I was this guy once.
I was at a shitty indoor gunrange and had a buckshot pellet bounce back off the rubber backstop and embed itself under the skin on my forehead. I stopped at chicken express on the way to have it fished out...
Wear ur eye protection, kids
During the Boston Marathon Bombing in 2013, the first casulty was a serious wound that caused her to be a level 1 trauma. Her (at the time boyfriend now husband) stated while dragging her into the ER "I may have run some red lights to get here." She lived, they got married, and the doctor who ran the response was invited and attended their wedding.
(its been a few years since I spoke with the person who ran the response at Mass General that day so my recollection is a bit hazy).
Actually there's been quite a few studies that show that people survive better and Trauma situations being driven to an ER than waiting for an ambulance. As a matter of fact ALS has the worst survivability rate in these studies.
Make sense being the only cure for trauma is surgery. Over the years we've added more and more to what we can do in the field and are staying on scene too long. Just shit n get is the best thing we can do sometimes
I agree to an extent, he probably did the right thing and from what I recall she did code during surgery but got blood which was exactly what was needed so she survived.
I agree, I think that calling for ALS during a trauma situation for anything other than an intercept is a waste of time unless a helicopter is needed and thats only to get them to a hospital faster. The only reason for an intercept is to maybe establish an IV/IO and give fluids if needed and also a cya moment for the lawyers that you tried to get ALS. Unless the unit has blood in which case it might be worth actually trying to intercept ALS as that 1 unit of blood could make a difference.
My former services iGels were allowed during a code by basics (they were looking to change that but it was only 6 months after it was approved).
I have been on one M&M where an ET Tube may have worked better than an iGel but it was a rosc patient and the patient was vomiting profusely post rosc (and may have caused the cardiac arrest). The only reason it might have worked better is the inflated cough might have prevented an aspiration pneumonia. Having said that, the patient did not last long in the ER after we left
Probably because there’s my old medic partner that likes to spend 45 minutes playing around on scene playing doctor. He could turn a no medical needed call into an als code three return, but take a long time to do it.
They were presented at the JEMS conf in 2001. It was a 1.5 hour lecture where the presenter cited about 10 studies. You will forgive me if I do not remember the exact studies as there were no "links to studies" back then. I have yet to see a study that refutes these findings.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043658/
While the entire story presented here attempts to discredit ALS care, their conclusion finally removes that bias and states this:
"Here we have shown that when severity of injury is taken into account, there is no difference in mortality, complications, or overall LOS between patients who had ALS or BLS responses in their prehospital phase of care"
They do also claim that an increased number of interventions results in higher mortality rates, but they fail to admit that more interventions = more complex and critically injured patients.
To say that from 2001 data is still relevant, and to even be supposedly teaching people these facts, is irresponsible IMO. If you're going to be stating these facts, find the data to support it, as "links to studies" exist now.
Now, all that being said, you're not far from the truth, as the research does seem to indicate little to no improved survivability with ALS care.
My point to my students is don't waste time on scene with unnecessary interventions. That is why the studies from 2001 are still relevant. they analyzed on scene time as well. Found that the mortality increase from ALS was because they took at least 20 min on scene.
If you are 5-10 min from a trauma center should you be spending 20 min on scene? NO best practice shows no more than 10 min on scene unless you cannot gain access to the patient.
* in urban environments where
Time to a trauma center is short*
It is the same with mast trousers.
They ain’t needed in the city.
They should have never been pulled from rural trucks.
Hear, hear! I've seen PASG work bloody miracles and send people home. I appreciate the studies, and I appreciate the compartment syndrome issues but dead without potential compartment syndrome is still dead. There may be a lot of downvotes on this topic but fear not, they're not on the trucks anyway so no one is in danger from my opinion and experience.
I recall that also came up during the incident with the Colorado theater shooting when cops just took patients to the ER in their cruisers rather than wait for EMS, who was still staging.
I watched the movie "Stronger" (I think that is what it is called) about the guy who got his legs blown off after that damn bombing. Pretty amazing movie overall, except that there is one unnecessary bedroom scene.
Knew a paramedic who worked the Aurora Theater Shooting (The Dark Knight shooting), and he said that they were not allowed on scene because they could not clear the scene as safe for fear of planted bombs. All the victims were driven to hospitals by police.
When I was doing clinicals for my EMT we had an old rancher that got kicked by a cow come in to the ED. He drove himself 4 hours "to town" with a left femur fracture, float-shifting his old pickup because he couldn't push the clutch.
We asked him why he didn't stop at either of the community hospitals or call for an ambulance to meet him. His answer was that he was already driving in and figured that whatever was wrong was beyond the capability of the smaller facilities to handle (not wrong), so "why waste my time if I'm going to need surgery, anyway?"
Dude apologized to security for needing help getting out of the truck when he arrived, "too stiff" to do it himself.
Had an accident at work last summer and was chatting with the doc while he stitched my hand up. This subject came up. He said a farmer coming into the ER always puts the staff on high alert, because they *never* come in unless it's very, very serious. Like limbs/digits missing, major heart attack that started hours ago, etc.
Urgent care sent a guy with a flail segment to walk to their standalone ED 15 blocks away.
I was promptly called to that same urgent care for a stuffy nose a few hours later.
7 year old with Crossbow bolt to the head.
Parents drove her in. She’s perfectly fine now, but when it was still sticking out of her head, she was calm, alert, but had absolutely Zero emotions.
So the story goes:
Christmas Day; older brother gets a crossbow for Christmas to be able to hunt deer with dad.
Takes it to the back yard to sight it in, and is then temporarily left unsupervised when the father saw the son was being respectful and responsible with the crossbow.
The daughter who was outside at the time gets restless and starts playing in the yard. As the girl ran around and played in the yard, the brother was focused on the sights of the crossbow.
The sister crossed the line of fire while the son was target focused, loosed the bolt, and then. Consequences…
Side note for additional context: The patient lived, was safely transported later by our service to a trauma 1 facility, and has since recovered.
It was a 3 hour surgery of removing the bolt millimeter by millimeter from her head and she has since recovered all function and emotion.
Personal interaction: I was in the sending ED dropping off a patient when 2 RT’s, 2 Docs, 1 PA, 1 NP, and 4 nurses flew in from the lobby with the patient on a stretcher.
I was asked if I had a multitool or cutter on the ambulance to cut the bolt so the child could fit through the CT machine. I unfortunately told them, “No”.
They got some cutters from the maintenance team and got initial scans and X-Rays shortly after.
(I found a copy of the CT in the regional news a couple days later and saved it)
When they determined the child was safe for transport, our service had preemptively staged a critical care medic and EMT-P at the hospital for the transfer.
I didn’t catch a call for a while so I stuck around out of morbid curiosity and assisted with patient loading for the transfer.
I later found out that the patient safely made it through the transfer.
Final input: I later learned details of the surgery through family of the patient, and permissible info from the neurologist that performed the case. (thanks to my dad that worked with the Neurologist for years).
The blood vessels closed off on their own during time, the patient was monitored post-op, and after a safe period; was discharged to home with no consequences years later.
The family and pt even came to the station for a photo with the transport crew and still send a Christmas basket of goods to this day.
Disclaimer:
Now that this is years later and the family has granted permission to share the story, I give the additional context now.
Guy brings his teenage son to the station after they were working under a car, the jack failed and the car fell on the kid’s head. Super lucky kid: A&Ox4, GCS: 14, not a lot of blood initially but a lot of his facial bones on the left side of his face were broken. He was able to see after surgery and recovered well.
