Jedediah Joe Capps

            When we arrived at OU’s Trauma Center, their trauma team was ready to go. I stuck around and watched them insert a chest tube into the side of her chest to drain the blood and fluid from her thoracic cavity. Watching them place the chest tube made me feel sorry for the lady. It was obvious that the patient had an extensive history of drug abuse. As we were transporting her to the hospital she kept saying that she was sorry for shooting herself and that she knew she had made a mistake. (Uh, Yeah! That would be a huge mistake!) I don’t know if I mentioned that she had used a .22 caliber pistol. I think she just wanted some attention, but then again, maybe she was sincere in her attempt to end her life. Hopefully, she won’t ever make the same mistake again.

Well, unfortunately I don't have any really exciting calls to write about this week, but I can tell you a little bit about the many un-emergent calls we are called to on a daily basis. The other day, I believe it was after the second or third call that (what do you know!) was non-emergent! I begin contemplating about the area I come from, I guess some would call it the sticks or redneck country, hick-town, what have you. Anyways, I was thinking about how things are done and about the life we tend to live (or the way of life) in a rural area. Many, of us would not think of calling 911 at the first sign of a child choking. The times I can recall one of my younger siblings or a niece/nephew choking someone always runs to the child and either picks them up or leans them forward and begins to slap them on the back. Thanks be to our Father in Heaven they have always regurgitated what was in their mouth or throat and have been okay.

       I wonder, at what point would you call 911? Do we wait until the child or adult is no longer breathing or making an attempt to cough or gasp for a breath of air? I think many of us would wait to call until that point. I am not saying this is right or wrong, but simply stating the mind frame I would have to wait until I thought it was an actual emergency to call. Would it be an abuse of the system to call 911 in the moment your child begins choking? Not at all! I cannot tell you of the relief I (and many other EMS personnel) would have, to arrive on scene and see that the child no longer has an airway obstruction and is alert and breathing. In fact, again.... where I come from if the child spit out whatever they were choking on I believe the caller would make an attempt to call 911 and cancel the ambulance if they (the Ambulance crew) were not already on scene by the time the child was Ok.

      With that I preface, my argument or comparison of different types of people I encounter here in OKC. We are often called to a home/apt for a person that has been sick for the past 2 or 3 days and has come to the decision that their illness is an emergency and they need to go to the hospital by ambulance.  Whether they are ill with nausea/vomitting or have been experiencing hot and cold chills, they call. Did it ever cross their mind that they could go to a clinic and see a Doctor that would charge them a lot less than what an ER visit costs? Oh wait! If they do that they would have to find a ride to the clinic, and if their only option was a cab, they would have to pay for it out of pocket. Instead, they would rather just call 911 and have an ambulance rush to their address, pick them up, and take them to the ER where we will either put them in triage (I should start practicing this more) or get them directly into a room. So, who's pocket does that come out of? Your's and mine! The Taxpayers of America, The land of the free! :) Did we lose the original and honest meaning of what "The Land of the Free" actually means?  Our lovely welfare system contributes more and more to that demographic of society.

        Now, this might make some of you sick, so I will forewarn you. This is an actual statement that was documented by our dispatcher from a caller who dialed 911.
REASON FOR CALL: and I quote, "They (the Hospital?) told me that if I took him/her myself they would just make us wait."
       (Yes, I see that would be a huge inconvenience for you, I see how this makes your situation an emergency.)
HAHA! (I am not really laughing, are you?)
Wait it gets better!
One of my fellow Paramedic students had a patient say this to them.......
Patient: "I want to finish my cigarette before we go."
Paramedic: "Ok, obviously this is not an emergency and if you need a ride to the hospital, you can just call a cab and get a ride."
Patient: "I can't do that cause I don't have the money for a cab."

CHAA   CHIING!!
And a $1500.00 Ambulance ride is charged to someone other than this    uh?     umm?       (do I call them a patient or do they deserve their own special title or category?)

I won't bring up the expenses that go along with an ER visit. I am sure you can find that out if you really want to know.

One memorable call I had was a woman that called 911 for her 4 y/o daughter who had grabbed a bowl or cup of hot syrup off the table and spilled it on herself. Now, my first impression is "Poor child, I hope that she is not severely burned."

We show up to find the child playful and in no pain at all, no burn marks to the skin (HER SKIN WASN'T EVEN RED!) The mother is trying to point out burn marks on the child's skin.
So the mother said, "I knew it was time to call 911 when she started talking about rainbow colors on the ceiling."

