Part of being a good medic is in the hands. It's not the strength or grip had by a mechanic or a plumber. It's not the dexterity or agility of a pianist or violinist. It's the actual sensation of touch. The ability to feel the slightest vibration, texture, or motion. That is essential for diagnosing and treating patients. Not only does it benefit trauma patients (i.e. detecting crepitus/edema, feeling blood pressure/pulse without a BP cuff, and examining abdominal injuries) but also in treating clinical patients (i.e. tender area palpation, the warmth associated with infection, and of course the gloved exam). Not all clinical situations are easy. I have done some very difficult IV sticks. Low-light conditions, heavy turbulence in a Blackhawk, combative patients, and elderly jugular vein sticks are just a few.
Most of what we do is painful. Hell, our job is pain and the management of such. Most people don't understand that fact. In order to minimize it, sometimes we have to be rough. For example, if pinching you would save your life, would you want me to do it for 10 seconds or for 2? A lot of medics have never applied a tourniquet. They may know that when it gets tight enough to stop bleeding in practice, it feels uncomfortable to painful. Now when it is used on a real trauma patient, it will cause excruciating often unbearable pain until it stops arterial bleeding especially if the tourniquet is near a joint.
I used to pull a Medevac rotation 17 miles from the North Korean DMZ every other week. I had a few trauma patients and lots of patient transfers. Contrary to popular belief, flight medics don't just fly those that are seriously messed up. We do transfers between hospitals when the condition of the roads is poor or congested.
Being the most experienced medic on site, I would leave our quarters in the basement to hang out in the aid station, teach the junior enlisted, and flirt with all the cutie female medics. It was the best gig in all Korea. We had our own rooms, a huge flat screen HDTV decked out with $5000 leather couches, and a full-size kitchen. I could tell you stories about the aviation groupies we had that would cook and clean for us, but you wouldn't believe the stuff these girls did anyways.
My worst medevac started out with a call that a soldier had severed his radial artery in his right arm/hand. The ambulance crew brings in this completely drunk kid. I remember that all I could smell was the copper taste of blood. It was everywhere. He seemed to have bathed in it before we picked him up. Ever see the movie "Carrie"? Yea, that was him. I'll never forget he was wearing a white t-shirt that said, "Fuck you, you fucking fuck!" I thought how appropriate.
So we get him of the gurney onto the table. Naturally the Physician's Assistant had to probe the wound and earn some cool points from the aforementioned hottie medics. This tard opens the bandages and peels back the blood-soaked ace wrap. I laughed so hard, I almost cried. His attempt to be suave and impressive back-fired on him when the movement of the hand dislodged what little clot had formed, spraying him in the face. He drops the limb, covering the ladies, and the wall on the opposite side with blood. He had forgotten to apply the tourniquet before examining the laceration. I ran in and pumped up the BP cuff as one of the girls applied direct pressure.
By this time the kid had taken 3 liters of NS (Normal Saline) and was still chuggin it intravenously. The PA got a hold of the vascular surgeon in Seoul and we were requested to fly him down. As I was getting ready for the flight I asked the girls to let him urinate and secure his good arm before coming aboard. He was on his 4th liter by the time I grabbed my Zoll M. FYI the Zoll M is the best heart monitor/defibrillator/NIBP machine around.
The gurney rolls out to the aircraft. As protocol dictated, I was standing on the edge of the blades ready to escort the litter under the spinning blades. It can be pretty nerve racking to stand under the downblast of a twin engine Blackhawk. The roar of the turbines and the wind caused the speed of the blades is enough to cause people to crouch or freeze.
I got him in the bird and waved off the 3-man loading crew. We took off as I hooked up his IV bag to the bird, the NIBP to his good arm, and the heart monitor to his chest. Though it wasn't necessary to get his EKG, it's the easiest way to check his pulse and oxygen saturation. After I secured his injured limb to the carousel above his body, I heard this yahoo screaming something to me at the top of his lungs. I peeled off the earcup of my headset and put my head as close to his mouth as possible. There isn't any insulation on the standard Blackhawk so the sound of the rotor is almost as loud as outside.