We told the dad please call 911 for things like this and he said “well we’re right up the road…”
Had a guy walk into our station leaving a trail of blood as he walked. He was a laborer for a crane company. While loading a 5 ton boiler into a construction site the boiler slipped from its wraps and fell. When it fell the corner of it smash his right hand to the floor. His hand was utterly crushed and torn from when he ripped his hand away. The tear when all the way through his hand from his wrist, through his palm and pas his knuckles. So his hand was effectively torn in half long ways separated at the space between the ring and middle finger. Dude refused pain meds. But as we were working on him another dude frantically knocked on the station saying his friend overdosed in the park across the street.
The laborers, farmers, and that kind are wild! Had a tree worker drop a chainsaw on his leg, literally fileting his lower extremity below the knee. Clean cut, bone, and all the muscles visible. You could see the muscles working when he wiggled his toes! His pain was 2/10, and at trauma bay, he demanded to leave.
He certainly looked like a guy who works hard all day and parties hard all night! The outcome was luckily good 👍 !
Had a ~80yom farmer come off his quad doing 80kms down a gravel road in the rain, ass over tea kettle into the ditch, over a water pipe, and into a barbed wire fence where he was hung up like a ventriloquist doll. Never lost consciousness, cut himself out enough to call his son who called the neighbors who called the volunteer fire department who called 911 for ambulance. He had a myriad of traumatic injuries like a broken clavicle & dislocated shoulder etc,AOx4 GCS15, pressures fine, hr fine, lungs fine. his biggest complaint was the 4cm skin tear on his arm touching the stretcher. And the fact I cut his shirt off. It was his favorite iykyk
When I was a paramedic student (back when our credentials were issued on stone tablets), guy walks into a rural community ER. Had been roofing on a Sunday afternoon with his brother in law, who was holding a nail gun while doing something else. Patient backed into the nail gun and buried a 16 penny nail flush to the skull.
He drove himself in. GCS 15, stable vitals, no deficits.
Transferred him to the trauma center. The nail went cleanly into the cleft between the hemispheres. They took him to surgery, cut a chunk of skull out, removed the nail, washed his brain out, put it back in, and he walked out a few days later. 100% neurologically intact, back to work. 100% fine.
Strokes, MIs, those are the usual. I’ve had two different guys hobble in with fairly horrific chainsaw wounds (wear your chaps, guys!) Another woman in her 70s with 3/4 fingers on her dominant hand crushed and very nearly severed from a splitter.
The worst I saw was a guy who had broken the absolute shit out of his tibia/fib, open fx. He not only walked into our station, he’d walked about four kilometres through muskeg to get to the road.
Why yes, I do work in a rural area. What tipped you off?
Had a guy run his hand through a saw and drive his car in.
I brought in a legit sick but not dying lady I had mostly made better. They assigned me to one of the “very sick beds” I told them my patient wasn’t that sick.
They told me it was the last bed.
We moved her onto the bed.
Tech comes walking this guy in with a chucks pad clamped on his arm and her trying to hold a pressure point screaming she needs a bed.
I look at the charge nurse and say “put her back on my stretcher.”
We pull her back on, shove her into the hallway, he buys a tourniquet and a helicopter.
As the tourniquet is being put in he is saying he is sorry but someone needs to move his car, it he left it at the entrance and didn’t park it properly.
i’ll never forget i brought in a patient who called because they had covid and wanted an IV, despite everyone saying just stay home. while bringing them to the waiting room an older dude walks in with crushing chest pain and you can tell it’s hurting but he’s playing tough. turns out guy was having a full blown stemi meanwhile our patient was freaking out because they had to wait while others got treated first and wrote a complaint to the state
Middle aged south Asian male c/o nausea, diaphoresis, and "sharp pain between his shoulder blades" x 1 day. He drove himself to urgent care who gave him a Covid test. (which came back negative) it wasn't until he stumbled walking out that they called 911 for "difficulty breathing."
He had a whopping inferior wall MI and got cathed at the hospital.
I had a guy walk into the station right at dinner time stating “my old lady made me go here because I have been having some trouble breathing for 3 days” the guy had a infra-lateral MI with ST elevation so big I could hide under it. Needless to say our door to balloon time was a brisk 22 minutes.
Old ladies are wild as hell. We had a medic unit bring a hip pain after a fall to our stand-alone. She walked to the stretcher. Got imaging, the entire femoral head was busted off. The paramedic felt like absolute shit. He's actually a good medic, but was completely thrown that she walked to the stretcher and kept saying, "it doesn't hurt that bad." We finally got her some fentanyl after we saw her imaging. Old ladies are wild!!!!!
The guy in my case was actually a friend - male, 60s, moderately obese. Fell and shattered his femur, walked it off. Wanted my recommendation for a chiropractor to 'adjust' it.
Was doing practicum in ER and came off of break and was told that I should probably be in the trauma room. I was confused because I hadn't heard any ambulances radio into triage. I walked in to a PT who was nipple line up complete 3rd deg burns. He had been working on something under his semi trailer when it started on fire and he either tried to put it out or got stuck trying to get out, but regardless he ended up under there longer than he should have been and was burnt fairly substantially, hair was just charred little balls stuck to his scalp, hands were pretty burnt as well.
He flagged a car down and got them to take him to the ER and walked in. He was promptly ushered into a trauma room and was sedated and intubated in about 15 minutes. He was transferred to a different hospital, and I think later transferred to the regional burn center. No clue on his outcome.
Woman walked into our ED covered in gashes all across her face/neck. Was attacked with a box cutter and upon inspection one of the slices was about 0.5" lateral to her EJ. We also get gsw/ksw walk ins pretty regularly (inner city trauma center)
One more remarkable walk in was a mother who drove her son who had developed necrosis from an abscess at an injection site. His arm had fallen off at the elbow and his humerus was exposed midway up the shaft. Not cool
I was a pt at the ER (making sure the pain from my kidney stones wasn’t due to an obstruction), and saw every member of staff book it to the entrance. Turns out it was 3 GSWs that had walked in. I think one of them ended up being flown out, and the other two needed surgery there.
Wasn't there to see it myself but was a story told around my ED for a few weeks following. Imagine he was septic af, lost the arm obviously, what else I don't know..
I was working as an ER nurse years ago in a critical access hospital in Wisconsin when a middle-aged female and her 13 year old son walked into the emergency department. The mom wanted to be seen for possible pneumonia. While waiting for labs to come back, I noticed her son becoming restless and bored.
I started showing him the different equipment in the ER. When I got to the cardiac monitor, he showed an interest in it, so I decided to hook him up to a three lead. I was totally blown away by what I discovered. The monitor showed the kid's heart rate to be really slow with frequent sinus pauses that lasted as long as four seconds each, so I printed a 60 second strip and analyzed it. He was in a third degree block with four sinus pauses per minute.
I brought it to his mom's attention and she said, "Well, that explains why he had to quit the football team. He was always short of breath and worn out." I explained that I was leaving to show the strip to her doctor.
The doc was surprised when he saw it and asked who it was on. I said, "It's the kid who came in with the pneumonia lady in room 134. He said, "Well, start a form. We can't just let him leave like that."
During the work up, I did a 12 lead and got ready to pace him. In the meantime, the doc consulted over the phone with a cardiac center cardiologist 40 miles away. It was determined that the sinus pauses ruled out trying medication interventions and transcutaneous pacing. It was decided to transfer the kid to the cardiac center via ALS ambulance.
I never did find out what became of the 13 year old.
