Life Saving Calls
(pictured: Lopez after the call smiling for the both of us)
LSA Medic 4 w/ EMT S. Lopez-Call No. 3:
Nature of call: Shortness of breath.
Events: home nurse giving antibiotics via IV for UTI when the patient presented with low SPO2% and SOB.
Mental status: COAx4, GCS15.
Chief complaint: shortness of breath.
Signs/ Symptoms: gasping, two word sentences, pale skin.
History/ Allergies: HTN, UTI / NKDA.
Airway: patent and clear.
Breathing: present-rapid and shallow, SPO2 78% room air.
Circulation: present, skin-pale and dry.
Assessment: Lung sounds-congestion present, Vitals-BP 244/114 (MAP 157), heart rate 96 BPM, Respiratory rate-28 BPM, blood glucose 159, Temp: 97.8F, EKG-NSR, 12 lead-no stemi or st depression, Pupils- PERRL, Stroke assessment-negative.
Treatment: O2 NRB, Albuterol, Atrovent, IV access. nitro considered for BP ( labetalol is contraindicated due to beta 2 blocking properties)
Reassess: SPO2 100% w/ 15 LPM and neb treatment, BP- decreased to normal limits (hypoxia increases pulmonary artery pressures increasing BP), Mental status remain normal, Respiratory rate-20 BPM w/ good depth, full speech present, skin condition-pink and dry, SOB subsided-patient reports feeling better.
Rule out: stroke, heart failure, hypertension crisis, fever/sepsis.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs and continue to provide emotional support. Repeat until we arrive at the hospital.
Conclusion: At the hospital, the patient thanked Lopez and me for saving their life.
LSA Medic 4: 1, Death: 0
(pictured: our unit at the hospital after transferring care)
LSA Medic 7 w/ EMT D. Michalk-Call No. 5:
Nature of call: Cardiac arrest
Events: patient has been sick with CHF. Nurse staff initiated CPR.
Mental status: COAx0, GCS3.
Chief complaint: N/A
Signs/ Symptoms: pulseless, pale, hypoxic.
Allergies/ History: NKDA/ CHF, HTN.
Airway: patent and clear
Breathing: absent.
Circulation: absent.
Assessment: Pulse check-absent, EKG-asystole, lung sounds-rales, glucose check-WNL.
Treatment: CPR, BVM, OPA, Intubation, O2, CO2 monitoring, IO access, Epi x2, Fluids-200 mls NS, Suction-bloody tinge sputum.
Reassess: EKG-PEA, Pulse-absent.
En-route: Repeat CPR, Pressure ventilation, Epi and EKG assessment until we arrive at the hospital.
Conclusion: At the hospital, ER staff continue CPR until the patient obtain ROSC.
LSA Medic 7: 1 Death: 0
Update: Received ROSC Save certificate and coin.
(pictured: Lopez and Paramedic Student CJ assessing the patient)
LSA Medic 4 w/ EMT S. Lopez & Paramedic Student CJ-Call No. 2:
MOI /Nature of call: Fall.
Events: pt attempted to get in their car and fell on concrete floor.
Mental status: COAx4, GCS15.
Chief complaint: head pain and left pelvis pain.
Signs/ Symptoms: left leg- short and rotated outward, left pelvis pain, head- pain/ hematoma present.
Allergies/ History: morphine/ cardiac hx, dm2. No blood thinners.
Airway: patent and clear
Breathing: present, rate and depth-good, spo2%- wnl.
Circulation: present, weak and slow, skin condition-good, no bleeding.
Assessment: trauma assessment, TBI assessment, PMS assessment before and after moving, vitals- BP-wnl, hear rate- 40bpm, respiratory rate-wnl, spo2%- wnl, glucose-wnl, temp-97.8f, EKG-sinus brady, 12 lead- left axis deviation, right bundle branch block, no other abnormalities.
Treatment: c collar, IV access, 250 ml NS bolus, atropine 1mg IV (rate unresponsive to fluids), no pain meds due to low hear rate.
