EMS Response

911: Let’s Provide Some Medical Care

/ Jordyn Redwood / Leave a comment

In the Season Two/Episode Eight airing of the FOX television show 911— there was a great scene on how to really provide no medical care.

The setup: A gay couple is getting ready to go on a bike ride. Much time is spent in a musical montage showing their lives together. It’s clear they have had a loving relationship and remain deeply in love. One gentlemen goes to load a bike onto a SUV when, in a series of unfortunate events, he gets pinned by the SUV to the entrance gate— akin to Anton Yelchin’s accident (though they do show in the episode the SUV was placed in neutral).

He is discovered by his partner who then calls 911. Upon arrival, there isn’t much done for his lover. He is essentially declared dead on arrival.

Then, the gentleman who discovered his partner, goes unconscious while a firefighter has his back turned. Literally only a few seconds have expired when the firefighter discovers he’s passed out. They provide one and a half cycles of CPR and kind of shrug their shoulders declaring that he’s died, too.

This is unacceptable management of this patient. It’s essentially a witnessed arrest so they were correct to start CPR immediately, but at the very least, he should have been connected to an AED for rhythm analysis and probable defibrillation. A very common reason for sudden collapse are arrhythmias that will respond to electricity. There’s no reason why this gentleman’s treatment  should have been so sparse. It would have increased the drama and the tension of the episode to have this patient get a full resuscitation.

The Good Doctor S1/E6: Killing Patients

/ Jordyn Redwood / Leave a comment

At some point in every medical person’s career, we face a time when we think or may have altered the course of someone’s life either by a medical error causing serious harm or death.

Truth is, it’s a team effort to keep patients from suffering from these complications. We are all responsible for looking out for one another regardless of scope of practice. For instance, if an EMT sees something the doctor (or new resident) is doing wrong, they should speak up to prevent harm from coming to the patient.

In this episode of The Good Doctor, the staff is dealing with an MCI or Mass Casualty Incident. A bus full of wedding guests has crashed. After several of them are treated, it is discovered that a woman is missing at likely still at the crash site.

A resident leaves with an EMS crew (this in itself is highly unlikely) and finds the missing woman. On scene, the resident diagnosis her with a flailed chest and subdural hematoma (a collection of blood on the brain).

What is a flail chest? It’s when two or more consecutive ribs are broken on the same side creating a free floating segment of the chest wall. This can inhibit the patient’s ability to breathe and also puts the patient at a higher risk of having a pneumothorax (or air collecting outside the lung inhibiting the lung’s ability to fill with air.)

The resident chooses to intubate and then drill a bur hole into the patient’s head for the swelling. Upon arrival to the hospital, the ER doctor notices that the patient’s oxygen level is low (like in the 70s— normal of 90 and above) and pulls back the tube and the oxygen levels increase.

When someone is getting intubated, it’s natural to push the tube in too far and because of the anatomy of the lungs, it will pass into the right lung. It’s later noted in the show that because the resident intubated the right lung and that’s the side that had the failed chest, the patient suffered from persistent hypoxia (or lack of oxygen) and her brain died because of that.

Was this patient’s death preventable?

Putting aside that this patient could have been hypoxic during the time she laid for an extended period of time in the ditch, this death could have been preventable if the EMS crew, who would have been monitoring the patient’s oxygen level (and so should the resident if involved in transporting the patient) had spoken up about the dramatically low level.

When a person is intubated, these are the following checks that happen to ensure the tube is in the right place.

1. Does the chest rise and fall equally. In this patient’s case, the right side of the chest would not have risen that much if several ribs were broken and the lung was deflated which should prompt the doctor to do number two on this list.

2. Are the breath sounds equal? The patient’s lungs are auscultated (listened to with a stethoscope) to determine this. They should be equal. If not, then there is a problem with that patient’s lung (one is deflated, etc) or the tube is in the wrong position. At that point, the tube could have been adjust. If the patient’s breath sounds were severely diminished on the right side (especially after trauma) then a need decompression should have been done on that side as a rescue measure to try and reinflate the lung some.

3. Are the patient’s vital signs improving? This would be primarily the oxygen level. It can take a few second to a few minutes for the patient’s oxygen levels to reach normal but they should improve. If not, then something is wrong with the tube and it should be evaluated.

