Protocol Variation

While working alongside my supervisor one evening, we caught a call for a motorcycle accident on one of the high speed intrastate highways going through our city. Dispatch gave no other information but did state they were receiving multiple calls on this accident. Now, when dispatch is advising multiple calls then you can pretty much assume that there is definitely some validity to the call and that things aren't going to be pretty when you arrive.

Pulling up on scene, I immediately noticed what used to be a crotch rocket type motorcycle that had disintegrated into many, many pieces strewn along the highway and a body lying face up on the edge of the highway next to and parallel to a guardrail. Approaching the patient, I saw that he was wearing all of his protective clothing along with a full face shield helmet. I also saw that the protective clothing had done him absolutely no good as there was major trauma that is incompatible with life to the patients thorax area. There was also blood spray going along the guardrail for what seemed like 50 feet.

A witness stated that the motorcyclist appeared to be racing another motorcyclist (that did not stop) and had passed her vehicle at an extremely high rate of speed and that when she rounded the curve there was just dust and debris flying through the air. This witness estimated the motorcyclist traveling at well over 100 mph.

Approximately 1 month prior to this event, we had one of our employees and a supervisor respond to a vehicle accident that involved "2" fatalities. On arrival, they found that a vehicle had stopped on the side of the road after going through a toll booth to adjust the tie down straps on his trailer and while doing this a DUI driver came through the toll booth and struck the rear of the trailer and the patient that was adjusting the straps on the trailer was cut in half and the top half of him was thrown through the windshield of the pickup truck that struck them containing the DUI driver. The Paramedic unit and Supervisor unit pulled up and one of the Paramedics walked over to the pick up truck, saw the DUI driver covered in blood and unconscious. He then noticed the other party next to her in the truck had been cut in half and was also unconscious and obviously deceased. The Paramedic then called Medical Control, advised them he had two fatalities, and received an official time of death. He then asked the engine crew to cover up the vehicle with a tarp so bystanders would not witness the grisly scene as they passed through the toll booth. He then placed his unit back in service and proceeded to the local hospital to get some supplies.

After arriving at the hospital, he gathered his supplies and was chatting with the nurses and physician on duty. Approximately an hour had elapsed since he received the official time of death from Med Control and he was dispatched back to the scene for a patient that was no longer deceased involved in the MVC. He arrived and was informed by the State Police Traffic Reconstruction Investigator that while he was marking the roadway he heard sounds coming from underneath the tarp. He lifted the tarp and the DUI driver looked at him and asked if he could help her get out of the vehicle. Now, I would of loved to see the look on the Troopers face when this occurred, it had to be priceless. The Trooper stated that when he arrived on scene he looked at the bodies and also determined they were dead as neither was breathing and because of the massive amount of blood present on both patients (not to mention one of them was cut in half). So the Paramedic proceeds to treat the now living patient and she was flown to a Trauma Center for treatment and eventually ended up making a full recovery. After she was released from the hospital, she sued for the false declaration of death and delay of treatment. Because of this incident, we now had a new protocol that stated we had to confirm all deaths via EKG (3 leads), regardless of circumstances.

Now back to my original story, I felt that background information was necessary before I continued.

So there I am looking at a patient whose insides were now on the outside and I was having trouble with deciding where to place the leads of the monitor so I could get a good Asystole rhythm and declare this patient DOA. I then decided to call Med Control and get a variance of our NEW policy and the conversation went like this:

(Med Unit) Med 302 to KGH ER
(ER) Med 302 go ahead
(Med Unit) I need Doc please for protocol variance orders
(ER) Doc 119 standing by
(Med Unit) Good evening Doc 119, I am on scene with an early 20's year old male that was involved in a high speed MVC while riding a motorcycle. Patient has injuries incompatible with life and is pulseless and apneic (not breathing at this time). I am requesting variance orders to not apply EKG at this time for confirmation of death as I can assure you patient is deceased and his heart is definitely not beating.
(ER) Med 302, how can you confirm this without an EKG?
(Med Unit) For starters, I see the patients heart laying in the roadway beside his right ankle and it doesn't appear to have any electrical or mechanical activity at this time.
(ER) *radio keyed up.....long pause.........variance granted!