Ok, your daughter is 4 years old, she is playing around and not worried about whatever took place with the syrup 30 minutes ago and because she has a bit of an imagination, YOU CALL 911! ???

The best part of this story is that the mother claims to be finishing her nursing program soon.   HAHA!

She pulls out this medical dictionary as I am giving my call ahead report to the receiving Emergency Department. I am guessing to look up words I was using to politely explain to the ED Nurse that the child has no signs of trauma and is completely fine. Or maybe she was just studying up for one of her tests coming up? Don't know, but if she becomes a nurse.... I don't know what to think!

Well, I do love to serve those in need and it is a bit refreshing to help someone who is truly experiencing an medical emergency!






       

So, things are going well! I am enjoying the new experiences of each day! This last week has been the most eye opening of experiences. To start, Sunday morning first call of the day, which came at 5 a.m in the morning was for a man with breathing problems. As I walk into the home, a lady greets me and points to her husband who is sitting across the room in an office chair hooked up to oxygen via nasal canulla. The man is about 450 lbs. (imagine the man in picture and add about 30-40 years) and has a scraggily white beard, and looking very, very sick! The man was not the model of health. I start my assessment and history of the man's present illness. As I am asking questions, I learn that the man had just been released from the hospital the day before and was diagnosed with pneumonia, in addition existing severe case of COPD. As I am questioning the man and continuing my assessment, I see drool/snot coming from his oxygen tubing attached to his face. As my preceptor and driver enter the room followed by 5 firefighters, she comes up to me and asked me if I had listened to his lungs yet (as she takes her stethoscope and listens). She looks up at me and says "He isn't moving any air!" At this point, I am not only kicking myself for not jumping right to it and listening to his lung sounds, but I am also freaking out! THE MAN IS NOT MOVING ANY AIR IN OR OUT OF HIS LUNGS! I yell to my driver to grab me a BVM, so I can start bagging the man and start breathing for him as he has lost the ability to do it himself. My preceptor then asks, "Didn't you notice the cyanosis in his lips?!" I am thinking to myself how in the world did I not take that into account as I totally see that they are blue-ish in color. And here I am, asking the man questions about his present illness, when I should've been performing interventions to save the man's life!
     Well, not 15 seconds pass, and the man stops breathing all together and collapses. I finally get the BVM in my hand and start bagging him. The firefighters are scrabbling around trying to prepare a route to move this man out to the ambulance. My preceptor and driver are preparing the cot, and I begin cutting the man's shirt off to throw the fast patches(defibrillation pads) on the man's chest. The firefighters finally get a back board and we are all trying to maneuver to move this guy to the cot. One firefighter is trying to get around the head of the guy and me and he begins to kick stuff out of the way, which is classic scenario of trying to move a patient from whatever "hole" your trying to get them out of. I mean there was stuff everywhere in this house. This man weighs 450+ lbs. and there I tiny paths to maneuver through the house. I highly doubt he ever went to some parts of his house! Now, I am trying to emphasize and paint a picture of the difficulty of moving any and all patients from their living quarters and the challenges of maneuvering a cot in such tight spaces, not focus or make fun of this man's weight. We finally get him loaded on to the cot (which doesn't seem like its ever made for any of the rounder patients we frequently pick up) and get him into the ambulance. The man is now pulseless and I continue bagging him, while our crew and two firefighters begin chest compressions. My preceptor is preparing advanced airway equipment and as well as attempting to get IV access. There are so many things going on at once in a cardiac arrest call, that it is like a whirlwind of events, so many things needing to be done and prepared and all at once. Meanwhile, the man is building up a lot of thick mucous secretions. My preceptor tells me I need to attempt to intubate the man. I have the laryngoscope  right there in front of me and she has prepared the tube for me. I am now taking into account the man's size and that he literally has no neck(pretty much the most difficult of patients to intubate). I make my first attempt and as I open his mouth and stick the laryngoscope into his mouth and view his throat, I see nothing but heavy secretions and that is it! I pull the blade out and call for suction and begin suctioning, and then begin bagging him again. I make my second attempt and cannot see any cords, I lift, bend and push his head back to get a better view, but my attempts to get a better view are unsuccessful. I pull the blade out and begin bagging and prepare to move for my preceptor to make her attempt. Luckily, she gets the tube and we are now getting a huge improvement on ventilating this man. We confirm with lung sounds present and ETCO2 and I continue bagging. We are driving lights and sirens to the ER and a minute before we arrive we get ROSC (Return of Spontaneous Circulation or simply put, the man pulse returns) and we get him into the ER. This call was a huge eye opener for me and I am still kicking myself for not noticing the signs of his severe respiratory distress upon entering the room. Not a mistake I will make twice! My preceptor and I had a long talk about it and she assures me that it is really the experience that makes the training and knowledge all come together and stick for  that next moment or call when you face the same circumstance again.
The following Monday, we get a call for a man with a diabetic emergency. As we arrive on scene, I step out of the Ambulance and see this man in the driver seat of a red pickup. He appears to be completely naked, excluding that he still had his socks on. A Police officer and Firefighters are on scene. I walk up to the truck and the Fireman tells me that the man's sugar is 441 and that he shouldn't be driving. I step closer to the truck and ask the man what is going on today? He looks at me with the most disgusted facial expressions and says "You skinny white boy, ya'll just tryin to mess wit me today!" I ask him where his clothes are at, and he just shakes his head with the same disgusted look. My preceptor steps up beside me and ask the man where his clothes are and the man begins to laugh. Ha! Ha! "I know you! I recognize you!" She is as surprised as I am. She has never met this man in her life. The man asks us, what we want from him. I say we are just here to help you out. He laughs and says, "You don't give a *@$! about me!" By the way, the man can only answer one question correctly. He knew who the president of the U.S. was. We finally convince him to come with us as his only other choice was to go with police officer. As we get him into the ambulance he is furious that we are just trying to get him locked up in the hospital. We take another blood sugar and it comes up 475! This man's sugar was sky high! No wonder he was so out of his mind. After arguing with him for about 20 minutes, I finally convince him that it wasn't normal for him to be completely naked and that he wasn't supposed to be driving. Funny thing is, that once I convinced him that he wasn't behaving normal, he was convinced that his daughter who he lives with set him up. He said, "That Jemima! I am gonna whoop her _ _ _!" After it was all said and done, the man gave the ER staff the same pleasant greeting he gave us! He was not happy to be in the hospital, but politely thanked me and told me it was great to see me, when I said goodbye to him as we left.

