Who you gonna call?

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Another crackhead I coded (Alt. title: I hate my OMD.)

My protocols are kinda screwy. One of the drugs I don't carry is Magnesium Sulfate. I'm sure you can see where this is going, being about another crackhead and all.
While I was still precepting as a Medic, we got a CPR call in the summertime. It was hot, and the guy was dead. He was reportedly smoking crack on the back stoop, came inside, and promptly dropped dead.
He was in Torsades-de-Pointes. Move along, nothing to see [do] here. So, we shock him anyway. I get an IV, and we push Lidocaine anyway. We do have Amiodarone, but I hate it. It's expense ($1/mg.) and habit of causing hypotension also turn me off.
Of course none of our actions did anything for the guy. I go to tube him, but can't. My preceptor gets the tube and we hit the road. I actually didn't get a successful tube during the whole time I was precepting, but I haven't missed one since I got turned-over. Go figure.
En-route, I continue to shock the crap outta the guy, to no avail.
We get to the ER, and Dr. Dave the Trauma Magnet is there. He's pissed because the pt. needed Mag and didn't get it, and by this time, it was too late.
Time of death...

Despite our best efforts...

You may think you know where this is going, but I guarantee you don't.
It's early on a Saturday morning, duty crew starts at 0800. We're just pulling into the parking lot of a local strip mall for breakfast. Being that early in the morning, staffing is at bare minimum. I have a Firefighter/EMT driving for me, and the Engine Co. has the minimum 3.
This particular Saturday, I was fresh from being precepted and newly on my own as a medic.
We get toned-out for a CPR in-progress. I'm immediately freaking out. We head that way. En-route, my driver tells me she's never been on a code. Great.
I'm grateful to have the folks I do on the Engine Co., we have a great relationship and I know I can count on them. I also hear Ambulance 12 being dispatched, and am glad to hear that-MedicChris and MedicCat are both on board, and they are a solid BLS crew at the time. This transpired when MedicChris was still in class to be a Medic and MedicCat had not started the process yet. I was glad to have at least a Medic-in-training coming along.
We arrive on scene and grab everything plus the kitchen sink off the unit. We proceed inside a small, single-story, single-family home. Once through the door, we are in a tiny living room with a sectional taking up two whole walls. On the sectional, there are several children, staring down at what will be my patient-a pulseless, apneic 38yo M, lying supine on the living room floor. There is also an audience of adults in the kitchen. Nobody is even attempting to shield the children from the horror on the floor.
I essentially throw my clipboard at Curt, the Firefighter on the Engine, and order him to write down everything I tell him to. I needed to keep track of things while I worked, and I sure as heck wasn't going to be writing anything down unless I sprouted five more arms in a hurry.
When we hook up the pt. to the LifePak12, he's in Asystole. Thanks to said LP12, I don't have to switch leads to verify-I get three right on the screen, and I can print a Code Summary later. Check.
We've gotten from the bystanders that he has been down for an unknown period of time. They tell us he's been drinking and smoking crack all night. I'm getting the feeling this will just be practice, but I'm still nervous.
I have the officer from the Engine Co. and MedicChris take the airway. I have Chris appy Cric pressure while Clancy bags the pt. so as to cut down on gastric distention. I proceed to estabilsh and IV and get the 1st round of drugs on board.
I then proceed to set up for intubation. I get my stuff together and then pull out of my airway kit a piece of equipment I've never seen before. This thing was the sorriest excuse for an ET tube holder I've ever seen. It was basically a piece of string and what barely resembled plastic. I hold it up and say "What the hell is this?" and get nothing but blank stares back. Whoops, I'm supposed to know what I'm doing! I abandon my temporary lack of sanity and intubate the guy. I apply the wet noodle device, but poor Chris ends up holding the ET tube in place the rest of the call anyway. Hindsight being 20/20, I don't know why I didn't just grab some dang tape.
Once I tube him, I push the second Epi and Atropine, and we load him up and move him out to my unit. We get him in the back, and I call report while Chris and Curt keep up their end of things. At this point, poor Chris is not only holding my ET tube in place, but bagging and chest compressions with one hand.
I tell the ED we're bringing in an Asystolic pt. who's intubated, has an IV, and has two rounds of drugs on board, a third to follow. ETA 5-6 minutes or less. I hang up, then push the third Epi. Chris says he sees something on the monitor. I look over, and sure enough, the pt. is in VF or VT (I can't remember which, either way it was a shockable rhythm!). I'm flabberghasted, as is Chris. So, I shocked him. He goes into a Sinus rhythm. At this point, I don't know what to do. This outcome is completely and totally unexpected.
So, I suction his airway and by then we're at the hospital. We practically sprint in and I announce (nearly gleefully) that he's got a pulse-NOT what they were expecting. They get a BP (he has one!).
My complete shock and awe continues as he is released from CCU within a few weeks and then released from the hospital all together later on. By this time, I've met the man and talked w/him at some length. He swears that he'll never do drugs again, but I've heard it before. I don't hold my breath on that one.
A year later, he has ZERO deficit, and is still drug-free. His children have their father, and in a way they never did before. They keep him another year before he goes back to drugs. I'm not surprised, but am disappointed.
Yes, I've made my contribution to society-another crack head. Despite my best efforts, he lived.