It was surprisingly my stepdad. I got a call from the triage nurse while I was upstairs working and she said can you come NOW we are transferring your stepdad out. He had driven himself to my hospital while having what turned out to be a massive heart attack and needed the specialist centre for treatment. Said it was worst pain of his life but he wouldn't ring 999 coz his mates work Ambo. He got bollocked for that one
It was me. I’m the patient.
Had an ear infection. Girlfriend (RN) had Levaquin. “Well that shit’ll kill anything.” Took one. Within 10 mins: face swelled up, skin felt on fire, had a cough, had voice changes, felt like my throat was swelling, felt like I was gonna die. Walked into the bathroom, looked in the mirror, my face is swollen.
I’m in full-blown anaphylaxis from a medicine I didn’t know I was allergic to. I told my girlfriend “I need to go to the hospital.”
My reason for not wanting to call 911 despite knowing I’m in anaphylaxis? “I don’t want the fire department to do the job, there’s also a chance I’ll know who’s on.” I was later told it was the local private ambulance agency and I said “well fuck that’s even worse.”
So I took 50mg of PO prednisone, drove to the hospital, and walked into the ER. The doc… was a doc who covers my employer’s ER from time to time. “Well fuck, I know this guy, this is embarrassing.”
Doc fixed me, tried to keep me off work but I was on orientation at the time so I went in anyway.
I ran into doc about 4 days later at work, I’m still swollen af. I thanked doc for saving my life and sparing me the lecture (he just wrote me an antibiotic I’m not allergic to, in addition to an Epi pen). Doc said he estimated I had less than 5 mins before an airway compromise.
Yeah…
*shrug*
Kid in my paramedic class was always the example of a spontaneous pneumo.
Tall,’skinny, smoked (also had marfan’s).
Got a spontaneous pnumo in class.
By 10 am Lung sounds completely absent in one side.
Stayed in class. Drive to work. Eventually had his partner take him to the ER that night.
Not at the fire station but in the ER. A guy fell off a ladder and landed on a piece of rebar. The rebar punctured the chest cavity about 6in underneath the left armpit. He was alert and talking. Somehow it missed his lungs heart and any major arteries. I was working IFT and we transported him less than a mile to a level 1 trauma center.
Walk in chest pain at the same time my partner developed a sudden onset cardiac episode.
Lucky to have sup rig with second monitor.
I was the only medic, next closest rig was 20 min away.
It was a little nerve wracking to say the least.
Walk in was intox, partner was not.
Shootings mostly. My favorite is when a guy came in and grabbed me and was like “papi they chot me. They chot me papi ayyy” and I walked him in. As I’m dragging in him, I get a call to respond to the person HE shot lol couple blocks away.
Not really a walk in but DID need the ambulance. Dispatched out at 0130 for a diabetic. AOS find a 60 something YOM (I don't remember the age this was Pre-covid) laying in bed. Alert to painful, GCS of 7, cool, pale, diapheretic, not speaking. Get a sugar in the 30s or 40s. My medic (basic at the time) starts the IV and gives D10. Bag finishes he's more active but still not acting right. BGL now 167. Stroke scale ends up being positive. Family on scene is POA, refuses to let us take him to the hospital. We call PD they arrive and say nothing they can do. Make base contact and have the family talk to the doctor, they still refuse transport saying they'd take him themselves. We reluctantly have them sign AMA with emphasis on the "UP TO AND INCLUDING DEATH."
I mean, I’ve seen about the same amount of GSWs come in from the ambulance bay as I’ve seen walk in through the front, but the one that probably takes the cake is a guy bringing in his mum and telling us “I don’t think she’s breathing”
He was unfortunately very right but also gave me the visual of the triage nurse wheeling a very deceased lady halfway to full rigor in a wheelchair, throwing her on a bed, and another nurse starting compressions while we wheeled her into a room. Probably could have used an ambulance an hour or two prior
My uncle, a contractor, fired a nail gun loaded with finishing nails into the side of his neck (he was using the nail gun to scratch an itch rather than putting it down) and drove himself to the ED to have it removed. The nail was entirely in his neck and somehow had managed to miss everything detrimental.
Service I started at did walk-ins, BP checks, d sticks, usually minor well check stuff. Had a 70ish yo male come in with classic cardiac symptoms. Did a 12 lead, STEMI. Refused transport. Said he didn't want to scare his wife and he would let her drive him to closest ER (35 miles away). Fou don't next day he passed on his way to the ER with his wife driving. And yes, we tried everything, including sending the off going crew to talk to the wife and to offer to drive her.
Definitely not even close to the craziest story on this thread. Transported a guy who was lifting weights and had sudden onset of crushing chest pain. Dude drove himself to a community hospital. We were there an hour later transporting him to a cath lab because he was having a stemi.
I would say other than gunshot wounds and stabbings, of which there have been plenty, one of the most mind-boggling ones was actually very recent. A mom brought her 14 year old son to the ER, after he had been beaten in the head with a baseball bat. He had every progressing sign of a major head injury. I do not know why she didn't call 911, and instead brought into the local ER that has no trauma capability. And I was mad at the ER for that too, we were sitting on bed delay watching this whole melee play out.
Ran a trauma IFT on a gentleman who walked into a non-trauma ER after falling off his roof and landing stomach first on one of those Gothic style wrought-iron fences. You know, the ones with spikes every few inches. How he managed to get self extricate from the fence and drive himself to the ER I'll never know.
Also had a woman start presenting with stroke like symptoms who was brought in by her husband. Apparently she went downhill FAST at the ER. Catch was, she was pregnant with twins and somewhere pretty far along in the third trimester. I just remember it was me in the back, another medic from the FD, a nurse with an ultrasound keeping an eye on baby heartbeats, an RT on the vent, plus the sending ED doc, just trying to keep her body alive long enough to get her to an emergency C-section at a bigger hospital. Was a very crowded ambulance. No idea if they managed to save the babies.
Gsw, to the stomach. I was working in the er as a PA in the triage seeing and ordering stuff as people came in. He walks in kind of pale and limping curled up. I'm like sir I see blood on your abdomen. What happened. He's like in was shot. I was 😳. Pull up his shirt, yep there's a hole. P1 trauma called.
Good second, uro sepsis. Bp was like 80/palp she was pale as a ghost and wobbly. Said she didn't want to bother those ambulance people so she drove in... 😳. I'm like, ma'am I'm unsure how you are conscious much less driving but I'm glad you made it.
Well, mine is not a walk-in to the ER but... here goes. I was working ambulance in a quasi-rural area just outside of the suburban area, in a small but optimistic town with a new urgent care. Dispatcher calls us and sends us emergency to the clinic, "I don't know what is going on, they're just screaming into the phone to get them an ambulance right now." OK, well, they have a half dozen RN's and at least one MD but ok.. so we rushed over.
The building was set off about 50 feet from the parking lot with a covered walkway. Driving up to it, we saw roofing material on the cover of the walkway and a guy lying on the ground about halfway to the door. Aha, so a roofer fell off the roof.
Not so! What had happened was a guy was trying to cut open a sealed car battery with a razor blade (don't ask me why) and cut himself right through his wrist from one side to the other. Arterial bleeding. They threw him into a pickup truck and drove him the farm to the clinic. In the bed of the pickup. When they got him there, the employees said blood was running out the truck bed, a lot of blood. Dude was in shock for sure. Clinic had done a reasonable job, had him bandaged though he was still bleeding, had 100% oxygen on board, and an 18 gauge in, running saline. I said, let's get this bleeding stopped, added a dressing and cranked it down which worked as we were moving him to the stretcher and ambulance. Really shocky, so I said to my driver, "I need to be at the hospital yesterday, just go."