4. Is there the presence of carbon dioxide measured as end tidal CO2? There are quick measure devices in the field to check that carbon dioxide is coming up through the tube. This also ensure the tube is in the right place. In the hospital setting, we will watch this number continuously.

5. Ultimately, in the hospital setting, an x-ray is done to confirm proper placement in the field but if the above items or done, the tube (or endotracheal tube in this case) should be in the right position.

If the EMS crew would have spoken up and/or if all three of the crew members had been performing their job correctly by monitoring the patient’s oxygen levels (which is a very basic thing to be monitoring) then this patient’s death could have been prevented.

It’s up to every member of the healthcare team to ensure patient safety.

9-1-1 S2/E1: What Can be Diagnosed in the Field?

/ Jordyn Redwood / Leave a comment

Fox’s 9-1-1 series is beginning Season 2. The series is enjoyable, but there is some definite leeway the series takes when making certain field diagnosis.

In the first episode of the season, a man gets hit with an old artillery shell in his leg. As noted on the picture on the right, by simply shining a flashlight into the wound, the paramedic declares that his femoral artery has been severed. This could be more believable if there was even some mild pulsatile bleeding, even with a tourniquet in place, at the site which is characteristic for arterial bleeding.

Later in the episode, a picture of the wound is shown with a “live” shell in the anterior thigh. The fact that it is a live shell is made by a firefighter who is former military based on the color. I can’t comment on whether or not that’s true— I’m not military— but the team does make a decent choice (since the patient is stable) to not take him inside the hospital.

When the bomb squad gets there, they are able to take this sweet x-ray in the field. It is a plain, diagnostic x-ray. There is no way for an EMS crew to take an x-ray like this. Can the bomb squad? Yes. So the show is doing it’s due diligence by having the bomb squad perform this task. However, the bomb squad would not need the military to diffuse this— my law enforcement brother who used to work with the bomb squad verified this.

What other things have you seen shows diagnose in the field that they wouldn’t be able to do?

911 S2/E2: Determining Death

/ Jordyn Redwood / Leave a comment

In Episode 2 of this season’s Fox series 9-1-1, a devastating earthquake has hit LA county.

The team is searching for victims when they come upon a patient where only her lower legs are visible. The paramedic reaches down and assesses her pulse at her foot and determines that she’s dead. Time to move on.

Can you feel someone’s pulse in their foot? Yes, you can. He’s palpating what’s called the dorsalis pedis pulse.

Should it be used to determine if the patient is dead? To this, I would say no. The problem is, when the body goes into shock, it shunts blood toward the central aspects of your body to ensure blood flow to your vital organs so even though the person is alive, you may not be able to feel the pulses in the feet. This is why when checking for life, the use of central pulses is encouraged— for instance the femoral or carotid pulses. Also, this victim could just have two broken legs with compromised blood flow to her feet causing the lack of pulse.

However, I’m not going to give them too much grief for this. In a mass casualty situation, sometimes you do just need to move on and save who you can.

Disaster Status: Part 3/3

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Dianna Benson returns to conclude her fascinating three part series on hazardous materials. You can find Part 1 and Part 2 by following the links.

I was on-shift the night an industrial hazardous waste plant burst into flames. I have all the inside information, but it won’t be released to the public, so I’m sorry to say I can’t share most of it with you. What I can say— inside the facility was stored toxic material that ignited.

The fire quickly grew to a plume of smoke then the entire facility erupted into a fireball with several rapid fire explosions. This swift and extreme domino of events occurred simply because the burning toxic chemicals were stored right next to oxygen cylinders— and oxygen feeds fire. You guessed it, properly stored oxygen is essential.

The reverse 911 system was activated. Recorded messages called all nearby residents and warned them to evacuate. View the photos included here— it was an intense explosion and the burning toxic chemicals created a massive haz-mat situation.

The chemicals involved in that explosion react negatively when mixed with water, so we were forced to allow the fire to burn itself out. Two days post the onset of the incident, a foam application extinguished the remaining flames.

Even though this makes for boring fiction, emergency agencies that night proved pre-planning and inter-agency training and execution results in excellent emergency incident response outcome. My crew along with many other emergency crews, successfully worked the potentially deadly incident— no loss of life and only minor exposure issues occurred. But think of the endless possible dramas that could have happened.