Love Potion No. 9mm

I ran this call a little over a year ago. I remember the exact date, but won't post it for obvious reasons.
It's a weeknight, after dark, although I can't remember exactly what time it was. I just remember we hadn't gone to bed yet. We get toned-out for a shooting. The address is just a few short blocks of residential streets from our station, so I decide to stage on the ramp. From this point, I cannot remember what came over the radio, only that PD was on the scene very quickly, and told us it was OK to come.
We proceed to the scene, the Engine Co. pulls in first and we follow. First thing I see from the unit is a small sedan on someone's front lawn. There is a person in the drivers' seat, cops are all over the place, and folks have made their way to the passenger side of the car.
I get out of the unit, and Dave (the Lt. on the Engine) is waving me over to the passenger side of the car. Other folks are tending to the driver, who I note is talking so I make my way to the other side to where a pt. is not talking.
I arrive on the passenger side of the car, which is literally on the front walk to the house, and the pt. is lying next to the car almost on the front steps. I look down and I know immediately she's dead. In fact, I believe my words were, "Oh s---, she's dead." I bent down to check for a carotid pulse. Nada.
Here's where it gets complicated, all in the span of a few seconds. I've got two victims shot, and there's only one Medic there (me). So, triage takes precedence, and I direct Ryan, a FF, to hook up the LifePak-12 and wait til there's a flat line, and run me a strip. I've essentially declared this young, unfortunate woman dead. I insist that nobody else make their way over, so as not to disturb the crime scene.
I then turn my attention to the man in the front seat. I lean over the passenger seat to see he is still talking, I figure out that he's also alert & oriented. Airway, LOC, check. I can't remember how his shirt came off, but upon exposing his chest, I notice two large, circular holes in his right anterior chest wall. Oh, boy. I was already incredibly hyped-up, now I was near freaking-out (in my head). I was outwardly terse and rushed, but hope I didn't portray the true panic I actually felt. I ordered a Med-Evac.
I did a quick rapid survey of his body to identify any other life-threatening injuries. There were none. Check. I asked him a few pertinent questions, and then proceeded to make my way to his side of the car for his extrication.
I stand up and turn back to Ryan, who says he's still not getting a flatline. At some point I had turned back to check the actual rhythm, and it was agonal. It was still agonal. I asked him just to print me a strip right then and be done with it.
At some point, Jon (my Rescue Chief at the time) had shown up. While I was concentrating on the still-living pt., he was verifying that the other one was indeed deceased. When I realized he was there, I was so relieved, I cannot begin to express how much.
We got my pt. out of the car, onto my stretcher, and into the back of my unit. During his brief extrication (I think my words were "Let's get him out NOW!"), word came over the radio that there was another shooting just a few blocks away. The next-closest medic unit was on the way there, with another Engine Co. headed their way, and one headed to the LZ.
I cannot remember who was in the back of my unit w/me other than Jon. He was at the head of the pt., placing Bio-occlusive dressings on the entry wounds for me. I knew they were entry wounds, because the pt. had been driving when he was shot, and there were holes in the windshield. Scene survey can tell you so much!
I got two IVs started quickly, and initiated a fluid bolus, because he was initially tachycardic and hypotensive. I'm thinking the worst despite his still-positive LOC.
We get several sets of vitals, and I dress the defensive wound on his hand (he put it up to shield himself from the bullet[s]). The bleeding was controlled from all three wounds. During all this, we were enroute to, then arrived at the LZ.
We find out that the other pt. is also getting a helicopter ride, but that mine is going first. Either that says something bad about my pt., good about the other guy, or vice-versa. We use the same LZ for both guys.
The flight crew arrives and we place my pt. on a backboard & c-collar for the trip. Upon placing him on the backboard, a bullet comes out of the exit wound on his back. Jon collects it for PD. There is no other exit wound. So, we have two projectiles, one still in him.
