EMS is a bit of an odd business. We are rather parochial in our approach to how we do our job and how we react to “help”. Some of that is based on the peculiar circumstance where people come up to us on calls and offer advice, suggestions, and sometimes even orders to us while we are busy treating patients. Think about that. Complete strangers, to us and often to the patient, just walk up and start participating in the goings on. More than once over the years I had to ask, rather pointedly, bystanders to leave the scene. On some occasions I even had to ask the police to have a “chat” with these people. A few times the police had to have more than a chat and someone left the scene in handcuffs. Not many times, but just enough to make me a tad suspect when a well meaning (giving them the benefit of the doubt) stranger tried to intervene.
As a result, I always tried not to be “that guy” when I was off duty and came across an accident or some other scene. Mostly I’ve confined my help to making a call to 9-1-1 and not interfering with the responding crew. I’d do what I could, but I’d get out of the way once the EMS crew showed up. On one memorable occasion Ambulance Driver and I were sitting in a restaurant having breakfast with my son and his family when one of the other patrons collapsed and went into cardiac arrest. That was the lone exception and we thought at the time it was reasonable to intervene. Other than that, I rarely saw a reason to get actively involved in EMS calls when I wasn’t responding to them. Certainly I would never wander on over to an active scene and ask if I could “help”. Because it wouldn’t be help, it would be getting the way.
A recent series of posts over at Captain Chair Confessions reminded me of an incident that happened several years ago where I did have to sort of intervene. You should read all three of his posts, but this one is the one that started my mind down memory lane.
Your printer speed is set to fifty.”
He looks like I just explained sting theory.
“Normal is twenty-five.”
Although I think CCC might mean string theory, his point is valid.
Here is what happened in my case.
It was a Saturday morning and I was puttering around town doing some errands when my cell phone rang. It was a very close friend who lived a couple of minutes away from where I was. He told me his wife, who I’m also very close to, wasn’t feeling well and had a rapid pulse, but refused to allow him to call 9-1-1. He asked if I would come over and talk with her.
Not because I didn’t want to help, but because I knew how, uh, determined she could be. Yeah, that’s the word.
So, I motored on over and walked into the house. Peg gave me the short story while her husband interjected his comments. Just like a real call, but I couldn’t ask him politely to wait in another room. Better than that, I could tell him to shut up.
I felt Peg’s pulse, which was banging away at about 180 beats per minute. Hmm. Other than that the exam I could do was pretty normal. She told me that she had been treated for this before and was even on medication for rate control for a while, but her doctor had determined that she didn’t need medication any longer and had stopped it a few weeks ago. I made a few not so complimentary comments about her doctor and told her she needed to go to the hospital.
First she wanted me to drive her. Uh, no. Then she said I could call 9-1-1, but not until after she took as shower. I gave her my standard line about hospitals no longer having dress codes and directed her husband to call 9-1-1 and tell the fire department that his wife was having an episode of rapid Atrial Fibrillation. Which was my first mistake. I should probably just have told him to say she was having palpitations of some other laypersons term.
In a few minutes the fire department arrived with a big red shiny truck and a smaller red shiny ambulance. SOP in our town. No police, which was also the SOP back then. Which was fine since they weren’t needed.
The crew walks in and I stand back. I have nothing to tell them that they aren’t going to figure out on their own pretty quickly and since Peg wasn’t very symptomatic I felt no need.
“He’s a paramedic!” my friend helpfully interjected. The fire crew just looked at me and I gave them a little wave. They then turned back to Peg and started their exam, which of course included an EKG. I was standing back watching, keeping my mouth shut, and trying to stay out of the way. The monitor showed AF at about 180, which made sense. Only the shape of the QRS complexes looked all wrong. I looked at the leads and sure enough the left and right leg leads were reversed. Not a big deal and there are two kinds of paramedics. Those who have reversed limb leads and those who lie about never having reversed limb leads.
As casually as I could, I leaned over to the LT and whispered that the leg leads were reversed. I didn’t want my friend to hear because he’s kind of a Nervous Nellie. Hell, he’s the original Nervous Nellie He in turn quietly told one of the medics, who corrected the problem. Now the rhythm strip looked normal, just fast. Then it looked normal because the rhythm has spontaneously broken back to a controlled rate.
Which started another round of “I don’t need to go” to the hospital from Peg. Which got a “Just get on the stretcher and stop arguing.” from me and a “I wish I could have said that.” look from the medic.
All of which is more intervening than I usually want to do because I’ve been there when helpful friends offer help that isn’t really help.
And as I said, I never want to be “That guy”.