All photos are courtesy of Apex Fire Department.

Disaster Status: Part 3/3. Write realistic hazardous materials scenes. Click to Tweet.

*Oringinally posted January, 2011.*

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Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden Son, Final Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.

 

Disaster Status: Part 2/3

/ Jordyn Redwood / Leave a comment

Returning today is award winning author, Dianna Benson, for Part 2 on her series involving hazardous materials. You can find Part 1 here.


A Real-life Haz-Mat Incident

In Graniteville, South Carolina On January 6, 2005 in Aiken County, a railroad engineer left his train for the night to sleep at a hotel in town. Before leaving his train, he failed to properly reline the railroad switch for mainline operations. Meaning, he simply forgot to change the rails on the track. Changing the rails would’ve closed off the track where his train was parked, successfully forcing an incoming train to veer-off onto another track and pass the parked train.

In the middle of the night, an incoming train, planning to pass the town, collided with that parked train, which contained chlorine gas, sodium hydroxide, and cresol. The collision derailed both locomotives and many freight cars. The parked train’s tank car, containing ninety tons of chlorine, ruptured and then released sixty tons of the gas, creating a haz-mat spill and also polluting a nearby creek.

A true haz-mat team— trained, experienced, and equipped for such a catastrophic event— is not located in small-town Graniteville. Only a few of Graniteville’s emergency crews are trained in haz-mat. Their training, expertise, and equipment is insufficient for an incident of this magnitude.

Inside the Avondale Mills plant near the crash site, a man in respiratory distress called 911. From a dispatcher’s viewpoint, this situation is heart-wrenching. Even if rescue crews could’ve safely entered the area to extricate the man, it would’ve been pointless due to his immediate exposure to chlorine.

He was suffering from bronchial chlorine burns and he died a painful death while on the phone with the 911-dispatcher. For haz-mat training purposes, I listened to that chilling 911 recording. Overwhelmed in every way, that dispatcher could only listen as this man gasped his last breaths. Understandably, she had no words of comfort to offer him. That gave me a passion to become a 911 dispatcher once I’m too old to run the streets.

When that man plead with the dispatcher, “Please, don’t hang up. I don’t want to be alone.” I would’ve spoken with him about his family and his passions in life in order to get him as calm as possible. I would’ve talked about God and offered to pray with him. Often when people suspect their death is imminent, they suddenly forget all about being atheist, agnostic, stumbling in their faith, or whatever else, and reach for God.

Due to this haz-mat incident, nine people died, two-hundred and fifty were treated for chlorine exposure, and five thousand-four-hundred residents within a mile radius of the crash site were forced to evacuate for nearly two weeks while haz-mat teams and clean-up crews decontaminated the area.

Think of the fictional characterization possibilities within this tragedy:

1) Plagued by guilt, the train engineer is pushed over the edge by predisposition to mental illness, and becomes a murderous psychotic (an example of a villain in one of my books). What similar characters could you develop? To be honest, though, my heart goes out to that train engineer. My greatest fear in life is making an unintentional mistake as an EMT, resulting in a patient’s death.

2) The 911 dispatcher: For fictional purposes, let’s suppose it was this dispatcher’s first day alone (no longer training) on the job that horrible night in early 2005, and she resigns, making her first day also her last. Think about the baggage she would carry for years to come. In addition, what if she was already in a severe financial bind and now being jobless she’s in dire straits? She’d make a likable and fascinating main character.

3) Me, a future 911-dispatcher— what if a character had aspirations to be an amazing dispatcher but fails miserably? What if he/she is unable to handle the stress of the work and is then lost in life on where to head career-wise? Another idea for a terrific main character.

Disaster Status: Part 2/3. Write realistic hazardous materials scenes. Click to Tweet.

*Originally posted January, 2011.*

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Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden Son, Final Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.

Disaster Status: Part 1/3

/ Jordyn Redwood / Leave a comment

Nothing can complicate a story more than a disaster hitting the town in your novel. What would a realistic response look like from the EMS community? There’s no one better to talk about disasters than an EMS professional. Dianna Benson is here for a three part series on EMS and hazardous materials.