I will just start by saying, this is a completely different world compared to Idaho EMS. No offense to the many great medics and EMS personnel back in Idaho, but the volume of calls and the EMS response here is totally different! Let me explain, I was lucky to get 2 or 3 calls in Idaho on a 24 hour shift, where as here in OKC (Oklahoma City) we will surely have at least 4 calls in a 12 hour shift. Here in OKC we respond to every single call, let me repeat that, EVERY SINGLE CALL FULL CODE (this means we respond to every single call lights and sirens and they drive very, very fast here)!  I told Kim the other night that it will be a miracle if I survive the internship because of the way we fly through traffic here. Each time we respond to a call, I buckle up, and just sit back in my seat and brace myself as we fly through the city streets.
     And let me tell you, just how comfortable the ride is in the back of an ambulance! Have you ever been in an old farm truck or better yet a tractor and driven over corrugated field? Well, try to imagine how you felt and now imagine those corrugates randomly popping up and some times they feel like your jumping a small drainage ditch as the ambulance is being driven anywhere from 60 to 85 mph! It is nice when the driver shouts a moments notice warning to me as we jump a curb or cross over the median into oncoming traffic. I think that's my favorite part, when I know I am heading into oncoming traffic and can't see anything because one; I am facing backwards in the back of the ambulance, and two I don't dare sit up in my seat and turn to see through a small 1 sq ft. hole that opens up into the passenger compartment where the driver and medic sit. I try to have faith that all will go well, but I think in those instances I am relying mostly upon grace, that somehow Heavenly Father will guide us through and protect us as we weave in and out of traffic and speed through red lights at intersections.
      Kim asked me just last night, "I thought you loved driving with the lights and sirens?" I replied, "That was in Idaho when it was few and far in between, and we didn't respond with lights and sirens to every single call! Here we drive with lights and sirens and put ourselves and every other driver and passenger on the streets in danger for somebody that's been sick for the past 3 days and finally decides that because they still feel crappy they need to be driven to the ER by ambulance!" What part of their illness is emergent? The best part is when we have to wait on them because they have to gather their ipod, their eye glasses, and a favorite book to keep entertained in the ER because they will be sitting there for a while until the doctor can get a second to see a person with such a life threatening emergency. Don't get me wrong, I enjoy helping and taking care of people with life threatening emergencies and that are too sick to move or help themselves, but for others that abuse the system, well I just pray that people are not killed or hurt in responding their urgent need!
     I am learning so much here! My preceptor is great! She is very smart and knowledgeable and demands the most from me. She has had me jump right in and run the calls, which is very nerve racking at times. Honestly, sometimes I feel like I don't have a clue and have forgotten everything I knew or learned and she doesn't just feed information to me and give me answers, she just looks at me and asks me what I think we should do. The moment I make a decision she is right there to support it and do whatever is needed to help, but she demands that I make the decision and judgement on patient care. The past week I had 3 chest pain calls, and of the 3 people, I believe only one of them really needed  pain meds and was really having chest pain. The two that I ended up giving pain meds (morphine) to, ended up being the two that I believe were only seeking to get a fix, because they were out of pain meds at home. One of them actually said that they were out of their pain meds early because they had ACCIDENTALLY dropped some down the toilet. Haha! I try not to judge in the moment. If they complain of pain and get so dramatic as to cry about it or pretend to be confused about where they are and where we are taking them, I give in and give them what they seek. I would hate to withhold pain meds from someone that really needs them so I give them to those complaining of pain. Did I mention that both of these patient would rest peacefully on the cot until I asked them how they were doing and how their pain is. Haha!
