“Medic 23 are you clear from post one yet?”
We were told earlier that dispatch had an envelope from billing for us. I knew it was a run that needed fixing so I said I would just fix it when I returned. Dispatch apperently thought I was comming back to fix the run now.
“Yes we are clear from post one”
“I have an emergency transport comming out of Secular East ER going to Children’s hospital”
That’s strange, our competiton has that contract, but I’ll take any run they give me. Secular East is a decent hospital, part of a local chain if they need an emergency transport it must be truely urgent. Luckily for us & the patient we were still only 2 miles from the hospital.
Dispatch notifies us that it is a pediactic patient in respiratory distress. We make our way to the hospital. We arrive on scene and see a BLS crew outside. The crew tells us that the doctor is thinking about intubating the patient. We bring our equipment & cot into the bustling ER. The charge nurse asks if I am ACLS certified, I re-assure her that I am. The doc meets us in the room. Our patient is a 16 year old male who is experiencing an asthma attack that began the night before, it is now 6pm. The doc gives the verbal report to us, the patient began this episode the night before, the ER has administered 5 breathing treatmets in the past hour, 2 grams bolus of magnesium sulfate and 125mg of solu-medrol. The patient is still retaining CO2 (last ABG showed PCO2 of 52). The nurse says respiratory is getting an hour long nebulizer treatment ready for the transport. Doc says he is not going to intubate the patient now and they will hold off on the terbutaline. Children’s hospital is aware that we are comming.
We hook the patient up to our ECG, move him over to our stretcher. The patient is using accessory muscles to breath and he is looking tired. We roll out to the exit doors and wait for respiratory to show up with the nebulizer treatment. The doctor sees us waiting and asked where respiratory was (and implied that he was not happy that we were still in his ER waiting). I calmly tell him that I can administer DuoNeb enroute if he doesn’t want to wait. Doc looks at the wall clock “If they are not here in 60 seconds, leave. Don’t let your neb run out”.
RT (respiratory therapist) arrives in 45 seconds with the albuterol. Time to get moving.
My partner and I are well aware of the urgency of this transport. This is the first time I have seen this doctor “hurried” and, politely, rushing us out the door. We waste no more time and hit the road. I give the patients lungs a listen, still wheezing bilaterally. I tell the patient if he feels like he is getting tired let me know. I really wish I had capnography right now!
A rapid and uneventful transport. The ER at children’s was waiting for us and they immediatly started on nitrox treatment, ordered another magnesium drip and terbutaline. I know I did not do much other than transport, but I feel like we made a difference.
I returned to the station to get my paperwork and a few supplies. The BLS crew was just getting off shift and told us the begining of this story. They had dropped a different patient off at the ER. The charge nurse asked them if they could transport to children’s hospital. The nurse told them that if needed, the doctor was going to intubate the patient and ride with the BLS crew to children’s hospital. Luck was on our side. Since I never left the area my ambulance was close to provide the service.
Somedays I really like this gig.