Durex Condoms as Ballistic Defense

I was working a 24 hour shift for one of the metro Atlanta counties and we received a call for a person shot at about 0230 hours one morning. As I slumbered out of the station, we received further information from dispatch that it was going to be a self inflicted GSW to the head and patient was down in the front yard and not moving.

As we arrived in the neighborhood, we noticed the local PD arriving on scene and we followed them in. Immediately, I noted a white male face down in the front yard. As we approached the patient, I noticed a large caliber handgun (later found to be a 45 Magnum) lying next to the patient. There was a large pool of blood under the patients head and after a quick assessment I found he was Signal 48 (DOA). I noted a through and through wound to the head with the entrance near the right temple area and the exit towards the back left area of the head.

Later during the call, the local PD officer came to us and asked if we thought the bullet was still inside the patient. I explained that it "most likely" was not unless the patient had shot himself in the head, put the gun in his other hand, contorted his arm in such a way that he could self administer a second shot to the other side of his head, and in that case there would actually be two rounds in his skull not one (for the record, I have never been known to be a smart ass). We then decided to put our "CSI" skills to work and locate the lost round. We felt as if we had enough training for this endeavor as we had watched two episodes of CSI Miami that night during our down time.

After figuring out how the patient was most likely standing when he shot himself, we began looking at the residence (which is a row of apartments and the patient lived in the end apartment). We found a possible entry point in the outside wall of the front bedroom of the residence. We informed the PD investigator of our find and then followed him into the residence and to the bedroom. Once in the bedroom we found the bullet had passed directly over the bed and went into the wall across the room just above the dresser. We then accompanied the investigator next door while he asked that homeowner if he could look at her walls in search of this deadly, evasive bullet. That homeowner consented and we entered her residence.

Once inside, we noted a bullet hole behind her recliner chair and noted the bullet had passed through the chair and upon inspection of a large, heavy oak hutch across the room, we noted a bullet hole going into the second drawer from the top. I opened that drawer and saw a large, industrial size box of Durex condoms with an entrance hole but no exit hole. I then opened the box of condoms and saw that the bullet had pierced the first condom packaging and that the condom had STOPPED the large caliber round dead in its tracks. Now I don't know about you but that would be a good bit of advertising because if a Durex condom can stop an 45 magnum round after it has passed through 2 sides of a bony skull, 2 walls, a recliner, a heavy oak hutch drawer, and the packaging of the condom.....then sperm has no chance at all of escaping.

Now lets discuss the industrial size box of condoms for a minute. I am not sure why this particular lady (and I use that term very loosely) had such a large box (condoms).......maybe she was wishful thinking. This lady was approximately 45 years old and looked 60. She had more wrinkles than a nursing home. It was about 0300 in the morning at this time and she was still in heavy, heavy makeup complete with bright red lipstick. She was wearing a short house dress that came down to just above mid thigh. Her legs had so many visible veins it looked like a road map for NYC. She weighed about 250 and I bet 240 was from the waist up because she had this large body on little bitty legs. She was definitely a sight. I don't think there is enough alcohol in the world for any "logical thinking" man to sleep with this woman. Don't get me wrong, I know that beauty is only skin deep but I also believe that ugliness goes all the way to the dang bone. In fact, thinking back on the sight, I am positive that there are some things in this world that Viagra and alcohol would not work with and this was one of them. So to sum it up, if she thought she was going to be using all of the condoms in that industrial size box, she was either wishful thinking OR going to be using the condoms as balloons at an upcoming birthday party.

Man Stuck in Sewer Pipe

While working in Atlanta for Grady EMS, we were dispatched to a "man stuck in a sewer pipe". We responded from one of the fire stations in the northern part of the city. On arrival we observed several people standing over a sewer grate that was in a parking lot of an apartment complex. As we exited the ambulance someone from the crowd yelled that there was naked man in the sewer beneath the grate.

Now, working in the city of Atlanta you have an opportunity to see anything and everything but generally naked men (or women for that matter) do not run around in the city sewer system. You will, however, find snakes, rats, a variety of dead domesticated animals, and maybe an occasional alligator, but never naked people. Even the homeless of the city tend to shy away from this activity.

