Thirty percent of the calls in my town are patients over 80 years old. Lots of pneumonias, CVAs, COPD, hip fractures, etc. We rarely get kids. Started off the day with a 95-year-old who “went into a trance” and “fell out.” When we got there, there were people running toward the house in panic and a woman standing in the doorway, crying and holding her throat. Code, I said, has to be. But it wasn’t. Granddad just went into a trance and fell out. He was lying there on the kitchen floor with jelly on his shirt, talking to us. He threw up some orange juice on the way out the door – got it all over the stair chair– but other than that he was okay. He had eight family members standing around giving him attention. Then we did a three-year-old who choked on some candy, but was okay. We transported anyway, just to be safe. I never want to leave a kid with a refusal, who turns out to have a problem. Then, amazingly, we were sent for another toddler – a two-year-old with some kind of leg injury, no lights or sirens. We got there and found a crying baby and mom saying he was running and he fell and his leg went under him at an odd angle. I looked at both legs — they looked symmetrical. He had full range of motion. I didn’t feel any point tenderness or crepitis, but he kept grabbing at the right femur and he couldn’t stand on it. We should go get it checked out, I said. So we bundled up the boy and with mom sitting in the back, we started to the hospital. “Is there a reason we’re not going lights and sirens?” she asked. I explained how we only go lights and sirens when someone’s life is at stake. We only go lights and sirens if there is something the hospital can do that we can’t that will make a difference in his condition is the amount of time that is saved by going lights and sirens. She wasn’t happy with my explanation. Whenever we hit a bump, he grabbed at his leg, which I now had on top of a pillow wrapped in ice. He would cry and then breathe hard, and cry and breathe hard. Without a deformity, I was hard pressed to give morphine, but he impressed me that he was in some serious pain. I didn’t have a grimace meter, but I would put it at very unhappy, crying face or whatever is a ten. I explained to mother that I think he needed some morphine and I would call the hospital to ask for it. “Morphine? Do you think he needs that? Is that something you can give him? What if he has a reaction? Are you qualified to give it?” I had to keep from smiling. I felt like saying no, but I have some leftover from my last score and I don’t mind sharing just to shut the boy up. Yes, I am qualified, I say. We are licensed to carry and give the drug, which is very safe, but I will first consult an emergency physician before giving it. I called and got orders for 2 milligrams, which I have to say didn’t really touch the kid. Mom was going “When is it going to work? How come it hasn’t worked yet?” And when briefly he closed his eyes, she said, “He’s going to sleep, he’s going to sleep, is that okay?” She’s a mother and she loves her kid. Nothing wrong with that. My hair is getting pretty long and at my age, I may look like I’ve walked down some roads. Maybe I need a trim. At the ER, the first thing mom asked them was if it was okay that I gave him morphine. Yes, that’s fine, they said. The head doctor came up and thanked me for giving it, saying it was the best thing I could do for him, but mom wasn’t listening, she was looking around waiting for some TV moment where they push the kid into the trauma room, and needles and oxygen comes out and there is George Clooney to tell her everything will be all right, as he puts his arm around her and walks her toward a quiet spot in the ED. They sent us down to a room and I heard them put in an order for an X-ray and more morphine, but no one followed us to the room. We moved him over to the ED bed, and his femur was starting to look swollen now. “Are you leaving?” She asked, again almost frantically. There was no hospital staff there yet. “I just have to write my report, and then I’ll be back.” “Isn’t anything going to happen?” She asked. “They’ve already ordered an X-ray and more pain medicine,” I told her. “They’ll be down shortly. Everything is in the works.” When I came back, the ED staff was putting in an IV. Mom looked at me and smiled, somewhat apologetically, and said thank you. I felt it was sincere. I felt like she was saying sorry, I’m just a flustered mom. It is hard with kids to figure out there pain. They are always screaming at first. I don’t often get them with a real injury. If I had to do it over again, I would have asked for 2 milligrams with permission to give an additional 2 in 10 minutes dependent on pain, mental status and vital signs. The last call of the day was for a 92-year-old who fell and broke his hip. I think his son was a doctor based on the report he gave us. He had no objection to my giving his dad morphine. I gave it to him where he lay, and then waited for it to take effect before we moved him. 5 milligrams of morphine did the job.