My guy tells us he loves us as he's wheeled away to the LZ. How sweet. I know he was just scared out of his mind, and grateful to still be alive.
Jon says to me, "Do you ever get tired of kicking ass and taking names?" I'll never forget that. I think we high-fived, but I can't remember.
I then showed him my shaking hands, and made a reference to a medic who came before me (S.M.) who's hands shook with adrenaline, too. It's amazing how they steady just before I insert IV catheters, then go right back to shaking after. Apparently, his did the same, or so I've been told/compared to.
Our guy's bird takes off, the other guy's lands. I watch as "Doc" and his crew load him up, and they have intubated and are bagging him. Not a good sign.
The second helo takes off, and I made my way back to the scene. I had to make some notations about the pt. whom I had declared dead.
I walk down there, my driver Chris by my side. We had to park several blocks down and hoof it, because there was a large area now declared a crime scene. Gang Task Force and other Plain-Clothed police were there, and we saw them in a driveway. I supposed this was where my pts. were shot. I'd already learned that they tried to escape their attacker by driving away.
I arrive on our scene and talk to "Ward", one of my favorite police officers. He was the one who pulled her out of the car. Apparently he knew she was dead, too, because he never bothered to initiate CPR.
I make my way to the other side of the car, being taking care not to disturb the crime scene (again). She now has a sheet draped over her. I think back to a lecture I attended given by a Medical Examiner where they said they don't like that. Sheets can transfer fibers and muddle forensic evidence. But, the onus of Chain of Custody fell on PD now, so I bit my tongue.
I lift the sheet to examine her bullet wound. It is located on her left side, in (I think) her 5th or 6th intercostal space (can't remember which, but it was a vital one). No exit wound. She either took it right in the heart, or the aorta, or spleen... who knows. Whatever happened, she bled out in seconds.
We make our way back to the unit and then the station where I write my reports and we clean the unit. I'm cleaning the stretcher and realize I've gone over the same spot somewhere like 3 or 4 times. I recognize the sign that I'm a little shook up by the call. I immediately place the unit OOS because I'm in no shape to come to anyone's aid but my own.
Almost immediately after the dispatcher announces that my unit is OOS, Jon calls me. He asks me what's up, and I tell him I'm freaking a bit. He says, come talk to me, I'm in the parking lot.
I make my way outside to his buggy, and Ed (the Rescue Captain) is there, too. We talk for about an hour. I feel much better, and am grateful for their understanding and reassurance. Informal as it was, I was debriefed.
While we're talking, we're actually observing the third crime scene, and the press swarming around it. That particular crime scene was literally across the street from my station.
The story behind all this is one of a real or imagined love triangle, which I do not know. The woman who died on the scene and the man she was with were shot by her ex-boyfriend. My male pt. was either her new love interest or perceived to be by her ex.
The driveway the police had cordoned-off was to her residence. Apparently the two were sitting in his car outside her house and approached by the shooter.
Once shot, they drove away, and ended up landing in some poor guy's front lawn. Their car took out his light pole, and had dented his brand new SUV (still had 30-day tags on it). I felt bad for the homeowner, having all this drama transpire right in front of his house.
After shooting my two victims/pts., the assailant proceeded to the third and final crime scene, the one across from our station. When he got there, he shot himself twice-once in the chest, and once in the head. He was pronounced dead at the hospital.
My pt. lived. He had a few broken ribs, and a PNX. I actually got to follow-up on him, because I work for the company that owns the hospital where he was flown. I also work with the MD that was the Attending that night, who later filled me in on the continuum of his care.
This one made TV news. I still have the clipping of the article that was in the paper.