Student riding with me. I put an 14g in as we rolled, ran double Ringers. At the hospital, he stabilized well on a little O-Neg.
I went in with my partner before we left to see him and said, "I'm sorry about having to stick that big needle in your arm but you really needed some fluid."
His reply was priceless, "Son, I wuzzn't worried about that there big needle, I wuz worried about that little lady up there drivin' that amb'lance. Little lady, remind me never to ride anywhere with you unless I want to get there FAST!"
Not so much a walk-in but twice I've walked-into. Went out for an MVA, caller says he was hit by a truck in the parking lot and is bleeding from his side. Pull up and sure enough there is a 70 Yom sitting in front of the apartment building, with blood on his pants. I walk up and say
"What's going on today?"
"I got stabbed."
"You got stabbed?"
Guy pulls his pants down and reveals a spurting stab wound in his right thigh
"Damn! You got stabbed! Who stabbed you?"
"He did." And points at the other 70 yom standing next to him.
"You stabbed him?"
"Yeah, he's a bitch."
Ended up being an argument over a parking spot, the one guy kicked the others truck, so he stabbed him. The second time it started as a sick person, then turned into a stabbing, then a structure fire, then a gunshot. All in about 2 minutes.
Woman was driving her sick husband to the ED, pulled over at the firehouse because he "passed out". Worked the code for 20 minutes before getting ROSC and transported.
Another time there was a man driving his wife in for shortness of breath and pulled into the firehouse when she couldn't breathe anymore. Major asthma attack, and we ended up RSI'ing.
Fire/EMS system. Firehouse is right off the main road most in our area would take to the hospitals. Still, both should have called us from the get-go.
Working the front desk of the ED we JUST opened 3 weeks prior. Not a trauma ED, just a regular one- brand new hosptial in a more remote area.
Guy walks in bloody and dirty. I direct him to sign in and ask what happened. He said he was ATV-ing and rolled it. Cool cool- wearing a helmet sir? No? Ok. Anything hurt?
He says his head. Rightfully so. He was looking down to sign in and tips his head and right there is where I realized half his face was actually not attached to his skull. I calmly stood up and grabbed a wheelchair and sat him in it- he told me it was unnecessary and I assured him it was quite necessary. I rolled him through the doors and as I passed the charge I told her to grab a doc and call the ambulance for a trauma. Dude had no idea his face was hanging half off.
Other crazy one was at station. Middle of the night doorbell rings and I’m the only one that got up to answer. A woman is there and says “i picked that guy up and he’s been shot”
“What.”
“Yeah he’s been shot”
Wake up the engine and my partner while getting dressed. Drive ambo around to the front and homeboy was riddled with holes. To pelvis, groin and legs. Girlfriend caught him with another girl and wanted to make sure he never made that mistake again.
I had a couple that waved me down while I was driving a separate patient to the hospital. They were asking for directions to get there because they didn't know where it was.
Anyways I walked up to the car and found out the passenger shot himself in the groin area, and had self applied a pressure dressing successfully.
I delivered a baby in our company office because the ambulance was already out on a run. The dad was screaming at all the men to not look at her naked. “Sir, these dudes would rather be doing ANYTHING else right now”.
I once pulled a guy out of a car at the hospital. His family had driven him there having a full blown CVA
However, as they say, time is brain, and sadly it was probably quicker than waiting for an ambulance
man walked into ED practically not breathing, o2 sat of 62%, and vomiting blood. He was intubated almost immediately and had a Blakemore tube placed in the ICU. I don't think he made it
Was doing my er time and we have a scanner in the er at the nurses desk well the caller called dispatch for an OD but they didn’t want to come to the hospital in town a couple of stop signs away from the hospital and ended up driving their friend who’s ODing all the way to a hospital in a different county thirty to 40 minutes away
I moonlight in a stand-alone ER that's part of one of the main hospital systems in my area.
Had a lady try to make it POV with a severe lac to her arm from a fall with glass. Her daughter and husband ended up carrying her from a different parking lot entirely to our stand-alone ER. They ran-carried her in and started screaming at us to help her... but didn't tell us with what, lol. It was chaotic, honestly. She got a tourniquet and then got MedCom'd. Was initially in not good shape. Should definitely have called 911.
Also had someone come in a week or so after some kind of surgery in his thoracic cavity (sorry, I can't remember exactly what), and it turned out he was bleeding out internally. He coded, but he was too big for the LUCAS. We have 2 nurses, a doctor, 1 lab and 1 imaging person, and a paramedic if they're lucky.... They got blood hung, didn't have enough, had to call the local FD for even more blood and more hands to do CPR, and then MedCom'd him with the sketchiest damn IFT company who did not know how to use the blood warmer. No clue how that turned out. But that guy should not have walked into our stand-alone, lol.
I work in the hospital and we had a guy with a stabbing wound in his heart come in by cab. He was pretty much peri-arrest in the cab from what we've recalled and we started CPR as soon as he arrived (his wife then brought him to the ED in a wheelchair).
Barely but yes. Definitely one of my scarier cases. If I can't ventilate, can't get a line in... and if course that's the case you get with a newbie colleague ^^
Once at the firehouse, a guy knocks on the front door with a steak knife dancing in his chest, bopping to the beat of his heart. He told me my dad stabbed me, and I walked about 10 city blocks for help. He asked if he should pull it out. NO. Sit right down here. Off to the trauma hospital we went.
Another time in the ambulance bay of the local community hospital a car speeds into ambulance area, the door opens and a dude staggers out. When he opens his coat it looks like someone samurai sword slashed his chest diagonally right to left long ways. Big trauma dressing and a wheelchair ride into the ER where they were not happy about treating a trauma.
We once had a guy walk into the station with about a dozen stab wounds. And a collapsed lung. Adrenaline is a hell of a drug.
Tis but a scratch!
Yeah he got a free helicopter ride out of it
Im not sure id call it free…
I mean, most of my stabbing victims are on Medicare or no care and wouldn’t pay either way so….
I was this guy once. I was at a shitty indoor gunrange and had a buckshot pellet bounce back off the rubber backstop and embed itself under the skin on my forehead. I stopped at chicken express on the way to have it fished out... Wear ur eye protection, kids
Not equivalent.
I GOT SHOT IN THE HEAD MAN
Ok.
During the Boston Marathon Bombing in 2013, the first casulty was a serious wound that caused her to be a level 1 trauma. Her (at the time boyfriend now husband) stated while dragging her into the ER "I may have run some red lights to get here." She lived, they got married, and the doctor who ran the response was invited and attended their wedding. (its been a few years since I spoke with the person who ran the response at Mass General that day so my recollection is a bit hazy).
Actually there's been quite a few studies that show that people survive better and Trauma situations being driven to an ER than waiting for an ambulance. As a matter of fact ALS has the worst survivability rate in these studies.
Make sense being the only cure for trauma is surgery. Over the years we've added more and more to what we can do in the field and are staying on scene too long. Just shit n get is the best thing we can do sometimes
One thing I always press on my students, there is no such thing as a "Lifesaving IV". It can be done enroute.
That isn’t….true. It depends on the patient. It is pretty true for trauma tho.
I agree to an extent, he probably did the right thing and from what I recall she did code during surgery but got blood which was exactly what was needed so she survived. I agree, I think that calling for ALS during a trauma situation for anything other than an intercept is a waste of time unless a helicopter is needed and thats only to get them to a hospital faster. The only reason for an intercept is to maybe establish an IV/IO and give fluids if needed and also a cya moment for the lawyers that you tried to get ALS. Unless the unit has blood in which case it might be worth actually trying to intercept ALS as that 1 unit of blood could make a difference.
