We work 7 to 7. Copying my work habits from the USA, I typically get to work by 6:30 – 6:45. That way, if a call comes in for an ambulance at 6:55, the paramedic who just worked a whole shift before doesn’t have to go out for another couple hours.
Well, that’s what happened to me. The paramedic scheduled to relieve me this particular morning is a young local who is notorious for being late. If he shows up at 6:59, he considers himself early. If you show up at 6:50, he’ll rag you for being late. Punching people in the face is considered impolite in this culture so I just let it slide.
This morning, We get called at 6:52am (8 mins before "quitting time") to a residence. I’ve been working solo that night. I’m based out of an ER so when there’s only 1 medic on duty, a nurse from the ER typically goes with me to help out. Today, I get Hassan. He’s an experienced nurse from Lebanon and we’ve worked enough patients in the ER together that we trust and respect each other.
The call is for a woman with a dislocated hip. Our call takers and dispatchers here are not trained as EMDs (Emergency Medical Dispatchers). They just get the location and send us on our way. We have an extension of the hotline in the ER and, often, we’ll hop on the line with the dispatcher to get more relevant information. Hassan has done this and found out that the husband, who called, heard his wife’s hip "pop" out of joint. My mind is running over the limited extrication tools we carry on the ambulance. When we arrive on scene, the first thing I pull out is the scoop stretcher.
Hassan has preceded me into the house. By the time I enter, he’s been talking to the patient and her husband for a bit but they all expectantly look my way when I come in the room. Maybe it’s Hassan’s accent (his English is very good) or maybe it’s the patient’s and her husband’s VERY Texas accents but they all look to me for guidance when I come in as it seems nobody can communicate much.
She’s sitting in a very uncomfortable position in an office chair. She’s got one of those looks on her face that makes me believe the max pain-scale number is likely true. She said she was walking and her right hip just popped out. She got herself into that chair before she fell.
Happen before? Yep, Couple times.
Fall and hit her head? Nope.
Oriented to day, place and person? Yes, yes and yes.
Pain from 1 to 10? Ten! (Duh!)
Now, here’s the problem: She ain’t tiny and she’s sitting in a rolling office chair with arms. I’ve got to get her to my cot and change her position. That’s gonna hurt a lot. I send Hassan out for the drug bag and set about starting an IV. When he gets back, I get him to call a doctor at the ER to get us permission to give morphine. The patient’s had it before, not allergic and it didn’t make her throw up the last time.
Her vitals are good and her stomach is empty (just in case, you know?). Our doctors here (the local ones) are VERY conservative with pain medications as narcotic medication errors often lead to protracted jail sentences in this country (Yeah, really!). I get permission to start with 5mg and to follow with another 5 if needed. My patient weighs about 80 kilos so I know 5 milligrams of morphine is not going to do the trick, especially when we pick her up and move her to our cot. After a few minutes, her pain has only dropped to an 8 out of 10 so I dose her with the other 5 mg of "happy juice."
After a few more minutes, her pain is down to a 3 so I think we’re ready to move her. In one swift movement, we get her standing on her good leg, seated on our cot and then positioned correctly. There’s a few gasps and yells but nothing like we would have had without any analgesics.
After that, there’s not much more for me to do but get her comfortable for the 5-minute ride to the ER. She’s snowed enough by the morphine that she dozes on the ride between bumps and I’m keeping an eye on her respiratory rate.
My relief shows up at her bedside while I’m transferring care. He doesn’t show a whit of remorse or even acknowledge the fact that I took a call that held me over by an hour. Yah, whatever. I got the most interesting patient of the day. I win.