Worst Possible Haz-Mat Situations

In a hazardous-material situation, a small town can easily and rapidly become overwhelmed and thus unable to efficiently handle the crisis at hand due to their limited resources. Below is a list of some additional factors beyond “the town is small” that would heighten the chaos, and for writers, would create solid fictional conflict.

Scenario: Traveling at high speeds, two tanker trucks collide; both roll-over. One truck is an atmospheric pressure tank; the other is a cryogenic liquid tank.

Additional possible factors….

The accident occurs:
1)      Near a school during school hours
2)      Near a stadium filled with spectators and athletes/performers
3)      Near a power plant
4)      Near a hazardous waste facility
5)      Near the town’s landfill (landfills contain countless haz-mats)
6)      Near the town’s water treatment plant
7)      Near the town’s only EMS station
8)      Near the town’s only hospital
9)      Near the town’s only fire department
10)  Near the town’s only police department
11)  During rush hour traffic
12)  During a storm
13)  At 3am
14)  The closest haz-mat team is four hours away

In all of the ten “near” cases above, assume those buildings/areas are contaminated by hazardous material spills from both trucks. Haz-mats are often airborne (so air vapors), which are the most deadly simply because air vapors are invisible— they travel quickly, through most any material (including ventilation systems), and without warning. Plus, they’re next to impossible to contain. Sometimes an unusual cloud or smell is detected, but obviously that warning comes concurrent of the smell and/or cloud discovery, so those individuals in or near the hot zone are already exposed. Keeping safe distance from the hot zone is the only way to eliminate exposure.

Minimum safe distances depend on the chemicals of the hazardous materials present, but an example of an initial minimum safe distance is: 1,000 feet downwind, 500 feet upwind, 330 feet complete radius. Avoid downwind areas entirely and stay upwind. Clearly, continuous monitoring of wind changes is vital.

What additional scenarios and additional factors can you think of?

Disaster Status: Part 1/3. Write realistic hazardous materials scenes. Click to Tweet.

*Originally posted January, 2011.*
*********************************************************************************************

Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden Son, Final Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.

Author Question: Treatment of Teen Suicide Victim (1/2)

/ Jordyn Redwood / Leave a comment

Pink Asks:

Hi there! I’m so glad I’ve found your site and thanks for taking the time to read this. Ok, here goes.

I’m writing about a fifteen-year-old boy who is being abused physically and sexually by his father. One day at school, he tries to commit suicide by slitting his wrists. He becomes scared by the amount of blood, so he leaves the restroom to try to find help. He is found by his teacher and passes out. Now, I know with any kind of suicide attempt, the police are always contacted, and given the all clear for the paramedics.

Jordyn: I think it would depend on the city, county, school district (and whether or not there was a school resource officer) as to the level of police involvement if he just really needs medical attention. I would advise that if this is written about a real place you ensure they have co police response because a paramedic team would be able to handle this call.

Pink: What will the ED staff do to stabilize a patient who has slit their wrists? Is surgery necessary if the wound is pretty deep?

Jordyn: We always look at airway, breathing, and circulation first. If the patient is talking to us then we can quickly check off the first two as at least functional for the time being. As far as circulation the priority is to stop all active bleeding first by direct pressure. Also, does the patient exhibit any vital sign measurements that show he’s suffering from blood loss—which in this case could be increased heart rate, low blood pressure, and also low oxygen levels.

After that, the medical priority for this patient is to further control the bleeding and determine how much blood he’s already lost. Direct pressure is the method used to control the bleeding. Blood work would be done to look at his blood counts to see if he needs any blood replacement. Next would be to look at if he damaged any arteries, tendons, ligaments or nerves during the attempt. Generally, an exam of the function of the fingers can reveal if there is a concern there. For instance, do his fingers have full range of motion? Do any fingers have areas of numbness? Arterial bleeding is very distinct so it’s usually obvious if an artery has been severed. If he has damaged anything that would limit the function of his hand then he would need follow-up evaluation by a hand surgeon for surgery. If there is no damage to the structures as listed, there is a possibility the wound could be closed in the ER as a simple laceration repair.

Pink: Upon discharge, what will the patient be given to take home for treatment of their wound (the slit wrist)?