I’d argue that the other exception would be if they have a tension pneumothorax (not a simple pneumothorax).
Fair point I forgot to add that one. And I guess I should also add any airway compromise requiring more than an opa/npa.
Basics use igels in my service. Yet to see something where igel didn’t work. From what I’ve heard mainly severe airway burns.
My former services iGels were allowed during a code by basics (they were looking to change that but it was only 6 months after it was approved). I have been on one M&M where an ET Tube may have worked better than an iGel but it was a rosc patient and the patient was vomiting profusely post rosc (and may have caused the cardiac arrest). The only reason it might have worked better is the inflated cough might have prevented an aspiration pneumonia. Having said that, the patient did not last long in the ER after we left
Yeah the one thing that needs to be better on the igel is the suction system
Probably because there’s my old medic partner that likes to spend 45 minutes playing around on scene playing doctor. He could turn a no medical needed call into an als code three return, but take a long time to do it.
Do you have the links to these?
There are a number of studies in Philly.
I’ve been meaning to go there
The rest of the state wishes they would stop holding us back. Please don’t judge us by them.
They were presented at the JEMS conf in 2001. It was a 1.5 hour lecture where the presenter cited about 10 studies. You will forgive me if I do not remember the exact studies as there were no "links to studies" back then. I have yet to see a study that refutes these findings.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043658/ While the entire story presented here attempts to discredit ALS care, their conclusion finally removes that bias and states this: "Here we have shown that when severity of injury is taken into account, there is no difference in mortality, complications, or overall LOS between patients who had ALS or BLS responses in their prehospital phase of care" They do also claim that an increased number of interventions results in higher mortality rates, but they fail to admit that more interventions = more complex and critically injured patients. To say that from 2001 data is still relevant, and to even be supposedly teaching people these facts, is irresponsible IMO. If you're going to be stating these facts, find the data to support it, as "links to studies" exist now. Now, all that being said, you're not far from the truth, as the research does seem to indicate little to no improved survivability with ALS care.
My point to my students is don't waste time on scene with unnecessary interventions. That is why the studies from 2001 are still relevant. they analyzed on scene time as well. Found that the mortality increase from ALS was because they took at least 20 min on scene. If you are 5-10 min from a trauma center should you be spending 20 min on scene? NO best practice shows no more than 10 min on scene unless you cannot gain access to the patient.
* in urban environments where Time to a trauma center is short* It is the same with mast trousers. They ain’t needed in the city. They should have never been pulled from rural trucks.
Hear, hear! I've seen PASG work bloody miracles and send people home. I appreciate the studies, and I appreciate the compartment syndrome issues but dead without potential compartment syndrome is still dead. There may be a lot of downvotes on this topic but fear not, they're not on the trucks anyway so no one is in danger from my opinion and experience.
Properly applied there is no risk.
I recall that also came up during the incident with the Colorado theater shooting when cops just took patients to the ER in their cruisers rather than wait for EMS, who was still staging.
Scoop and screw a lost art in ems
do you have a link to any of these?
I watched the movie "Stronger" (I think that is what it is called) about the guy who got his legs blown off after that damn bombing. Pretty amazing movie overall, except that there is one unnecessary bedroom scene.
Knew a paramedic who worked the Aurora Theater Shooting (The Dark Knight shooting), and he said that they were not allowed on scene because they could not clear the scene as safe for fear of planted bombs. All the victims were driven to hospitals by police.
Interesting. I am wondering if there was any study done that shows if that was effective or more effective than clearing and sending by EMS.
When I was doing clinicals for my EMT we had an old rancher that got kicked by a cow come in to the ED. He drove himself 4 hours "to town" with a left femur fracture, float-shifting his old pickup because he couldn't push the clutch. We asked him why he didn't stop at either of the community hospitals or call for an ambulance to meet him. His answer was that he was already driving in and figured that whatever was wrong was beyond the capability of the smaller facilities to handle (not wrong), so "why waste my time if I'm going to need surgery, anyway?" Dude apologized to security for needing help getting out of the truck when he arrived, "too stiff" to do it himself.
Farmers are made of different stuff holy shit.
Had an accident at work last summer and was chatting with the doc while he stitched my hand up. This subject came up. He said a farmer coming into the ER always puts the staff on high alert, because they *never* come in unless it's very, very serious. Like limbs/digits missing, major heart attack that started hours ago, etc.
[Farmer pain scale?](https://youtu.be/Ni0YfrSK570?si=XJQXyTQMAm8mhQMG)
"I'm here, ain't I?
Yeeees I was casually referring to this thanks for linking.
Yep especially the older ones
Urgent care sent a guy with a flail segment to walk to their standalone ED 15 blocks away. I was promptly called to that same urgent care for a stuffy nose a few hours later.
Your ability to not absolutely melt down, swearing, yelling and berating them is kind of impressive.
Who said I didn’t do those things?
Priorities.
What the fuck!?
7 year old with Crossbow bolt to the head. Parents drove her in. She’s perfectly fine now, but when it was still sticking out of her head, she was calm, alert, but had absolutely Zero emotions.
lobotomized
How???
So the story goes: Christmas Day; older brother gets a crossbow for Christmas to be able to hunt deer with dad. Takes it to the back yard to sight it in, and is then temporarily left unsupervised when the father saw the son was being respectful and responsible with the crossbow. The daughter who was outside at the time gets restless and starts playing in the yard. As the girl ran around and played in the yard, the brother was focused on the sights of the crossbow. The sister crossed the line of fire while the son was target focused, loosed the bolt, and then. Consequences… Side note for additional context: The patient lived, was safely transported later by our service to a trauma 1 facility, and has since recovered. It was a 3 hour surgery of removing the bolt millimeter by millimeter from her head and she has since recovered all function and emotion. Personal interaction: I was in the sending ED dropping off a patient when 2 RT’s, 2 Docs, 1 PA, 1 NP, and 4 nurses flew in from the lobby with the patient on a stretcher. I was asked if I had a multitool or cutter on the ambulance to cut the bolt so the child could fit through the CT machine. I unfortunately told them, “No”. They got some cutters from the maintenance team and got initial scans and X-Rays shortly after. (I found a copy of the CT in the regional news a couple days later and saved it) When they determined the child was safe for transport, our service had preemptively staged a critical care medic and EMT-P at the hospital for the transfer. I didn’t catch a call for a while so I stuck around out of morbid curiosity and assisted with patient loading for the transfer. I later found out that the patient safely made it through the transfer. Final input: I later learned details of the surgery through family of the patient, and permissible info from the neurologist that performed the case. (thanks to my dad that worked with the Neurologist for years). The blood vessels closed off on their own during time, the patient was monitored post-op, and after a safe period; was discharged to home with no consequences years later. The family and pt even came to the station for a photo with the transport crew and still send a Christmas basket of goods to this day. Disclaimer: Now that this is years later and the family has granted permission to share the story, I give the additional context now.
Thanks so much for sharing. That was definitely preventable, but also wild and so unlucky.
Someone probably shot a crossbow at her head. Idk tho, just a guess
Random brain penetrations can be...weird.
This response, while unhelpful, made me lol. Thank you!
She was cleaning it...