Reassess: heart rate increased to 80 w/ cardiac med, mental status- remain normal, ABC’s normal, vital signs normal. Pt reports feeling better.
En-route: reassess mental status, ABC’s and vital signs. Repeat until we arrive at the hospital.
(pictured: the EKG strip of the arrhythmia)
LSA Medic 4 w/ EMT Willie-Call No. 2:
Nature of call: chest pain.
Events: pt arrested and taken to jail.
Mental status: COAx4, GCS15.
Chief complaint: Non-traumatic chest pain and SOB.
Signs/ Symptoms: pain-left side, 10/10, radiating to the right side, SOB.
Allergies/ History: NKDA/ none.
Airway: patent and clear.
Breathing: present, rate above normal, spo2% wnl at room air.
Circulation: present, rate- 120bpm, quality-strong. Skin condition-good.
Assessment: EKG- a flutter, 12 lead- a flutter, no stemi or st depression, Lung sounds-good. Vitals- BP-wnl, heart rate-120bpm, respiratory rate- above normal, spo2%-wnl, temp: wnl, glucose-wnl.
Treatment: IV access, 200 mls NS, call medical director for cardizem approval.
Reassess: heart rate decreased wnl w/ cardiac med, mental status- remain normal, ABC’s normal, vital signs normal. Pt reports feeling better-pain subsided.
En-route: reassess mental status, ABC’s and vital signs. Repeat until we arrive at the hospital.
(pictured: Paramedic student Marcos assessing the lungs sounds of the patient)
LSA Alpha 2 w/ EMT S. Lopez & Paramedic Student Marcos-Call No.3:
Nature of call: shortness of breath.
Events: Pt's symptoms developed at a middle school, school nurse reports pt’s SPO2 88% room air. Pt has been dealing with a respiratory infection.
Mental status: COAx4, GCS15.
Chief complaint: chest pain, sob, and weakness.
Signs/ Symptoms: tripod position, rapid and labored breathing.
Allergies/ History: none.
Airway: patent and clear.
Breathing: present, rapid and shallowed, SPO2 92% post inhaler.
Circulation: present, rapid and strong. Skin condition good.
Assessment: lungs sounds-wheezing present, vitals- BP wnl, hear rate 108 bpm, respiratory rate 28 bpm, SPO2 92 % room air, glucose 107, temp 98.8f, EKG-sinus tachy, 12 lead-wnl.
Treatments: O2, neb treatment, IV access.
Reassess: SPO2 100%, chest pain, sob and weakness subsided. Pt reports feeling better.
En-route: monitor and reassess mental status/ABCs/vital signs. Repeat till we arrive at the hospital.
LSA A2: 1 Death: 0
(pictured: AEMT A.Pena unloads the patient at the hospital, while I carry the monitor in one hand and the stretcher in the other)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 3:
Nature of call: sick call.
Events: family witness syncope from chair to the ground, pt turning pale. Pt initially refusing assessment/transport.
Mental status: COAx3-event, GCS15.
Chief complaint: none reported.
Signs/ Symptoms: pale and diaphoretic.
History/ Allergies: HTN, DM.
Airway: patent and clear.
Breathing: present-rapid, SPO2 95% room air.
Circulation: present, pulse- strong and regular, skin-pale, cold and diaphoretic, No bleeding.
Assessment: pulse- wnl, heart tones- wnl, Lung sounds-clear, Vitals-BP 79/52 (MAP 61), heart rate 97 BPM, Respiratory rate-26 BPM, blood glucose-166, EKG-NSR, 12 lead- STEMI-V3/V4-anterior MI. Pupils- PERRL, Stroke assessment-negative.
Treatment: supine position, ASA 324mg, IV access-NS bolus, rapid transport nearest cardiac hospital.
Reassess: no c/c or symptoms, skin condition improved, Vitals-BP 111/80 (MAP 90), heart rate 89 BPM, Respiratory rate-26 BPM, SPO2 95% room air.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Provide emotional support. Repeat until we arrive at the hospital.
