If you are in EMS in the same system for any length of time, you often find yourself responding to some addresses again and again. Mostly they are residences of the elderly, especially large apartment type buildings. Or housing projects for the poorer folks in the area. Not always the same apartment, but sometimes it is the same apartment and the same patient. What are commonly called “frequent fliers”, but whom I prefer to refer to as “valued repeat customers”. Maybe we should offer discount cards, but then again much of our clientele doesn’t pay for their health care or transportation, so what would be the point?

Anyway, we were dispatched to one of our common addresses for a common type of call, “Trouble Breathing”. As opposed to “Trouble Breeding” which is what some of our annunciation challenged dispatchers seem to be saying and what none of our younger patients seem to find difficulty with. I see I’ve once again drifted off on a tangent, an occupational hazard of the old paramedic.

Back to our story. My partner and I are very familiar with the address if not the particular patient. It’s one of those addresses to which we respond with a tedious regularity and at which it seems we never have an acute patient. This sort of attitude can lead to complacency and when we DO have a critical patient it can take a second or so longer than normal to realize that. It’s something that we must guard against and some of of us are better at it than others. One of the my regular partners is very, very, good at not falling into that sort of mind set, another, not so good. I think I fall somewhat into the middle, my saving grace being that I can recover and change directions quickly. Adapt, improvise, overcome, as Clint Eastwood once said. Guess which one I was with this time.

Are call was frustratingly short of information, which is actually OK as often it seems the calls rich in detail turn out to be totally different from the reality.

We were met by a security guard who let us into the building and lead us to the apartment which for once was on the same floor as the entry door. Which is generally a good sign because as people in EMS can attest, the more ill a patient is, the further from the entrance they live. Sort of like the secret elephant burial ground or something. We followed the helpful security guard to the apartment of the patient and entered. One light was on in the kitchen but it shed no light, literal or figurative on the situation.

“Hello?” we called, trying to find out who we were there for and why. Silence answered our hails which could only be ominous. Usually we are met by someone, sometimes the patient even, and they can tell us what they at least think is going on. Not this time.

“Hello?”, we repeated as we entered the bedroom. In the dark, barely illuminated by the light from the kitchen was a man lying face down on the bed, motionless.

Oh oh.

“Sir, can you hear us?” my hopeful partner asked. Silence was his answer. Even if the patient could hear us, he couldn’t talk to us.

“Let’s roll him over and see if he’s breathing.” I suggested. It seemed like the thing to do so we did and he wasn’t.

Surprise. So I whipped out our trusty Bag Valve Mask Resuscitator and started to ventilate the patient while my partner checked for a pulse (which the patient had) and applied the cardiac monitor. At this point the fire department arrived to help. Mostly that consisted of finding lights and turning them on. Much easier to work in the dark if it’s light. If you know what I mean. Then the BLS crew arrived and the ALS portion of the call started.*

“I think we’re going to have to intubate him.”

“Really?”

“Yeah.”

So, an IV was started, medications given, and an endotracheal tube was passed into the trachea. Ventilation continued with good results. The patient’s previously critically low blood pressure increased, his incredibly wet skin dried up, his heart rate picked up to where it should be, his “numbers” on the cardiac monitor, which monitors more than that, started to look better.

In due course we moved the patient to our stretcher, then to the ambulance, then to the hospital and turned him over to the hospital staff.

What will become of him I am not likely to ever know. Which is just one of the things you have to get used to in this line of work. Most of the time we just never find out what happened to the patient after our small part in the course of their lives is over.

* As I’ve often said the first five minutes of any ALS call involves BLS level skills.