Jordyn: If the patient gets a simple laceration repair (merely closing the skin even if it takes a lot of stitches) then pain could be managed at home with over-the-counter pain relievers like Tylenol or ibuprofen. If the patient requires surgery, a short course of a narcotic may be given for pain control,    but we also have to look at other factors to determine if this would be wise for the patient (are they a current drug addict or is there continued concern for suicide attempt). If the patient has surgery, then it is up to the surgeon to determine the patient’s home pain relief.

Pink: If a nurse or doctor notices any bruises on the patient’s body, can they examine an unconscious patient?

Jordyn: Yes, an unconscious patient’s skin can be externally examined. In fact, it is often protocol to do so because we are looking for clues as to why the person is unconscious.

Well continue this discussion next post.

This Is US: Jack’s Needless Death

/ Jordyn Redwood / 4 Comments

This television episode caused more people to reach out to me over any other. This Is Us has been building up to Jack’s death for eighteen months. It needed to be big. It needed to be dramatic. Can you tell I’ve been watching the show? It was really none of those and medically— well, just weird to be honest.

If you haven’t watched the episode then don’t read this post because it will reveal his cause of death . . . like right now.

Jack’s ultimate demise? A heart attack called the widow maker caused by the stress of the fire.

Jack is in intense smoke and heat for several minutes. He emerges and is first checked by EMS. He is being given oxygen and a dressing to his arm for “2nd degree burns”. The EMS person says she can’t treat the burn and he is seemingly refusing transport, but she does encourage him to be seen. Also, giving oxygen is correct, but it is not the right type of mask. A note on burns. Burns will evolve over the next several days so you don’t really know how severe a burn will be for a while.

Jack does eventually go to the hospital to get his burns checked. The doctor is initially giving him instructions on burn care.  The doctor says, “I’d like your heart rate to come down.” and glances at the monitor— which doesn’t have any readings on it. No waveforms. No numbers. He then says, “There’s soot in your airway so we’ll have to run some tests. The swelling is minor.”

That’s about it. The doctor tells Jack he basically dodged a bullet and seems none too concerned about his potential airway damage.

Just as I mentioned above, airway burns from smoke inhalation are similar to skin burns in that they evolve over time. Smoke inhalation and the potential for upper airway swelling is taken very seriously. There is a nice overview here. At the very least, there should be discussion of admitting Jack to the hospital. As quoted from the article, “Studies have shown that initial evaluation is not a good predictor of the airway obstruction that may ensue later secondary to rapidly progressing edema.” If there is concern about significant injury to the airway then the patient is electively intubated until the airway injury heals. It’s VERY difficult to intubate someone with a lot of airway swelling.

Shortly after this consultation, Rebecca decides to make a phone call and get a candy bar from the vending machine. In that, perhaps under two-three minutes passage of time, Jack codes and dies. Even though she is just outside the ER nurses station, she never hears a code being called. Doesn’t see the commotion.

The doctor approaches her and says, “One of complications of smoke inhalation is that it puts a terrible stress on the lungs and therefore the heart. Your husband went into cardiac arrest. It was catastrophic and I’m afraid we lost him . . . Mrs. Pearson, your husband has died.”

After a few exchanges she goes to Jack’s room where there is a spotlight shining on his chest with a cursory ambu bag at the head of his bead . . . but no other equipment. I’m telling you in two minutes, a code has barely just begun and is never called so hastily . . . like ever. Later, explaining the event to Miguel, Rebecca says he had a widow maker’s heart attack.

The widow maker is a real term for a heart attack. It generally refers to occlusion of the left main coronary artery that feeds the left side of the heart. It is the same heart attack celebrity trainer Bob Harper had and survived. The reason the widow maker can be so devastating is that the left ventricle is the largest, strongest pumping chamber. If it dies . . . well, you’re hosed.

There would be no realistic way the doctors would know it was specifically this kind of heart attack as shown in the episode without an autopsy. Presumably, Jack went into one of the lethal heart rhythms, v-tach or v-fib, at the time of his code. In the time frame given on the show, the medical team would have barely started CPR and given the first line treatment which is electricity. A 12-lead ECG can be a strong diagnostic tool for this type of heart attack, but they never did one. Had they done that early on, they probably would have seen the changes.

