As you may or may not know, Germans tend to use more physicians in the field than Americans. That is why we have Emergency Physician Vehicles (my own free translation .. plus my own abbreviation: EPV). Today and exactly a week ago, I had the pleasure of joining the crew of one.
Last week it was just like every time when I volunteer for these things - nothing happened. I spent eleven hours with two pagers attached to myself, always making sure I'm not the one member of the crew who is the farthest away from the vehicle. Because if I was late in an alarm, these guys (and the patient) would have waited - either that or they'd go without me. Since either of that wasn't appealing, I kept myself within a rather tight radius from the car.
After nothing happened all morning that day (I was there from 7:30 am), we went to the fire department to eat (best food they said - and who was I to disagree with firemen). And it was good. Very good. And free. Bunch of bulky guys twice my size - and no German. Strictly Bavarian. And after sitting around at the department for another two hours or so it finally happened. The thing in my pocket started beeping. Rather softly but firmly. I did as any good medical professional does - fumble aroud with the thingy until the beeping stopped. Then I looked up and people were already starting to mount the EPV.
Flashing blue lights on and on the road - driving around town like I'm only used to from riding my bike. No respect for traffic lights, right of way or any kind of sanity. What differed from the bike though, were the flashing lights and the siren. I really need that for my bike. Surprisingly, most of the time, other drivers actually react sensibly and get their rides off the street one way or another. Except for a few maybe. If we hadn't had such a good EMT at the wheel, we might have crushed that blonde in her BMW convertible. She did have a green light at the big intersection. But we had a blue light. Everyone stopped but her - and she had well enough time. Anyway, we arrived at the patient's place safely.
The place was already crawling with medical personnel, we brought the first doctor though. The case wasn't that spectacular. An elderly Parkinson's patient who had apparently suffered a stroke or intracranial bleed this morning. The wife told us he had had a few episodes of violent seizures, now he was unable to speak and Babinski's were positive on both sides. The Clinic we came from didn't accept him so we took him to Pasing for a CT.
And even though I stayed until 7:30 pm that day, no other alarms were sounded. Stubborn as I am, I would have stayed a few more hours for the people who try to drive drunk on Saturday night, but I had to do half a day's work at the lab still. So I left. Even though the physician regretted to see me go as "now things would get ugly". I don't know if they did.
I did come back today though. And so far, today is apparently more "normal". We had three alarms so far, and apparently according to some tendency of these things, they came one after the other.
The first was at a nursing home - rather easy diagnosis. Textbook stroke with hemiparesis. The patient, who reportedly used to be able to take care of himself before the incident, was aphasic now and half his face hung down from the paralysis of the right facial nerve. His GCS was 11 for the aphasia - he did seem to understand and execute commands though. The main occupation of the physician was talking to the daughter and the nurse of the home and occupying himself with the neurologic status of the patient. The EMTs put everything for a venous line on the bed next to the patient while I was taking his blood pressure. Apparently they assumed I'd be the one to stick the patient. So I did. When the line was in, the physician ordered me (still not sure why me again, all this was the job of an EMT ..) to administer 10 of Urapidile, since I measured his BP at 190/90. Thankfully the EMT handed me the syringe so I didn't have to look for it. Then we packed the patient on a gurney. He was rather peaceful, only once in a while lashing out with his good side. Until the elevator. He suddenly appeared to have his mouth full. "Ummm .. do we have something handy?" Everyone was hardly able to move in the narrow elevator with the gurney, leave alone open a suitcase and get anything out of it. After a few feeble attempts, the doors opened and we got the poor guy a bag to dispose of his vomit. The rest went rather smoothly. Even though today's driver is a bit more daring. I think it was rather lucky the guy had disposed of the contents of his stomach already.
This alarm was at around 10:30 am though, so soon after disposing of the patient we took off from the clinic for the fire department - food time! We thought. Sitting in the car, you could easily follow how all our pagers sounded almost simultaneously. Practically, we were already underway and responded in about five minutes to the emergency call of a woman from Afghanistan whose daughter had collapsed in the apartment. When we came in the patient was lying on her side on the floor - vaguely resembling a stable recovery position. She was alert and breathing, her BP 90/60 at pulse 100. We knew why pretty quickly - she had some kind of GI-infection and hadn't eaten and drunk anything since noon yesterday. So she is dehydrated and collapsed after vomiting again. Big surprise. We basically asked if the daughter had seized or could be pregnant - when they negated both (of course) we told the mother to give her daughter some fluids and food, then we left. We were hungry after all.
Everybody ate fast. Apparently they were aware that the dam was broken - the little boxes could start beeping any time. And they did - when we were just done luckily. Blue lights, siren and a maniac at the wheel - minutes later we were with an awake and responsive patient - who couldn't tell us what date or even what month it was. He was oriented to person and place though. Very interesting. The wife told us he had a history of hypotension, so I measured the 190/100 twice. Then we had the preliminary diagnosis of hypertensive crisis. The wife also told us that her husband has been asking her the same questions over and over before. I was used to the dosing of Urapidile now. I measured his BP regularly, in the car as well, and was pleased to watch it go down under therapy. While the two EMTs were in front driving the car and the physician took care of the protocol he had to fill out, I blurted the vital parameters of the patient out to him periodically.
Now I'm sitting at the one PC in the ready room that the EMT is anxious to hammer his report into, so I should leave. Will report back if there's more today.
