuck out
his hand so we could shake.
As
we did, he smiled and firmly squeezed my hand in a friendly way. At
the same time, in a very nice voice, he said, “Thanks, doc. Thank you
for what you did. I will never forget it.”
It
was a good moment after a bad call.
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