Conclusion: At the hospital, ER doctor confirms STEMI present. The wife thanked me for convincing and helping her husband, the pt.
LSA Alpha 2: 1, Death: 0
(It was a save that day, but days later, a family member reached out to me, telling me the patient, their dad, passed away. My partner, AEMT A. Pena, and I are honored to be able to give the family more time with him. Our condolences to the family. LSA A2: 0, Death: 1)
(pictured: At the hospital, AEMT Pena is switching O2 tanks on the stretcher to take the patient inside.)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 2:
Nature of call: breathing problems.
Events: nursing home respiratory therapist reports pt is not responding to albuterol, spo2 % is low. Nurse states pt has been having respiratory issues for weeks now, not new.
Mental status: COAx2, GCS14.
Chief complaint: N/A- non verbal.
Signs/ Symptoms: rapid breathing, audible wheezing, pale and cold.
History/ Allergies: HTN, DM, AMS.
Airway: partially blocked-stridor.
Breathing: present-rapid, SPO2 61% w/ nrb 15lpm.
Circulation: present, pulse- weak and regular, skin-pale, cold.
Assessment: Lung sounds-wheezing, Vitals-BP 122/61 (MAP 81), heart rate 34 BPM, Respiratory rate-32 BPM, EKG-sinus brady, 12 lead- wnl, Pupils- PERRL.
Treatment: o2, atrovent, epi IM (spo2 74%), IV access, CPAP( spo2 80%), Solumedrol, rapid transport to hospital.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Consider magnesium drip and RSI. Repeat until we arrive at the hospital.
Reassess: skin condition improved, Vitals-BP 120/75 (MAP 90), heart rate 102 BPM, Respiratory rate-24 BPM, SPO2 90% w/ CPAP.
Conclusion: At the hospital, transferring care-spo2 100%, vitals-wnl, mental status and speech ability improved.
LSA Alpha 2: 1, Death: 0
(pictured: entering the back room of a small house to the patient)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 1:
Nature of call: non traumatic chest pain.
Events: family reports days ago the patient, 81 year old, was diagnosed w/ “ heart problems” at the hospital. ASA given prior to EMS arrival instructed by LSA dispatch.
General impression: obvious discomfort and ill patient.
Mental status: COAx4, GCS15.
Chief complaint: chest pain (10/10, pressure, non radiating and new) and SOB onset 20mins before calling 911.
Signs/ Symptoms: pale, rapid and labored breathing w/ 2 word sentence, audible stridor and rales.
History/ Allergies: HTN, DM.
Airway: partially blocked.
Breathing: present-rapid, SPO2 64% room air.
Circulation: present, pulse- strong and regular, skin-pale and warm.
Assessment: pulse- strong and regular, heart tones- present-wnl, lung sounds-congestion, Vitals-1st BP-196/123(MAP 147), 2nd BP-214/115 (MAP 150), heart rate-108 BPM, Respiratory rate-28 BPM, blood glucose-211, temp: 96.8F temporal, EKG-sinus arrhythmia,12 lead- wnl without STEMI, ST depression, L/RBBB.
Treatment: full fowler position, hi-flow O2, albuterol, IV access, nitro.
Reassess: mental status same, no new c/c or symptoms, skin condition improved-pink, Vitals-BP 176/92 (MAP 120) post nitro, heart rate 97 BPM, Respiratory rate-28 BPM, SPO2 97% w/ nrb.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
LSA Medic 4: 1 Death: 0
(pictured: rapidly walking in to the hospital)
LSA Medic 4 w/ AEMT M. Rodriguez and Paramedic Student A. Borchers-Call No. 2:
Nature of call: unresponsive 79 year old female at nursing home.
Events: nurse reports last normal yesterday morning, unable to give normal mental base line. No vitals checked prior to calling 911.
Mental status: COAX 0, GCS 3.
