Thursday, December 20, 2012


The ambulance took a sharp turn then sped down the country road. The siren blared, though it was slightly muffled inside the cab and had to compete with the roar of the diesel engine. Ryan and Tim had just been sitting down to lunch when the call came in for a man suddenly feeling ill. As they raced down the road they took bets on whether the run would be something real or just BS.

They turned into a long driveway leading to a farm house. An endless sea of corn could be seen spreading out behind the farmyard. Parked next to the garage was a green John Deer tractor. It seemed to have been parked haphazardly. As they pulled up to the house Ryan could see a middle aged man sitting on the front porch steps. They parked the truck and Ryan told Tim to grab the bag as he approached the man.

The man tried to call out a greeting, but seemed to have trouble. Instead, he just waved for the EMTs to come to him. Ryan scanned over the man, starting his assessment before he reached him. The man was pale and sweaty. His dirty work clothes were covered down the front with vomit.

“My name is Ryan, I’m here to help sir,” he said as he put on his gloves, “Can you tell me why you called?”

The man let out a groan that sounded roughly like, “I feel like crap.” He grasped at his stomach in pain. Up close, Ryan could see part of why the man was having trouble talking was because his mouth was filling with saliva and he was drooling all over himself. The man’s eyes were watery like he had been crying. Starting to suspect something, Ryan looked down and saw that the front of the man’s pant were stained with urine. Ryan had not noticed until now that there was a strong chemical smell in the air, the diesel fumes had a way of masking every other scent nearby. A focused sniff told him the man had defecated.

Salivation, lacrimation, urination, defecation, gastrointestinal upset, and emesis. All the signs of SLUDGE syndrome. Something was stimulating the man’s parasympathetic nervous system into overdrive. That meant a nerve agent. Some kind of insecticide was the likely culprit on a farm. However, Ryan had also heard stories of farmers hitting buried chemicals or old munitions and releasing chemicals. Whatever the case, there was a good chance that something deadly was in the air.

Ryan fought down the urge to swear and instead turned to Tim who had just arrived with the bag, “We need to grab this guy and go now! We’ve got a possible Hazmat situation.” Tim looked stunned by the sudden pronouncement, but recovered and helped get support the farmer to the ambulance.

“Sir, is there anyone else here? In the house or the field?” Ryan asked as they loaded the man onto the cot. The man shook his head. That was a small relief at least. Ryan hopped in back with the farmer and Tim dashed around to the front of the ambulance to drive.

“Get us going, I don’t want to wait around if there are chemicals in the air,” Ryan called up to Tim as he put an oxygen mask on the patient and cranked it to sixteen LPM. The patient was breathing on his own so far and did not show signs of any physical injury. Ryan started taking vitals as the ambulance turned onto the road. “Get ahold of the fire department. Tell them to get the Hazmat team down here.”

Gathering information was not going well. The man was having trouble speaking and what he said was hard to interpret. Ryan worked fast to keep assessing the patient. He placed the heart monitor on him and got a cardiac reading. The man was slightly bradycardic. To Ryan’s way of thinking a slow heart beat was better than no heartbeat.

As Ryan started an IV in the patient’s left AC he could tell the man was starting to fade out of consciousness. “Damnit!” he swore as the man finally passed out. He connected the line and set the drip rate to keep the vein open then moved over to get the suction ready.

By the time he had it ready, he could already hear the start of the man gurgling on his own saliva. He pulled down the oxygen mask and opened the man’s airway. He slipped the yankauers suction tip into the man’s mouth. The saliva was sucked out and he put the mask back on the patient.

As he started to reassess the patient, Ryan made his call into the hospital, “We have an adult male, about forty, that has probably been exposed to a nerve agent. Have Hazmat precautions ready when we get there. His vitals are BP ninety over sixty, pulse eighty, and respirs twelve. ETA eight minutes.”

The ambulance bounced down the road as Ryan continued to monitor the patient. He had to stop his continuing assessment to suction the patient again. He took a blood sugar reading, which was normal, along with a temperature. He wanted to have a thorough assessment ready for the ER. Vitals were low, but mostly stable. As long as they were not getting worse, Ryan was happy.

The ambulance turned into the hospital and parked at the ER entrance. People were out and waiting, ready with the hoses. Ryan was glad this happened in the summer instead of winter. They unloaded the patient and rolled him over to be rinsed off. He was transferred to a clean cot and the nurses rolled the patient into the ER. With patient care transferred, Ryan and Tim went through decontamination.

“So, more interesting than it sounded when we got the call,” Tim said.

“Yea, yea. Hand me a towel,” Ryan replied. Interesting was good, not having to find dry cloths was better.

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