Medics man mobile ER
May 30--He'd been standing naked in his driveway and didn't seem to know why.
The 69-year-old man sat on his porch swing in an open bathrobe and plaid slippers. Paramedic Josh Dail inflated a blood pressure cuff around his forearm.
"Where's your clothes at?" Dail asked. "They said you were laying out here with no clothes on. Why were you doing that?"
The man shrugged his shoulders and mumbled, offering no explanation.
Dail learned that the man's fiancée had died that week and he'd been in a car crash three days ago. Three pills were missing from his fiancée's bottle of Klonopin, an anti-anxiety medication.
"Did you take any of those medicines today?" Dail asked.
The man shook his head no.
"Let's run up to the hospital and get you checked out, OK?" Dail said. "A lot of this isn't making sense to me. We just need to make sure you're OK."
Dispatchers had sent Wilson County Emergency Medical Services paramedics to the man's home along with sheriff's deputies and Black Creek volunteer firefighters around 10:55 a.m. Saturday. A caller said a naked man was standing and lying near the road.
Dail held the man's arm and guided him down the porch to a stretcher. He covered the patient with a white sheet and applied the shoulder, chest and leg straps to secure him to the bed.
Inside the ambulance, paramedic Brian Wittenburg placed a pulse oximeter probe on the man's finger. Dail drove to the hospital as his partner checked the patient's blood sugar and gave him an intravenous injection.
"Any idea why you were walking outside on the road with no clothes on?" Wittenburg asked. "Do you remember doing it?"
The man gave no response. Wittenburg asked the man if he drinks alcohol, smokes cigarettes or takes street drugs, recording his answers on a patient questionnaire.
Wittenburg asked the man how he was feeling, and he muttered that his head hurt.
"Have you had that headache since you got in your auto accident?" Wittenburg said. "When you had that accident, did you see the doctor?
The man had not been evaluated since the crash. Paramedics learned he had wrecked another car three times while driving home Friday.
"Are you seeing anything double or having blurry vision?" Wittenburg asked. "Tell me about the pain in your head. Is it a sharp, stabbing pain? Dull, achy?"
Dail and Wittenburg said the crash may have caused a subdural hematoma -- internal bleeding on the brain -- that triggered the man's persistent headache and altered his mental state, making him confused and disoriented.
At Wilson Medical Center, the paramedics parked in the emergency department's ambulance bay and wheeled the patient into an exam room. They told a registered nurse about his condition and vital signs and shared their suspicion about a possible brain injury.
'IT'S IN YOUR BLOOD'
Wilson County EMS assigns two emergency medical technicians to each ambulance. Dail and Wittenburg are both EMT-paramedics, the highest level of training North Carolina offers. EMTs at the basic and intermediate levels are typically paired with a paramedic so that each team can offer advanced life support.
Wittenburg's EMS career started in 1991. He worked in central Florida before moving to North Carolina and has worked at Wilson County EMS since 2008.
"I was 17, I got to drive the ambulances fast and run the lights and sirens," Wittenburg said, explaining his early interest in EMS. "Then you come to realize that it's not really about that."
Emergency medical technicians work 24-hour shifts and have three days off between workdays. Wittenburg said he enjoys his job's variety and unpredictable nature.
"You never know what you're going to get," he said. "Each day's different. You can go from one extreme to another. Plus, you start to do it so long and it's kind of like it's in your blood."
The biggest challenge of being a paramedic, Wittenburg said, is "people's perception of what we can and can't do."
"People think that we're just ambulance drivers or they think we're doctors on the other extreme," he said. "I can do 95 percent of what can be done in the emergency room in the back of the ambulance."
Paramedics have standing orders from an emergency medical physician and often can perform more procedures independently than registered nurses, who treat each patient under a doctor's specific direction, Wittenburg said. RNs receive more education and typically earn higher salaries than their EMT counterparts.
"Our mission is to go in and within a minute or so, be able to determine what's wrong, start the treatment, begin to stabilize and get them to definitive care at the hospital," Wittenburg said.
Medics respond to a variety of calls, from shootings, stabbings and car crashes resulting in life-threatening trauma to medical emergencies like heart attacks and strokes. There are also decidedly less-severe calls -- patients who have chest pain, shortness of breath, dizziness or nausea.
Patients rarely fight the EMTs working to evaluate and treat them, but Wittenburg said many are less than forthcoming.
"Most are very cooperative," he said. "Most of the time, they don't tell us the whole truth, so we kind of have to play detective to pick apart the story and find the real truth."
INJURIES AND CHRONIC CONDITIONS
Many patients EMTs are sent to check out are elderly or have chronic illnesses. Dail and Wittenburg went to a care center in Wilson around 12:20 p.m. Sunday after staff reported that an 84-year-old woman had been punched in the face by another patient.
A nurse helped Dail and Wittenburg maneuver the woman from her wheelchair to the stretcher. A red blotch was visible on her lower lip and cheek.
"What made that lady hit you?" Wittenburg asked her. "Do you remember? Do you remember why that lady hit you?"
The woman seemed confused and disoriented. She spoke unintelligibly during the short ambulance ride to Wilson Medical Center.
At 5:29 p.m., the paramedics drove to a mobile home, where a man said his 75-year-old mother was lethargic and disoriented. She had a litany of medical conditions including congestive heart failure, arthritis and chronic obstructive pulmonary disease.
Dail administered oxygen and rolled the woman out to the ambulance on a wheelchair. Wittenburg sat beside her stretcher on the padded ambulance bench and talked to her while Dail drove to the hospital.
"Are you a Tar Heels fan?" he asked, noticing her University of North Carolina shirt. "I'll still be nice to you."
On the way to the hospital, Wittenburg dug through a toiletry bag filled with the woman's pill bottles. He noticed a prescription for nitroglycerin was long expired.
"Sweet Pea, you know your nitro pills -- your heart pills -- you know they're no good, right?" he said. "They expired three years ago. Can I throw them in the trash?"
Wittenburg radioed in to the hospital and told an emergency room staffer that the woman was oxygen-deficient. The ambulance arrived minutes later and he and Dail wheeled her inside.
After each trip to Wilson Medical Center, EMTs retrieve fresh linens from an exterior storage closet at the hospital and place them on the stretcher. Medical supplies are replenished each time the ambulance returns to the Wilson County EMS station on Glendale Avenue.
Dail's ambulance sped to a call in Wilson Sunday evening. A 70-year-old man who recently had double-bypass surgery had an elevated pulse. The paramedics took him to the hospital for evaluation.
"How's your heart rate been all day?" Dail asked. "Have you been eating and drinking?"
Dail tried to start an IV, but his needle found a valve that blocked the injection. One-way valves in human veins prevent caval backflow, or blood traveling backward in the vein.
"We've got miracle things in our bodies we don't even know about," he said, explaining the complication to the patient.
Dail and Wittenburg arrived at the hospital at 8:39 p.m. and brought the man into the emergency room. Twelve minutes later, they were returning to the EMS station, ready for the next call, the next emergency, the next patient.
corey@wilsontimes.com -- 265-7821
Copyright 2013 - The Wilson Daily Times, N.C.