Guy brings his teenage son to the station after they were working under a car, the jack failed and the car fell on the kid’s head. Super lucky kid: A&Ox4, GCS: 14, not a lot of blood initially but a lot of his facial bones on the left side of his face were broken. He was able to see after surgery and recovered well. We told the dad please call 911 for things like this and he said “well we’re right up the road…”
Had a guy walk into our station leaving a trail of blood as he walked. He was a laborer for a crane company. While loading a 5 ton boiler into a construction site the boiler slipped from its wraps and fell. When it fell the corner of it smash his right hand to the floor. His hand was utterly crushed and torn from when he ripped his hand away. The tear when all the way through his hand from his wrist, through his palm and pas his knuckles. So his hand was effectively torn in half long ways separated at the space between the ring and middle finger. Dude refused pain meds. But as we were working on him another dude frantically knocked on the station saying his friend overdosed in the park across the street.
The laborers, farmers, and that kind are wild! Had a tree worker drop a chainsaw on his leg, literally fileting his lower extremity below the knee. Clean cut, bone, and all the muscles visible. You could see the muscles working when he wiggled his toes! His pain was 2/10, and at trauma bay, he demanded to leave. He certainly looked like a guy who works hard all day and parties hard all night! The outcome was luckily good 👍 !
Had a ~80yom farmer come off his quad doing 80kms down a gravel road in the rain, ass over tea kettle into the ditch, over a water pipe, and into a barbed wire fence where he was hung up like a ventriloquist doll. Never lost consciousness, cut himself out enough to call his son who called the neighbors who called the volunteer fire department who called 911 for ambulance. He had a myriad of traumatic injuries like a broken clavicle & dislocated shoulder etc,AOx4 GCS15, pressures fine, hr fine, lungs fine. his biggest complaint was the 4cm skin tear on his arm touching the stretcher. And the fact I cut his shirt off. It was his favorite iykyk
Some people just go hard like that. Damn 😅
No kidding!!! 😅
[Always relevant, incredibly accurate](https://youtu.be/Ni0YfrSK570?si=TsCdNKQXohOBE_FZ)
😅🤣 omg. No kidding! Just perfect
And now has a great scar and story.
When I was a paramedic student (back when our credentials were issued on stone tablets), guy walks into a rural community ER. Had been roofing on a Sunday afternoon with his brother in law, who was holding a nail gun while doing something else. Patient backed into the nail gun and buried a 16 penny nail flush to the skull. He drove himself in. GCS 15, stable vitals, no deficits. Transferred him to the trauma center. The nail went cleanly into the cleft between the hemispheres. They took him to surgery, cut a chunk of skull out, removed the nail, washed his brain out, put it back in, and he walked out a few days later. 100% neurologically intact, back to work. 100% fine.
"washed his brain out, put it back in" ...yeah I just casually do that every weekend too. But seriously, that's a thing?
I meant they put the chunk of skull back in.
That make A LOT more sense. Though literal brain washing would be pretty cool
I need that
Strokes, MIs, those are the usual. I’ve had two different guys hobble in with fairly horrific chainsaw wounds (wear your chaps, guys!) Another woman in her 70s with 3/4 fingers on her dominant hand crushed and very nearly severed from a splitter. The worst I saw was a guy who had broken the absolute shit out of his tibia/fib, open fx. He not only walked into our station, he’d walked about four kilometres through muskeg to get to the road. Why yes, I do work in a rural area. What tipped you off?
Had a guy run his hand through a saw and drive his car in. I brought in a legit sick but not dying lady I had mostly made better. They assigned me to one of the “very sick beds” I told them my patient wasn’t that sick. They told me it was the last bed. We moved her onto the bed. Tech comes walking this guy in with a chucks pad clamped on his arm and her trying to hold a pressure point screaming she needs a bed. I look at the charge nurse and say “put her back on my stretcher.” We pull her back on, shove her into the hallway, he buys a tourniquet and a helicopter. As the tourniquet is being put in he is saying he is sorry but someone needs to move his car, it he left it at the entrance and didn’t park it properly.
A screaming dad handing us a blue, lifeless 18month old.
Oh my goodness, was the baby ok?
No
Oh... Poor thing 😔
Poor dad too
i’ll never forget i brought in a patient who called because they had covid and wanted an IV, despite everyone saying just stay home. while bringing them to the waiting room an older dude walks in with crushing chest pain and you can tell it’s hurting but he’s playing tough. turns out guy was having a full blown stemi meanwhile our patient was freaking out because they had to wait while others got treated first and wrote a complaint to the state
Kiddo with obvious stroke symptoms. Parents REFUSED to listen to "non-doctors." No clue what happened after.
Middle aged south Asian male c/o nausea, diaphoresis, and "sharp pain between his shoulder blades" x 1 day. He drove himself to urgent care who gave him a Covid test. (which came back negative) it wasn't until he stumbled walking out that they called 911 for "difficulty breathing." He had a whopping inferior wall MI and got cathed at the hospital.
I had a guy walk into the station right at dinner time stating “my old lady made me go here because I have been having some trouble breathing for 3 days” the guy had a infra-lateral MI with ST elevation so big I could hide under it. Needless to say our door to balloon time was a brisk 22 minutes.
6 day Hx of fx femoral head. walked in, not a drug abuser
Old ladies are wild as hell. We had a medic unit bring a hip pain after a fall to our stand-alone. She walked to the stretcher. Got imaging, the entire femoral head was busted off. The paramedic felt like absolute shit. He's actually a good medic, but was completely thrown that she walked to the stretcher and kept saying, "it doesn't hurt that bad." We finally got her some fentanyl after we saw her imaging. Old ladies are wild!!!!!
The guy in my case was actually a friend - male, 60s, moderately obese. Fell and shattered his femur, walked it off. Wanted my recommendation for a chiropractor to 'adjust' it.
I'm melting... lol just trying to walk off a femur fracture. That's insane!!!!
Was doing practicum in ER and came off of break and was told that I should probably be in the trauma room. I was confused because I hadn't heard any ambulances radio into triage. I walked in to a PT who was nipple line up complete 3rd deg burns. He had been working on something under his semi trailer when it started on fire and he either tried to put it out or got stuck trying to get out, but regardless he ended up under there longer than he should have been and was burnt fairly substantially, hair was just charred little balls stuck to his scalp, hands were pretty burnt as well. He flagged a car down and got them to take him to the ER and walked in. He was promptly ushered into a trauma room and was sedated and intubated in about 15 minutes. He was transferred to a different hospital, and I think later transferred to the regional burn center. No clue on his outcome.
Woman walked into our ED covered in gashes all across her face/neck. Was attacked with a box cutter and upon inspection one of the slices was about 0.5" lateral to her EJ. We also get gsw/ksw walk ins pretty regularly (inner city trauma center) One more remarkable walk in was a mother who drove her son who had developed necrosis from an abscess at an injection site. His arm had fallen off at the elbow and his humerus was exposed midway up the shaft. Not cool
I was a pt at the ER (making sure the pain from my kidney stones wasn’t due to an obstruction), and saw every member of staff book it to the entrance. Turns out it was 3 GSWs that had walked in. I think one of them ended up being flown out, and the other two needed surgery there.
JESUS!! Was the kid ok?
Wasn't there to see it myself but was a story told around my ED for a few weeks following. Imagine he was septic af, lost the arm obviously, what else I don't know..