Chief complaint: N/A
Signs/ Symptoms: rapid breathing, unequal pupils, cyanosis to finger tips.
History/ Allergies: full code, dm2, dementia and Alzheimer’s.
Airway: patent and clear.
Breathing: present-rapid and labored-spo2 64% room air.
Circulation: present- strong and regular.
Assessment: stroke assessment, trauma assessment, lung sounds-diminished, Vitals-BP-117/112(114), initial heart rate 243 and then 120 BPM, Respiratory rate-30 BPM, blood glucose-Hi, EKG-sinus tach. 12 lead- left axis deviation, elevated t waves, no other abnormalities.
Treatment: full fowler, hi flow o2, albuterol, IV-NS bolus, consider RSI.
Reassess: SP02 90% maintain w/ o2 and albuterol. Other Vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: at the hospital: ph 7.1, sepsis, DKA, potassium-7.2
(pictured: arriving at the hospital with the patient feeling better)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 1:
Nature of call: unresponsive 84 year old female.
Events: at Dr office, staff reporting witnessing syncope but no trauma, patient was caught. Family reports patient has been sick for days with vomiting and diarrhea.
Mental status: COAx2, GCS14.
Chief complaint: dizziness. Denies chest pain, sob and abdomen pain.
Signs/ Symptoms: pale.
History/ Allergies: HTN, DM.
Airway: wnl.
Breathing: wnl
Circulation: present, pulse- strong and regular, skin-pale.
Assessment: pulse- wnl, Lung sounds-clear, positive skin turgor, Vitals-BP-87/48(61), heart rate 64 BPM, Respiratory rate-20 BPM, SPO2 94% RA. blood glucose-209, temp: 97.8F temporal, EKG-nsr, 12 lead- wnl.
Treatment: supine position, IV access and fluids.
Reassess: no new c/c or symptoms, dizziness subsided, skin condition improved, BP still remain low post fluids, lowest MAP 61.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: We travel up and exit the elevator, not knowing we are about to save a life.)
LSA Alpha 1 w/ EMT R. Longoria -Call No. 2:
Nature of call: sick call
Events: patient upstairs seeing a vain specialist due to syncope earlier in the day and then becoming hypotensive during the visit. Doctor in the room attempting to find a vein for an IV.
Mental status: COAX4, GCS15.
Chief complaint: general body weakness
Signs/ Symptoms: cold, pale and lethargic.
History/ Allergies: DM2, recent pancreatic surgery.
Airway: wnl.
Breathing: present-rapid and labored.
Circulation: pulse present-strong and rapid, skin-pale and cold.
Assessment: Lung sounds-clear, Vitals-MAP 51, heart rate 111 BPM, Respiratory rate-28 BPM, SPO2 95% w/ 2 LPM nasal, blood glucose-389, Temp-97.1F, EKG-sinus tachycardia.
Treatment: supine position, IV access and bolus NS fluids, blanket.
Reassess: no new c/c or symptoms, vitals-BP increase MAP >65, heart rate decreased to WNL. Skin condition improved- pink and warm. EKG-NSR.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs and continue to provide emotional support. Repeat until we arrive at the hospital.
Conclusion: patient improved and felt better thanking us for helping them.
Non-life-Saving Calls
(Pictured: on scene waiting for the family to arrive)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 2:
Nature of call: MVC.
Events: As per dispatch notes, truck crashed into a pole and drove away and crashed again. Mcallen PD interviewing patient, 30 year old, on scene.
General impression: patient ambulatory without obvious illness or life threats.
Mental status: COAx2, GCS14. No recall of events.
Chief complaint: none reported.
Signs/ Symptoms: none reported.
History/ Allergies: none reported.
Airway: patent and clear.
Breathing: present-wnl.
Circulation: skin- pink and diaphoretic (weather considered)
Assessment: refused assessment and transport.
Treatment: N/A
Reassess: N/A
Conclusion: prescription note found by PD stating patient is being evaluated for seizures and shouldn’t drive. Family members are called to take responsibility of the patient since the patient is coherent enough to refuse medical attention but not to drive due to possible seizure episode. Family signed as a witness patient refusing medical attention.