His breath smelled like cheap tequila and stomach bile. I could only make out two words. "TO" and "PEE!" Pretty simple problem. Impossible timing. No solution. I yelled back that he has to hold it and gave him the 15 mins til touch down hand gesture. Sometimes in life you look back on events in your life and say, "That's where things went to shit. That was the turning point." I saw that after another minute of biting his lip, he began screaming again.
"Let me have my good arm!" The moment I loosened the waist strap his hand shot down his pants and grabbed his instrument in an attempt to pinch it off. Although he was successful, I think the heat or the feeling hit him like punch to the noggin. He begins to pass out as his pulse spikes. The grip lets go. The last time I had the sensation of a golden shower was changing my little brother when he an infant. Of course he laughed. So as I'm working on this guy we both get a shot in the face. I instantly grab the wool blankets and smother the geyser. Next thing I know, he is semi-conscious. Conscious enough to turn his head and start convulsing. Not an epileptic seizure, but the kind right before you up-chuck. I start cussing like a sailor while the rotor drowns out the sound of chunks covering my safety vest and the Zoll M. I tried to catch every piece because when someone vomits in the bird the smell doesn't leave for a week.
If that wasn't enough trouble, when he turned to puke the third time, he had dislodged his wounded arm and split the laceration wide open. The medics forgot to re-inflate the cuff when they put him on-board and it was dark so I didn't catch it on my intervention sweep. The spray fans out far enough to cover my crew chief, who feels warm liquid and believes we blew a hydraulic line. He starts screaming at the pilots and they in turn begin doing a series of hydraulic checks. I can't really talk at this point because I'd have to taste the piss and blood that is already in my mouth. So I grab the crew chief and push his hand onto the wound while I grab some sterile dressings. We finally land in Seoul at 121 General ER. The offload crew take a concerned look at me as I jump out. Screw protocol. I don't bother escorting the crew in or out. I jump into the ambulance to head from the LZ to the ER bay. I can feel my stench bleeding into the crevasses of the van. Usually the crew will ask me for vitals, but I'm sure my look shut down any attempts to be cordial. I do the signature exchange with the on-call MD with a sigh of relief. This asshole is no longer my responsibility.
The entire flight back was absolutely silent. When I got back to Casey, I refused to do any other missions that night. I took a 45 min shower, washed my flight suit, and crashed out. We had a good ole' laugh the next day as they referred to me as Doc the human toilet.
Most of what we do is painful. Hell, our job is pain and the management of such. Most people don't understand that fact. In order to minimize it, sometimes we have to be rough. For example, if pinching you would save your life, would you want me to do it for 10 seconds or for 2? A lot of medics have never applied a tourniquet. They may know that when it gets tight enough to stop bleeding in practice, it feels uncomfortable to painful. Now when it is used on a real trauma patient, it will cause excruciating often unbearable pain until it stops arterial bleeding especially if the tourniquet is near a joint.
I used to pull a Medevac rotation 17 miles from the North Korean DMZ every other week. I had a few trauma patients and lots of patient transfers. Contrary to popular belief, flight medics don't just fly those that are seriously messed up. We do transfers between hospitals when the condition of the roads is poor or congested.
Being the most experienced medic on site, I would leave our quarters in the basement to hang out in the aid station, teach the junior enlisted, and flirt with all the cutie female medics. It was the best gig in all Korea. We had our own rooms, a huge flat screen HDTV decked out with $5000 leather couches, and a full-size kitchen. I could tell you stories about the aviation groupies we had that would cook and clean for us, but you wouldn't believe the stuff these girls did anyways.
My worst medevac started out with a call that a soldier had severed his radial artery in his right arm/hand. The ambulance crew brings in this completely drunk kid. I remember that all I could smell was the copper taste of blood. It was everywhere. He seemed to have bathed in it before we picked him up. Ever see the movie "Carrie"? Yea, that was him. I'll never forget he was wearing a white t-shirt that said, "Fuck you, you fucking fuck!" I thought how appropriate.