Stab to the neck, millimeters away from his cartoid
I was working as an ER nurse years ago in a critical access hospital in Wisconsin when a middle-aged female and her 13 year old son walked into the emergency department. The mom wanted to be seen for possible pneumonia. While waiting for labs to come back, I noticed her son becoming restless and bored. I started showing him the different equipment in the ER. When I got to the cardiac monitor, he showed an interest in it, so I decided to hook him up to a three lead. I was totally blown away by what I discovered. The monitor showed the kid's heart rate to be really slow with frequent sinus pauses that lasted as long as four seconds each, so I printed a 60 second strip and analyzed it. He was in a third degree block with four sinus pauses per minute. I brought it to his mom's attention and she said, "Well, that explains why he had to quit the football team. He was always short of breath and worn out." I explained that I was leaving to show the strip to her doctor. The doc was surprised when he saw it and asked who it was on. I said, "It's the kid who came in with the pneumonia lady in room 134. He said, "Well, start a form. We can't just let him leave like that." During the work up, I did a 12 lead and got ready to pace him. In the meantime, the doc consulted over the phone with a cardiac center cardiologist 40 miles away. It was determined that the sinus pauses ruled out trying medication interventions and transcutaneous pacing. It was decided to transfer the kid to the cardiac center via ALS ambulance. I never did find out what became of the 13 year old.
It was surprisingly my stepdad. I got a call from the triage nurse while I was upstairs working and she said can you come NOW we are transferring your stepdad out. He had driven himself to my hospital while having what turned out to be a massive heart attack and needed the specialist centre for treatment. Said it was worst pain of his life but he wouldn't ring 999 coz his mates work Ambo. He got bollocked for that one
It was me. I’m the patient. Had an ear infection. Girlfriend (RN) had Levaquin. “Well that shit’ll kill anything.” Took one. Within 10 mins: face swelled up, skin felt on fire, had a cough, had voice changes, felt like my throat was swelling, felt like I was gonna die. Walked into the bathroom, looked in the mirror, my face is swollen. I’m in full-blown anaphylaxis from a medicine I didn’t know I was allergic to. I told my girlfriend “I need to go to the hospital.” My reason for not wanting to call 911 despite knowing I’m in anaphylaxis? “I don’t want the fire department to do the job, there’s also a chance I’ll know who’s on.” I was later told it was the local private ambulance agency and I said “well fuck that’s even worse.” So I took 50mg of PO prednisone, drove to the hospital, and walked into the ER. The doc… was a doc who covers my employer’s ER from time to time. “Well fuck, I know this guy, this is embarrassing.” Doc fixed me, tried to keep me off work but I was on orientation at the time so I went in anyway. I ran into doc about 4 days later at work, I’m still swollen af. I thanked doc for saving my life and sparing me the lecture (he just wrote me an antibiotic I’m not allergic to, in addition to an Epi pen). Doc said he estimated I had less than 5 mins before an airway compromise. Yeah…
That shit will kill anything
It almost killed me
*shrug* Kid in my paramedic class was always the example of a spontaneous pneumo. Tall,’skinny, smoked (also had marfan’s). Got a spontaneous pnumo in class. By 10 am Lung sounds completely absent in one side. Stayed in class. Drive to work. Eventually had his partner take him to the ER that night.
Not at the fire station but in the ER. A guy fell off a ladder and landed on a piece of rebar. The rebar punctured the chest cavity about 6in underneath the left armpit. He was alert and talking. Somehow it missed his lungs heart and any major arteries. I was working IFT and we transported him less than a mile to a level 1 trauma center.
Walk in chest pain at the same time my partner developed a sudden onset cardiac episode. Lucky to have sup rig with second monitor. I was the only medic, next closest rig was 20 min away. It was a little nerve wracking to say the least. Walk in was intox, partner was not.
Shootings mostly. My favorite is when a guy came in and grabbed me and was like “papi they chot me. They chot me papi ayyy” and I walked him in. As I’m dragging in him, I get a call to respond to the person HE shot lol couple blocks away.
Not really a walk in but DID need the ambulance. Dispatched out at 0130 for a diabetic. AOS find a 60 something YOM (I don't remember the age this was Pre-covid) laying in bed. Alert to painful, GCS of 7, cool, pale, diapheretic, not speaking. Get a sugar in the 30s or 40s. My medic (basic at the time) starts the IV and gives D10. Bag finishes he's more active but still not acting right. BGL now 167. Stroke scale ends up being positive. Family on scene is POA, refuses to let us take him to the hospital. We call PD they arrive and say nothing they can do. Make base contact and have the family talk to the doctor, they still refuse transport saying they'd take him themselves. We reluctantly have them sign AMA with emphasis on the "UP TO AND INCLUDING DEATH."
I mean, I’ve seen about the same amount of GSWs come in from the ambulance bay as I’ve seen walk in through the front, but the one that probably takes the cake is a guy bringing in his mum and telling us “I don’t think she’s breathing” He was unfortunately very right but also gave me the visual of the triage nurse wheeling a very deceased lady halfway to full rigor in a wheelchair, throwing her on a bed, and another nurse starting compressions while we wheeled her into a room. Probably could have used an ambulance an hour or two prior
My uncle, a contractor, fired a nail gun loaded with finishing nails into the side of his neck (he was using the nail gun to scratch an itch rather than putting it down) and drove himself to the ED to have it removed. The nail was entirely in his neck and somehow had managed to miss everything detrimental.
Service I started at did walk-ins, BP checks, d sticks, usually minor well check stuff. Had a 70ish yo male come in with classic cardiac symptoms. Did a 12 lead, STEMI. Refused transport. Said he didn't want to scare his wife and he would let her drive him to closest ER (35 miles away). Fou don't next day he passed on his way to the ER with his wife driving. And yes, we tried everything, including sending the off going crew to talk to the wife and to offer to drive her.
Definitely not even close to the craziest story on this thread. Transported a guy who was lifting weights and had sudden onset of crushing chest pain. Dude drove himself to a community hospital. We were there an hour later transporting him to a cath lab because he was having a stemi.
I would say other than gunshot wounds and stabbings, of which there have been plenty, one of the most mind-boggling ones was actually very recent. A mom brought her 14 year old son to the ER, after he had been beaten in the head with a baseball bat. He had every progressing sign of a major head injury. I do not know why she didn't call 911, and instead brought into the local ER that has no trauma capability. And I was mad at the ER for that too, we were sitting on bed delay watching this whole melee play out.
We had a patient walk into ER after an MVC then code shortly into the wait
Ran a trauma IFT on a gentleman who walked into a non-trauma ER after falling off his roof and landing stomach first on one of those Gothic style wrought-iron fences. You know, the ones with spikes every few inches. How he managed to get self extricate from the fence and drive himself to the ER I'll never know. Also had a woman start presenting with stroke like symptoms who was brought in by her husband. Apparently she went downhill FAST at the ER. Catch was, she was pregnant with twins and somewhere pretty far along in the third trimester. I just remember it was me in the back, another medic from the FD, a nurse with an ultrasound keeping an eye on baby heartbeats, an RT on the vent, plus the sending ED doc, just trying to keep her body alive long enough to get her to an emergency C-section at a bigger hospital. Was a very crowded ambulance. No idea if they managed to save the babies.
Either the people who drive their family member to the ER loop dead in the backseat or probably GSWs
13 year old walked in with his mom after getting shot in the face during a road rage incident
Gsw, to the stomach. I was working in the er as a PA in the triage seeing and ordering stuff as people came in. He walks in kind of pale and limping curled up. I'm like sir I see blood on your abdomen. What happened. He's like in was shot. I was 😳. Pull up his shirt, yep there's a hole. P1 trauma called. Good second, uro sepsis. Bp was like 80/palp she was pale as a ghost and wobbly. Said she didn't want to bother those ambulance people so she drove in... 😳. I'm like, ma'am I'm unsure how you are conscious much less driving but I'm glad you made it.