(pictured: posting at a different location after the call)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 3:
Nature of call: cardiac arrest.
Events: As per dispatch notes, 99 year old patient has DNR and family wishing no medical treatment. On scene, down time 15 mins, no out-of-hospital DNR present and family openly wanting no medical treatment.
General impression: chronically ill patient.
Mental status: COAx0, GCS3.
Chief complaint: N/A
Signs/ Symptoms: unresponsive, pulseless, skin pale/ jaundice.
History/ Allergies: heart failure and sepsis, discharged from hospital yesterday with complications and hospital DNR.
Airway: absent.
Breathing: absent.
Circulation: absent.
Assessment: pulseless, not breathing, hospital DNR bracelet and iv lock present.
Treatment: N/A
Reassess: N/A
Conclusion: medical director contacted and determine nothing could have been done based on down time, age, history and then family wishes. Family thanked us for respecting the patient and their wishes.
Medic 4: 0 Death: 1
(pictured: arriving at trauma level 1 hospital)
LSA Medic 4 w/ AEMT M. Rodriguez and Paramedic Student A. Borchers-Call No. 1:
Nature of call: mvc-car vs motorcycle.
Events: Mcallen FD on scene providing aid. Helmet in place. Patient covered in gasoline.
Mental status: COAx4, GCS15.
Chief complaint: right arm pain and knee pain 7/10.
Signs/ Symptoms: various lacerations, abrasions, swelling and deformity to right knee.
History/ Allergies: none.
Airway: patent and clear.
Breathing: present-wnl
Circulation: present, right arm and leg- pms intact. skin-wnl.
Assessment: pulse- wnl, lung sounds-clear, Vitals-BP-123/91(103), heart rate 65 BPM, Respiratory rate-20 BPM, SPO2 97% RA, blood glucose-179, EKG-NSR.
Treatment: c collar, splint, bandages, supine position, IV access, trauma assessment.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: loading patient on to the ambulance for rapid transport)
LSA Medic 4 w/ AEMT M. Rodriguez and Paramedic Student A. Borchers -Call No. 3:
Nature of call: chest pain.
Events: 61 year old male at Dr office presenting with stroke symptoms.
Mental status: COAX 4, GCS 15.
Chief complaint: right side headache 7/10 and dizziness. Denies chest pain and sob.
Signs/ Symptoms: bilateral peripheral vision loss, left hand weakness and unable to clearly verbalize.
History/ Allergies: cva, htn, cholesterol.
Airway: patent and clear.
Breathing: present-wnl
Circulation: present-wnl
Assessment: stroke assessment-VAN pos, pupils-perrl, Vitals-BP-158/90(113), heart rate 93 BPM, Respiratory rate-16 BPM, SPO2 96% RA, blood glucose-100, EKG-NSR, 12 lead- wnl, no other abnormalities.
Treatment: IV and rapid transport.
Reassess: no new c/c or symptoms. Vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: CT clean. No stroke.
(pictured: unloading at the hospital)
LSA Medic 4 w/ AEMT M. Rodriguez and Paramedic Student A. Borchers-Call No. 4:
Nature of call: stroke.
Events: 54 year old male at work began acting strange with 20mins onset before 911 called. Coworkers deny knowing if any alcohol or drug use.
Mental status: COAX 1, GCS 6.
Chief complaint: N/A
Signs/ Symptoms: spontaneous eye movement, responding to name and non verbal. seizure or drugs considered.
History/ Allergies: dm.
Airway: patent and clear.
Breathing: present-wnl
Circulation: present-wnl
Assessment: pupils-equal dilated and nonreactive, Vitals-BP-153/94(116), heart rate 120 BPM, respiratory rate-24 BPM, SPO2 97% RA, blood glucose-236, EKG-sinus tach, 12 lead- wnl, no other abnormalities.