      My very first call of my internship was a great welcome to OKC. It was a patient complaining of difficulty breathing and he ended up being out of his pain meds and needing more and had been in the ER the day before because his oxygen tubing (a nasal cannula) caught fire as he was smoking a cigarette while it was attached and flowing a highly flammable gas through it. I can only imagine what that would have looked like. He told me that someone handed him the cigarette and he was simply passing to a women to his side and it suddenly caught fire. Haha! Rrriiiight! AS HE TOOK A PUFF AND THEN CAUGHT FIRE!
       So, the call begins as we roll up to this very rundown house in a very rundown neighborhood. As we arrive the Firefighters are already on scene. DID I MENTION THAT IT WAS 5 AM? So, we walk in and the house is filled with that lovely cigarette smoke saturated smell, the place has probably never been cleaned and I can feel stuff crunching under my feet every step I take. There is a women sleeping on a bed right in the living room (she is still asleep or passed out, since 5 firefighters are in the house plus 3 EMS personnel and no one was whispering), I walk into a very small crowded kitchen where two fireman are standing and turn to my left and peer in a small room with my patient sitting up on the side of his bed. He is a very malnutritioned man with longer white hair and a white beard. He is wearing red socks, red sweat pants, and a red T-shirt. My first thought was it is Gandolf the Red! He had a stunning similarity to Gandolf the White or Gray from Lord of the Rings. So, my preceptor enters the room and I decide to watch from the door and place my gloved hand on the wall to relax in my stance. The Firefighter next to me says, "I would watch where I place my hands in this place unless you want a bunch of creepy crawlys on you!" I look at the wall and see hundreds of cockroaches scurrying around. I thanked the Fireman, for the heads up. He said, "I wouldn't stand in one place too long either." I could already feel them crawling on me.
      My poor preceptor squats down to the floor to search for the mans medication bag and she grabs a little white trash can and I see hundreds more of all different sizes most of them being little tiny baby roaches. I could not wait to get out of the house and into the well-lit ambulance, where I would be able to flick or smash anything I spotted crawling on me. Don't worry, I found one. I believe it was a flea that had jumped onto my arm from my patient, I smashed the thing and threw it on the floor. Sick, Dude!

Kim and I were sealed in the Mt. Timpanogos Temple Friday morning at 11a.m. We are so grateful for all the family and friends that made sacrifices to be with us.

http://www.byuicomm.net/fire-at-apartment-complex/

Today I am flying along with the Air Idaho Rescue crew. Turns out that my Program director is on shift today also, so I know it will be a great learning opportunity if we do get called out for a flight. This is the pinnacle of Paramedicine. The patients they transport are the most critical in illness and injury, thus meriting Air transport. The pictures posted were taken while we were performing the morning equipment check and look over of the plane. We're geared up and ready to go!

Wednesday morning I was able to go to Portneuf Medical Center in Pocatello for Intubations. I was able to learn from some great Doctors and Nurse Anesthetists, see how things are done in the OR (Operation Room), and put a lot of people to sleep and keep them ventilated during the course of their procedures. I had a blast! It was awesome to actually intubate a live person instead of a plastic mannequin! I was able to learn proper techniques of bagging/ventilating a person who's respiratory system is depressed or all together not functioning. I have been seriously looking into Nurse Anesthetists Programs and going on in school and this experience has only intensified my curiosity and desire to pursue such a path. I have posted a few pictures of just what takes place in endotracheal intubations and the views you see when your right in the action.