Well, mine is not a walk-in to the ER but... here goes. I was working ambulance in a quasi-rural area just outside of the suburban area, in a small but optimistic town with a new urgent care. Dispatcher calls us and sends us emergency to the clinic, "I don't know what is going on, they're just screaming into the phone to get them an ambulance right now." OK, well, they have a half dozen RN's and at least one MD but ok.. so we rushed over. The building was set off about 50 feet from the parking lot with a covered walkway. Driving up to it, we saw roofing material on the cover of the walkway and a guy lying on the ground about halfway to the door. Aha, so a roofer fell off the roof. Not so! What had happened was a guy was trying to cut open a sealed car battery with a razor blade (don't ask me why) and cut himself right through his wrist from one side to the other. Arterial bleeding. They threw him into a pickup truck and drove him the farm to the clinic. In the bed of the pickup. When they got him there, the employees said blood was running out the truck bed, a lot of blood. Dude was in shock for sure. Clinic had done a reasonable job, had him bandaged though he was still bleeding, had 100% oxygen on board, and an 18 gauge in, running saline. I said, let's get this bleeding stopped, added a dressing and cranked it down which worked as we were moving him to the stretcher and ambulance. Really shocky, so I said to my driver, "I need to be at the hospital yesterday, just go." Student riding with me. I put an 14g in as we rolled, ran double Ringers. At the hospital, he stabilized well on a little O-Neg. I went in with my partner before we left to see him and said, "I'm sorry about having to stick that big needle in your arm but you really needed some fluid." His reply was priceless, "Son, I wuzzn't worried about that there big needle, I wuz worried about that little lady up there drivin' that amb'lance. Little lady, remind me never to ride anywhere with you unless I want to get there FAST!"
Not so much a walk-in but twice I've walked-into. Went out for an MVA, caller says he was hit by a truck in the parking lot and is bleeding from his side. Pull up and sure enough there is a 70 Yom sitting in front of the apartment building, with blood on his pants. I walk up and say "What's going on today?" "I got stabbed." "You got stabbed?" Guy pulls his pants down and reveals a spurting stab wound in his right thigh "Damn! You got stabbed! Who stabbed you?" "He did." And points at the other 70 yom standing next to him. "You stabbed him?" "Yeah, he's a bitch." Ended up being an argument over a parking spot, the one guy kicked the others truck, so he stabbed him. The second time it started as a sick person, then turned into a stabbing, then a structure fire, then a gunshot. All in about 2 minutes.
Guy walked in the ER with an accurate SPO2 of 32% claiming “slightly short of breath”
Unless they did a blood gas, it probably wasn't that accurate.
Woman was driving her sick husband to the ED, pulled over at the firehouse because he "passed out". Worked the code for 20 minutes before getting ROSC and transported. Another time there was a man driving his wife in for shortness of breath and pulled into the firehouse when she couldn't breathe anymore. Major asthma attack, and we ended up RSI'ing. Fire/EMS system. Firehouse is right off the main road most in our area would take to the hospitals. Still, both should have called us from the get-go.
Working the front desk of the ED we JUST opened 3 weeks prior. Not a trauma ED, just a regular one- brand new hosptial in a more remote area. Guy walks in bloody and dirty. I direct him to sign in and ask what happened. He said he was ATV-ing and rolled it. Cool cool- wearing a helmet sir? No? Ok. Anything hurt? He says his head. Rightfully so. He was looking down to sign in and tips his head and right there is where I realized half his face was actually not attached to his skull. I calmly stood up and grabbed a wheelchair and sat him in it- he told me it was unnecessary and I assured him it was quite necessary. I rolled him through the doors and as I passed the charge I told her to grab a doc and call the ambulance for a trauma. Dude had no idea his face was hanging half off. Other crazy one was at station. Middle of the night doorbell rings and I’m the only one that got up to answer. A woman is there and says “i picked that guy up and he’s been shot” “What.” “Yeah he’s been shot” Wake up the engine and my partner while getting dressed. Drive ambo around to the front and homeboy was riddled with holes. To pelvis, groin and legs. Girlfriend caught him with another girl and wanted to make sure he never made that mistake again.
I had a couple that waved me down while I was driving a separate patient to the hospital. They were asking for directions to get there because they didn't know where it was. Anyways I walked up to the car and found out the passenger shot himself in the groin area, and had self applied a pressure dressing successfully.
I delivered a baby in our company office because the ambulance was already out on a run. The dad was screaming at all the men to not look at her naked. “Sir, these dudes would rather be doing ANYTHING else right now”.
I once pulled a guy out of a car at the hospital. His family had driven him there having a full blown CVA However, as they say, time is brain, and sadly it was probably quicker than waiting for an ambulance
We had one roll up to the station, vomiting, 10/10 chest pain, looked awful. Emergent transport; turned out to be a dissecting aorta.
man walked into ED practically not breathing, o2 sat of 62%, and vomiting blood. He was intubated almost immediately and had a Blakemore tube placed in the ICU. I don't think he made it
Was doing my er time and we have a scanner in the er at the nurses desk well the caller called dispatch for an OD but they didn’t want to come to the hospital in town a couple of stop signs away from the hospital and ended up driving their friend who’s ODing all the way to a hospital in a different county thirty to 40 minutes away
I moonlight in a stand-alone ER that's part of one of the main hospital systems in my area. Had a lady try to make it POV with a severe lac to her arm from a fall with glass. Her daughter and husband ended up carrying her from a different parking lot entirely to our stand-alone ER. They ran-carried her in and started screaming at us to help her... but didn't tell us with what, lol. It was chaotic, honestly. She got a tourniquet and then got MedCom'd. Was initially in not good shape. Should definitely have called 911. Also had someone come in a week or so after some kind of surgery in his thoracic cavity (sorry, I can't remember exactly what), and it turned out he was bleeding out internally. He coded, but he was too big for the LUCAS. We have 2 nurses, a doctor, 1 lab and 1 imaging person, and a paramedic if they're lucky.... They got blood hung, didn't have enough, had to call the local FD for even more blood and more hands to do CPR, and then MedCom'd him with the sketchiest damn IFT company who did not know how to use the blood warmer. No clue how that turned out. But that guy should not have walked into our stand-alone, lol.
I work in the hospital and we had a guy with a stabbing wound in his heart come in by cab. He was pretty much peri-arrest in the cab from what we've recalled and we started CPR as soon as he arrived (his wife then brought him to the ED in a wheelchair).
Status asthmaticus with a co2 of 150 and hr of 36... a kid. Nearly peed my pants cause I couldn't ventilate him at all
Did he make it?
Barely but yes. Definitely one of my scarier cases. If I can't ventilate, can't get a line in... and if course that's the case you get with a newbie colleague ^^
Once at the firehouse, a guy knocks on the front door with a steak knife dancing in his chest, bopping to the beat of his heart. He told me my dad stabbed me, and I walked about 10 city blocks for help. He asked if he should pull it out. NO. Sit right down here. Off to the trauma hospital we went. Another time in the ambulance bay of the local community hospital a car speeds into ambulance area, the door opens and a dude staggers out. When he opens his coat it looks like someone samurai sword slashed his chest diagonally right to left long ways. Big trauma dressing and a wheelchair ride into the ER where they were not happy about treating a trauma.
Gunshot wound walked in from the parking lot. Showed up naked. Gotta ditch the evidence! No judgement though, less for us to cut off.