Treatment: IV-NS bolus, narcan (rule out unresponsive origin)
Reassess: acute facial droop, transport upgraded to light and sirens. BP-138/83(103). Other vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: ETOH and cocaine in the system. Neg stroke.
(pictured: 12 lead ekg showing STEMI)
LSA Medic 11 w/ AEMT J. Castillo-Call No. 1:
Nature of call: psych call
Events: PD on scene leading us to a patient who reports feeling panic attack about an hour before calling 911.
Mental status: COAx4, GCS15.
Chief complaint: general body weakness post panic attack. Denies chest pain, sob.
Signs/ Symptoms: cough, paleness.
History/ Allergies: dm2, htn, open heart surgery.
Airway: patent and clear.
Breathing: present-wnl
Circulation: present, wnl.
Assessment: stroke neg, Lung sounds-clear, Vitals-BP-118/81(93), heart rate 104 BPM, Respiratory rate-20 BPM, spo2 100% RA, blood glucose-318, EKG-afib, 12 lead- v2 2mm stemi present.
Treatment: IV fluids, ASA and rapid transport to near by free stand (patient refusing cath lab capable hospital)
Reassess: no new c/c or symptoms. Skin condition improved. Patient reports feeling better.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: non conclusive heart attack, EKG normal for patient.
(pictured: arriving at the hospital)
LSA Medic 11 w/ AEMT J. Castillo-Call No. 2:
Nature of call: MVC.
Events: patient passenger side of a 4 door car, striking pole approx 10mph, no damage to car. Seatbelt in place, no airbag deployment and neg LOC.
Mental status: COAx4, GCS15.
Chief complaint: left knee pain, 7/10 and dizziness. Denies head injury, neck pain, back pain.
Signs/ Symptoms: obvious discomfort.
History/ Allergies: none.
Airway: patent and clear.
Breathing: present-wnl
Circulation: present, wnl.
Assessment:trauma assessment- abrasion and swelling present to knee, Vitals-BP-117/72(89), heart rate 105 BPM, Respiratory rate-12 BPM, spo2 98% RA, EKG-NSR.
Treatment: provide emesis bag for possible vomiting.
Reassess: no new c/c or symptoms. Vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: walking into the er with the patient)
LSA Medic 11 w/ AEMT J. Castillo-Call No. 3:
Nature of call: MVC.
Events: FD and PD reporting two patients from same vehicle. Rear ended approx >35mph, moderate to heavy damage. Seatbelt in place, airbag deployment and neg LOC. A second unit requested for the driver due to passenger continuously vomiting causing airway compromise.
Mental status: COAx4, GCS15.
Chief complaint: nausea, vomiting, back and arm pain.
Signs/ Symptoms: continues nausea and vomiting .
History/ Allergies: none.
Airway: compromise.
Breathing: present-abnormal
Circulation: present, wnl.
Assessment: trauma assessment,
Vitals-BP-121/81(94), heart rate 100 BPM, Respiratory rate-30 BPM, spo2 98% RA, EKG-NSR.
Treatment: c collar, iv, zofran
Reassess: no new c/c or symptoms. Vitals remain the same. Nausea and vomiting continued enroute, 2nd dose of medication given.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: walking up to the front door to the patient)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 2:
Nature of call: stroke
Events: family reports patient normal slight slur speech got worse and develop acute onset of loss of balance and coordination, onset approx an hour before calling 911 due to attempting to feed patient thinking it was his sugar but no improvement.
Mental status: COAx3, GCS14.
Chief complaint: weakness and general body pain. Denies headache, double vision, chest pain, sob and abdomen pain.
Signs/ Symptoms: slur speech and droop (normal due to hx.)
History/ Allergies: HTN, DM, CVA.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: stroke assessment-positive, Vitals-BP-103/56(72), heart rate 64 BPM, Respiratory rate-20 BPM, SPO2 98% RA. blood glucose-106.
Treatment: rapid transport -load and go due to onset of time and distant to hospital, IV access enroute.