My partner and I walked over to the grate and sure enough we see a naked man scamper back into a sewage drainage pipe that is about 36 inches in diameter. We attempted to make contact verbally with the "sewer streaker" but received no response. I did notice the crowd around us was becoming larger and this was most likely going to end up being a community event.

About this time, the Engine crew from the same Atlanta Fire Station we had been at when we received this call arrived on scene. I approached the Lt. as he got off the engine and advised him of our situation. I then asked if they could use some of their "cool" toys and remove the grate from the parking lot so we could attempt to retrieve the wayward naked visitor. Firefighters grabbed a pike pole and a halligan tool from the engine and proceeded to the grate. After about 5 minutes passed, the firefighters had the asphalt removed from around the grate and the grate was removed from over the sewer drainage area so we could make access.

My partner then got down and lied on his stomach and hung upside down into the sewer area and looked back into the drainage pipe. He saw the man approximately 8 to 10 feet away in the pipe. He told the man to come out and received no response. He then became more firm and advised the man to come out NOW because this would be a better outcome than if he had to come in after him. The man then slowly came out of the pipe and into the collecting tank area.

My partner grabbed one arm and I grabbed the other and the naked man was successfully extricated from the city sewer system. I advised the man that he needed to come with us to the hospital for evaluation and he began to follow us to the ambulance (yes he is still naked). I then grabbed a sheet from our ambulance and wrapped it around the man. Prior to doing this, I tried to be a good employee and be able to positively identify my patient and inquire if he had any insurance information, so I asked him if he happened to have any identification on him. He gave me the strangest look that immediately told me that there would be no ID card.

After we had the man in the ambulance and secured to our stretcher, I began my assessment and questioning of the patient. He advised that he had been in the sewer system for 3 days and that during this time he had been visited by aliens and impregnated by one of them. He then stated that he stayed in the sewer system because he was afraid the aliens would return and steal his baby. I found this explanation plausible because I have seen some very strange sights in the city of Atlanta but probably unlikely. He then became quiet and the rest of the ride to the hospital was made in silence.

My assessment of the patient revealed that he suffered from no prior medical problems and took no medications on a daily basis. He did not appear dehydrated so I did wonder (to myself) what he had been eating and drinking for 3 days in the sewer system. I also noted that the patient had multiple suspected rat bites to his entire body (literally from head to toe). There must have been over 100 bites on his body. Other than the alien pregnancy story he was alert and oriented and very aware of his surroundings.

Once we arrived at Grady Hospital, we took him through triage and he was assigned to the blue zone area of the emergency room. After going into the blue zone, the charge nurse told me to put him in the CPR room so he could be isolated from other patients and from any potential aliens that may arrive to steal his unborn child. While I was standing in the hallway outside his room giving the treating nurse report on this call, the patient came out of the room and asked where the restroom was. The nurse told him it was at the end of the hall and to the left and the man walked that way.

After a few short minutes went by the patient appeared at the end of the hallway and took an aggressive stance while staring at us. By the look on his face, he could of very well been under the influence of aliens at this time. He then snorted and took off in a run towards us. I only had a couple of seconds to react, so I took a step forward and planted my left shoulder into the man's chest as the air escaped from his lungs and he was slammed onto the hallway floor with his head making a empty thud type sound on the tile floor. I then got up and the nurse and I dragged the patient by his legs along the floor and into the CPR room while he was attempting to yell and flail his arms. When we got into the room hospital security showed up and we picked the patient up off the floor and "gently" slammed his body down onto the hospital bed and then held him down while he was restrained.

No injuries were noted to myself, the nurse, or any one else in the emergency room. The patients only injuries from this incident was a slightly bruised sternum and a badly bruised ego. He may of had tile burn from being dragged across the floor but I could not confirm this fact.

We later found out from the investigating officer with the Atlanta Police Department that the man had allegedly snatched a purse from a woman in midtown 3 days prior and jumped into an open sewage drain while being chased by some well-meaning bystanders. He then navigated his way approximately 10 miles from where he entered the sewer system to where we extricated him. There was absolutely no evidence found of any alien visitation with the patient and his pregnancy test came back negative. I am not sure of the outcome of his treatment in the emergency room but I am confident it involved some sort of stint in a psychiatric facility for a mental evaluation prior to answering any criminal charges that may have been brought against him.

Just another day in the big city!