So we get him of the gurney onto the table. Naturally the Physician's Assistant had to probe the wound and earn some cool points from the aforementioned hottie medics. This tard opens the bandages and peels back the blood-soaked ace wrap. I laughed so hard, I almost cried. His attempt to be suave and impressive back-fired on him when the movement of the hand dislodged what little clot had formed, spraying him in the face. He drops the limb, covering the ladies, and the wall on the opposite side with blood. He had forgotten to apply the tourniquet before examining the laceration. I ran in and pumped up the BP cuff as one of the girls applied direct pressure.
By this time the kid had taken 3 liters of NS (Normal Saline) and was still chuggin it intravenously. The PA got a hold of the vascular surgeon in Seoul and we were requested to fly him down. As I was getting ready for the flight I asked the girls to let him urinate and secure his good arm before coming aboard. He was on his 4th liter by the time I grabbed my Zoll M. FYI the Zoll M is the best heart monitor/defibrillator/NIBP machine around.
The gurney rolls out to the aircraft. As protocol dictated, I was standing on the edge of the blades ready to escort the litter under the spinning blades. It can be pretty nerve racking to stand under the downblast of a twin engine Blackhawk. The roar of the turbines and the wind caused the speed of the blades is enough to cause people to crouch or freeze.
I got him in the bird and waved off the 3-man loading crew. We took off as I hooked up his IV bag to the bird, the NIBP to his good arm, and the heart monitor to his chest. Though it wasn't necessary to get his EKG, it's the easiest way to check his pulse and oxygen saturation. After I secured his injured limb to the carousel above his body, I heard this yahoo screaming something to me at the top of his lungs. I peeled off the earcup of my headset and put my head as close to his mouth as possible. There isn't any insulation on the standard Blackhawk so the sound of the rotor is almost as loud as outside.
His breath smelled like cheap tequila and stomach bile. I could only make out two words. "TO" and "PEE!" Pretty simple problem. Impossible timing. No solution. I yelled back that he has to hold it and gave him the 15 mins til touch down hand gesture. Sometimes in life you look back on events in your life and say, "That's where things went to shit. That was the turning point." I saw that after another minute of biting his lip, he began screaming again.
"Let me have my good arm!" The moment I loosened the waist strap his hand shot down his pants and grabbed his instrument in an attempt to pinch it off. Although he was successful, I think the heat or the feeling hit him like punch to the noggin. He begins to pass out as his pulse spikes. The grip lets go. The last time I had the sensation of a golden shower was changing my little brother when he an infant. Of course he laughed. So as I'm working on this guy we both get a shot in the face. I instantly grab the wool blankets and smother the geyser. Next thing I know, he is semi-conscious. Conscious enough to turn his head and start convulsing. Not an epileptic seizure, but the kind right before you up-chuck. I start cussing like a sailor while the rotor drowns out the sound of chunks covering my safety vest and the Zoll M. I tried to catch every piece because when someone vomits in the bird the smell doesn't leave for a week.
If that wasn't enough trouble, when he turned to puke the third time, he had dislodged his wounded arm and split the laceration wide open. The medics forgot to re-inflate the cuff when they put him on-board and it was dark so I didn't catch it on my intervention sweep. The spray fans out far enough to cover my crew chief, who feels warm liquid and believes we blew a hydraulic line. He starts screaming at the pilots and they in turn begin doing a series of hydraulic checks. I can't really talk at this point because I'd have to taste the piss and blood that is already in my mouth. So I grab the crew chief and push his hand onto the wound while I grab some sterile dressings. We finally land in Seoul at 121 General ER. The offload crew take a concerned look at me as I jump out. Screw protocol. I don't bother escorting the crew in or out. I jump into the ambulance to head from the LZ to the ER bay. I can feel my stench bleeding into the crevasses of the van. Usually the crew will ask me for vitals, but I'm sure my look shut down any attempts to be cordial. I do the signature exchange with the on-call MD with a sigh of relief. This asshole is no longer my responsibility.
The entire flight back was absolutely silent. When I got back to Casey, I refused to do any other missions that night. I took a 45 min shower, washed my flight suit, and crashed out. We had a good ole' laugh the next day as they referred to me as Doc the human toilet.
lang_:
Wow, I'm pretty much speechless. That's amazing....just like you .