• Engine or Ladder with BLS Transport

    Engine 070 arrived on scene to find a 30 year old female, GCS 15, sitting in driver’s seat of pickup truck found in the ditch, along-side the feeder road. Chief complaint, head pain. Notified OEC and requested BLS transport.

     

    Patient states she was driving posted speed [40 mph] down feeder road and lost control of vehicle before ending in ditch. No other vehicles involved in accident. Patient denies loss of consciousness, remembers entire event. Patient was not wearing seatbelt upon our arrival, but patient states she was wearing it during accident and took it off prior to our arrival. No airbag deployment. Moderate damage to front of truck, no rollover. Patient has warm dry skin, strong radial pulse, clear equal lung sounds, equal reactive pupils, only visible trauma is abrasions on face, no visible deformities to extremities. Performed spinal immobilization test – patient is able to give a reliable exam, is GCS 15, no evidence of intoxication, no painful or distracting injury. No signs of spinal cord injury – no focal neurological deficits noted, no midline cervical tenderness on palpation, and no pain with flexion, extension, rotation of neck. No spinal immobilization needed. Obtained vital signs, patient has no past medical history, denies possibility of pregnancy.

     

    Ambulance 052 arrived on scene, assisted patient out of vehicle and on to awaiting stretcher, secured with seatbelt. Moved patient to back of Ambulance 052 along with belongings. Left patient in care of Ambulance 052, to be transported to appropriate hospital.

  • BLS Transport

    Ambulance 051 arrived on scene to find a 25 year old male, GCS 15, sitting at home in care of family members. Chief complaint, headache.

     

    Patient states symptoms started 6 hours ago while lying in bed, is sensitive to light, pain is 9/10 severity, dull, and on both sides of head. Patient has equal strong grips, denies any blurred vision, does not have any slurred speech, no arm drift, no facial droop. Patient has past history of migraines, has a neurologist, but today is Saturday and patient cannot get an appointment until next week. Patient has no other past medical history. Patient has warm dry skin, strong radial pulse, clear equal lung sounds, equal reactive pupils. Patient also complains of nausea but no vomiting. Obtained vital signs.

     

    Patient requests transport to Memorial Southwest. Assisted patient on to stretcher, secured with seatbelts, moved to back of ambulance. Notified base station of priority 3 transport to MSW, open. Turned off light in back of unit per patient request, obtained additional vital signs. Transported without incident, gave report to ER staff, placed patient in bed 14 with their belongings.

     

  • ALS Medic Unit Transport

    Medic 003 arrived on scene to find 55 year old male, GCS 15, sitting on front steps of home, in care of Engine 016. Chief complaint, chest pain.

     

    Patient states symptoms started 20 minutes ago. Patient states he went for a run, and when he returned home he went upstairs and took a shower. During the shower patient felt sudden onset of crushing chest pain, 10/10 severity. Patient has not taken any medication, does not have any previous cardiac history. Patient is pale and clammy, weak radial pulse, does not complain of shortness of breath, does have some nausea. Administered aspirin, obtained vitals, applied Lifepak monitor, 12lead shows STEMI, elevation in II, III and AVF, transmitted to critical 12lead. Right side EKG shows >1mm elevation in V4.

     

    Advised patient that our findings show he is having a heart attack and we are going to do everything on our behalf to ensure the hospital is ready for his arrival. Patient states he does not have a hospital preference, is normally healthy, only past history is smoking, takes no medication, no allergies. Notified base station on radio, advised that only Cath lab in Med Center that is open is Hermann, patient agrees to transport to Hermann. Established IV, administered 100mcg Fentanyl IVP. Did not administer oxygen, O2 saturation was 98%.

     

    Lifted patient off steps and placed on nearby stretcher, secured with seatbelts, moved to back of medic unit. Pain is now 8/10, subsequent 12leads show STEMI. Notified base station of priority 2 transport, continued to monitor en-route, transported without incident. Arrived at ER, triage nurse escorted unit to Cath lab, gave report to staff and helped patient onto procedure table, gave belongings to nurse.

  • ALS Squad Transport with BLS

    Squad 034 arrived on scene to find 59 year old female, GCS 15, sitting on stretcher in back of Ambulance 039. Chief complaint, respiratory distress.

    Patient states she developed sudden onset difficulty breathing 2 hours ago while lying in bed. Patient is showing signs of labored breathing, her respiratory rate is 30/minute, she is speaking 3-5 words at a time, diaphoretic, feet and legs are swollen and hanging off the stretcher, lung sounds are rales bilaterally, oxygen saturation is 75% on room air. Patient is on oxygen nonrebreather, O2 sat improved to 85%, patient still does not feel relief. Patient has past history of congestive heart failure, hypertension, diabetes. Placed patient on CPAP, flow rate 10 peep, coached patient on breathing. Obtained vitals, 12lead EKG shows sinus tach. Established IV on second attempt, administered one nitro. Patient is nodding head that she feels relief, respiratory rate is now 24/minute, oxygen saturation 96%, patient appears less agitated, lung sounds assessed again, still rales, administered second nitro.

    Patient requests transport to LBJ, notified base station of priority 2 transport with CPAP. Base station advised that LBJ is on divert, patient requests transport to Ben Taub, they are also on divert. Patient still requests LBJ, base station notified LBJ of our arrival. Continued to monitor en-route, transported without incident, gave report to ER staff, placed patient in shock room bed 2 with belongings.

  • Adult Nontransport [ALS]

    Medic 040 arrived on scene to find 33 year old female, GCS 15, sitting at her desk at work, in care of coworkers. Chief complaint, syncope.

