Tincanfireman
Airfield Operations
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We were dispatched today to do an interfacility transfer (in a city many miles from our usual area) from a community hospital to a rehab center. Upon arrival at the hospital, pt was alert and ambulatory in the room, being d/ced for pulmonary rehab. In addition, pt was orthostatically unstable; 130/80 supine, but only 80/60 standing (this is all according to the nurse). Since pt was ambulatory, alert and could tolerate sitting, they were technically a wheelchair patient, but as luck (theirs) would have it, none were available. With everything in order, pt sat down on the cot, I applied the ordered 2 LPM and off we went. I could stretch this into a two page entry from this point, but I'll condense it to this: fifteen minutes and 10 miles down the road later pt was in severe respiratory distress on a NRB at 15 LPM, O2 sat's dropping, clutching at the chest complaining of crushing substernal chest pain, color going to hell, and we were in a parking lot in an unfamiliar town (still 8 miles from the closest known ED) awaiting an ALS intercept. My new best friends (the local EMS medics) arrived within a few minutes and assumed patient care at this point before even more possible excitement ensued. I have no idea of his outcome, but if I find out I'll post it. Before you ask, I elected to stop and wait for ALS instead of continuing because: I knew there was another hospital in the vicinity, but no idea how to get there (or if it was closer, turns out it wasn't). In addition, I figured a stationary "target" was easier to find than a moving one and I didn't want to be playing catch-me-if-you-can with the ALS unit. I just wonder what the poor, non-certified wheelchair driver would have done if this person had tanked in the back of a wheelchair unit!! My point is (especially for the newer members of this board) that no run is necessarily a milk run, and that you never know when a routine transport will become a test of your skills and judgement. For what it's worth, I had a chance to speak with the charge nurse at the receiving center later on and she showed me a (loooong) list of problems with this person. Things like; Hx of CAD with stenosis, DVT, myopathy, CHF, pacemaker, HTN, diabetes, etc, etc, etc. Would have been nice if the discharging RN had mentioned them to me! (In all fairness, they may have been in the D/C summary, but I was a little too busy to read through it before I had to hand it over to the medics.) I hope this serves as a reminder to all of us that we should never let our guard down; Murphy lives in the back of every ambulance... =)