Also, he would likely have some signs and symptoms. Chest pain. Nausea. Left arm pain. Sweating. Demonstrating these might make the scenario seem more believable. Having Rebecca witness the code would have been more dramatic.

Also, it would make more sense that he would suffer this cardiac event while he is actually under duress— such as during the rescue of the children and the dog.

The only way to truly know that this is the type of heart attack Jack suffered as presented in the show would be to conduct an autopsy.

This Is Us— thanks for killing off a beloved character in a totally lame way— at least from a medical standpoint.

9-1-1 S1/E3: Evaluation and Treatment of Overdoses

/ Jordyn Redwood / Leave a comment

In Episode 3 of 9-1-1, the story opens with officer Athena Grant, played by Angela Bassett, finding her daughter unconscious from taking hydrocodone pills as seen in the trailer below. The daughter, who appears to be between twelve and fourteen, is whisked off to the hospital and admitted to the ICU in short order. One, did they treat this ingestion (or overdose) correctly? Two, would this type of ingestion warrant ICU admission?

It’s stated in the episode that the daughter took “six to seven” hydrocodone pills. Hydrocodone is a combination of acetaminophen (Tylenol) and a synthetic type of codeine. It comes in many different preparations with different amounts of acetaminophen and hydrocodone. Where do we start to evaluate whether or not the ingestion is worrisome?

1.  How is the patient? What signs and symptoms do they have?  The EMS crew in this situation is lucky. The mother knows exactly what the daughter took. She presents unresponsive with slow breathing. Number one treatment in this situation after assisting with her breathing? Give Narcan which this crew absolutely does not do. Narcan is a reversal agent for opioids. It can be given via a mist up the nose so you can generally reverse the sedative effects of the drug without even starting an IV. It is a life saving measure because it is the not breathing part that will kill you first. This is the medication they should have given first.

In absence of knowing exactly what the patient took, we can look at clusters of signs and symptoms called toxidromes which might point us in the right direction.

2. What did the patient take? When did they take it? How much did they take? Many drugs have multiple components and we have to evaluate EACH component and whether or not this could prove harmful to the patient. The opioid  (once reversed with Narcan) is probably the least concerning. The amount of acetaminophen ingested is our next priority and we would calculate how many milligrams per kilogram she took. We know for acetaminophen that when you start to get between 100-150mg/kg that there could be a potential for liver damage. There is a reversal drug for acetaminophen’s damaging effects on the liver called Mucomyst, but there is a window in which this can be given to be effective. Usually, a poison control center will help us manage these types of patients.

In this case, let’s say she took six pills of Lortab 7.5/500. From this we know that each pill has 500mg of acetaminophen. Assuming the average 12-14 y/o is about 100 lbs (converted to 45 kg) then she took about 66mg/kg of acetaminophen. A four hour Tylenol level (measured four hours after the ingestion) would be checked to ensure she wasn’t toxic, but in this case likely not.

3. Will this patient be admitted to the ICU? It might come as a surprise, but ingestions of medications are most often not admitted to the ICU. Most are managed and observed in the ER. In this case, the girl should have been given Narcan by EMS. We would continue to watch for the somnolent effects of the opioid and evaluate the risk of the acetaminophen.

Also, it’s generally protocol that an aspirin level is measured as well even if the patient denies taking any. We can’t always depend on the patient being truthful about what they took and aspirin can have very devastating effects as well. Other labs depend on the medication ingested and what parts of the body if affects. This patient would likely not be admitted to the ICU.

Also, if we get a toxic ingestion within an hour we can give activated charcoal (that literally looks like black sludge) that will bind the medication. This is not always done for several reasons. One is the risk of the charcoal ending up in a patient’s lungs during administration. Usually this is done under the recommendation of Poison Control.

4. Do we notify Child Protective Services? In this episode, Child Protective Services conducts a mental health exam on the teen. In the real world, this evaluation takes place through mental health providers not associated with the state. State involvement is generally reserved for what we would consider a risky home environment. A teen getting into their parents medicine cabinet for some pills would not fall into that category. What would? A two-year-old ingesting crack cocaine that was lying around the home. Each case is handled very individually, but this case presented in 9-1-1 would not rise to that level in my opinion.

As a side note, parents are not separated from their children during medical treatment. Can we please stop perpetuating this myth?

What do you think of 9-1-1?