    Coworkers state that patient was sitting at her desk, said she felt hot, dizzy and nauseous, and then slumped over in her chair. Patient was unresponsive for 30 seconds, patient did not fall and hit floor. Patient has warm dry skin, strong radial pulse, clear equal lung sounds, equal reactive pupils. Patient only complaint now is general fatigue. Patient states she went downstairs and donated blood for a blood drive about 30 minutes ago and had not eaten lunch yet. Patient denies any past medical history, denies possibility of pregnancy, does not take any medication. Obtained vitals and blood glucose, patient has strong grips, no facial droop, no slurred speech, no arm drift. Escorted patient to office for privacy to perform an EKG, 12lead shows normal sinus rhythm. Checked orthostatic vital signs, patient is not dizzy upon standing, patient has pink conjunctiva, no history of anemia. Patient denies any recent illness or lifestyle changes.

    Offered patient transport to hospital for further evaluation, patient refuses. Patient states she feels better now and her friend is going to drive her home so she can rest and come back to work tomorrow. Patient states her roommate is home and can monitor her and call 911 if she has another syncopal episode or any other symptoms. Advised patient that passing out is not normal, and should be taken seriously until evaluated by a physician. Patient understands and refuses transport. Advised patient of consequences of refusing transport up to and including death, patient understands and still refuses. Obtained refusal signature from patient against medical advice, obtained witness signature from coworker. Advised patient to call 911 again if needed.

  • Pediatric Nontransport [BLS]

    Ambulance 025 arrived on scene to find 12 year old female, GCS 13, laying in bed at home in care of family. Chief complaint, seizure.

     

    Mom states her daughter just ate dinner and was watching TV when she had a seizure lasting 2 minutes, grand mal. Patient was on the couch and slid to the floor. After seizure, mom carried her to her bed while she recovered. Patient has bite marks on tongue, shows urinary incontinence. Patient is alert to verbal stimuli, only oriented to person and place. Mom states patient has past history of seizures, is prescribed Keppra, is compliant with medication, last seizure was one month ago. Patient normally has a seizure every other month, saw her neurologist 6 months ago. Patient has warm dry skin, strong radial pulse, clear equal lung sounds, equal reactive pupils. Obtained vital signs, asked patient to sit up in bed, patient is now answering all questions appropriately and is GCS 15. Mom states she does not want patient to go to the hospital, they will only observe her, do some bloodwork, and send her home and tell them to follow up with their neurologist. Mom states patient has never had any cluster seizures or more than one seizure in a day. Mom states she will call neurologist office tomorrow and make an appointment. Asked mom if she calls 911 every time her daughter has a seizure, mom states no, she called this time because it lasted longer than usual, usually they are less than a minute, this time it was almost two minutes. Asked patient how she feels, patient states she feels fine, she denies any recent illness or lifestyle changes. Mom states patient does not have a menstrual cycle yet.

    Advised mom that any time 911 is called for a pediatric and non-transport is requested, that we contact our supervisor and a physician at the hospital to see if we all agree that is a good idea, and are not overlooking anything important. Contacted base station, conferenced with Ambulance Supervisor 016 and Dr. Acula at Ben Taub. Gave report, Dr. states it is fine if mother wants to monitor patient at home and follow up with neurologist tomorrow, but advises if patient has another seizure to go to ER by ambulance or private auto. Offered patient transport again, mother refuses. Advised mom of consequences of non-transport up to and including death, obtained refusal signature. Obtained witness signature from aunt. Advised mom to call 911 again if patient has another seizure or new symptoms develop.

  • Cardiac Arrest [ALS]

    Medic 009 arrived on scene to find 65 year old male, GCS 3, apneic and pulseless, lying supine on kitchen floor at home, with Engine 009 performing CPR.

    Engine 009 states patient’s son returned from grocery store and found him in arrest on kitchen floor, laying prone, rolled him over and performed bystander CPR, last saw patient one hour ago. Engine 009 states they have done one round of CPR, AED states no shock advised, I-Gel 5 inserted. Patient has past history of MI, hypertension. Applied 3lead to patient, established iv in left eternal jugular vein, applied end tidal monitor to I-Gel. At next pulse check, AED analyzed, advised shock, AED delivered defibrillation, continued CPR, removed AED and applied Lifepak pads. After one minute, pulse check, no pulse, monitor shows PEA sinus brady, continued CPR for two minutes, administered Epi 1:10,000. After two minutes, checked pulse, patient has pulse present at carotid and femoral. End tidal is now 38, blood pressure is 110/60, 12lead shows sinus tach rate 120, transmitted to critical 12lead. Ambulance Supervisor 017 arrived on scene, contacted telemetry. Lifted patient off floor and placed on backboard on top of stretcher. Removed I-Gel, suctioned airway, intubated patient with 8.0 et tube on first attempt, 24mm at teeth, end tidal 45, good waveform, lung sounds clear and equal, absent over epigastrum, inflated cuff and secured with tube tamer.

    Moved patient to back of medic, son requests transport to St Joseph, that is where patient went when he had a heart attack. In back of unit, confirmed tube placement again by listening to lung sounds, end tidal is 35, 12lead now shows normal sinus rhythm with ST elevation in v4, v5, v6, transmitted EKG. Notified base station that we are beginning transport, verified that they received new EKG. Obtained additional vitals, patient is hypotensive, end tidal dropped to 25, patient no longer pulsing, started CPR again, rhythm is brady-asystole, administered Epi 1:1,000. Notified base station. After 3 minutes, checked pulses, patient has radial pulses. Obtained vitals and 12lead EKG. Arrived at ER, gave report to staff, placed patient in bed 1 with belongings. ER tube confirmed by Dr. Albumin.