Reassess: no new c/c or symptoms, vitals remain normal.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: AEMT A. Pena putting back the equipment since the patient is refusing medical attention)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 3:
Nature of call: abdominal pain.
Events: dispatch advises to post for PD. Arriving on scene, a domestic dispute present, patient refusing medical attention and transport, family forcing him to be transported to hospital due to his chronic medical hx.
Mental status: COAX4, GCS15.
Chief complaint: none-refusing.
Signs/ Symptoms:. Jaundice, distended stomach.
History/ Allergies: liver cirrhosis.
Airway: wnl.
Breathing: wnl
Circulation: wnl
Assessment: n/a-refusing.
Treatment: n/a-refusing.
Conclusion: family was informed by me and PD that the patient has his rights for medical attention and can’t be taken by force against his will since he is coherent and there is no obvious life threat present.
(pictured: loading back the equipment after helping with a lift assist)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 4:
Nature of call: fall.
Events: family needing help lifting patient, 91 year old, off the floor from slip and fall from the toilet. Requesting lift assist, no assessment and transport.
Mental status: COAX4, GCS15.
Chief complaint: none
Signs/ Symptoms:. None
History/ Allergies: n/a
Airway: wnl.
Breathing: wnl
Circulation: wnl
Assessment: n/a.
Treatment: helped lift patient via direct carry on to wheel chair and then transferred on to the bed.
Conclusion: Patient and family were grateful for our service.
(pictured: performing a 12 lead ekg)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 5:
Nature of call: abdominal pain.
Events: patient reports having chronic abdominal pain, not new, except the duration.
Mental status: COAx4, GCS15.
Chief complaint: non traumatic abdominal pain, 10/10, lower quadrants, non radiating, weakness and diarrhea x3 days.
Signs/ Symptoms: obvious discomfort.
History/ Allergies: HTN, DM.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: focal abdomen assessment- pain and tenderness, Lung sounds-clear, vitals- bp-148/66 (93), hear rate-92, respiratory rate-20, SPO2 97% RA, blood glucose-189, temp: 99.3f oral, EKG-nsr, 12 lead- wnl.
Treatment: IV access and fluids.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: walking back to the unit after checking patient)
LSA Alpha 2 w/ AEMT A. Pena-Call No.6:
Nature of call: assault.
Events: patient reports being assaulted approx an hour before 911 call.
Mental status: COAx4, GCS15.
Chief complaint: left side head pain and jaw pain, 6/10. Denying LOC, neck pain.
Signs/ Symptoms: obvious swelling.
History/ Allergies: none.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: focal facial assessment- pain and swelling, vitals- bp-126/85 (99), hear rate-104, respiratory rate-20, SPO2 98% RA, EKG-sinus tachy.
Treatment: none-refused transport.
Conclusion: multiple attempts to transport patient for further care and indefinite medical clearance but refused.
(pictured: EMT Cantu helping me drain the iv tubing to give NS)
LSA Alpha 2 w/ EMT A. Cantu- Call No. 1:
Nature of call: sick person.
Events: family reports sudden onset of illness and vomiting 30mins before calling 911.
Mental status: COAX4, GCS15.
Chief complaint: chest pain, weakness, vomiting x2 and nausea.
Signs/ Symptoms: lethargic and paleness. Left eye neglect and peripheral vision loss.
History/ Allergies: HTN, DM, stroke.
Airway: wnl.
Breathing: wnl
Circulation: pulse-weak and regular. Skin- pale and cold.
Assessment: Lung sounds-clear, stroke assessment- VAN Pos, Vitals-BP-107/78(88) heart rate 85 BPM, Respiratory rate-20 BPM, SPO2 96% RA, blood glucose-180, temp: 96.3f oral, EKG-nsr, 12 lead- LAD and RBBB.
Treatment: rewarming procedure, emesis bag, IV access and fluids, ASA, consider zofran, rapid transport.
Reassess: no new c/c or symptoms, nausea subsided, skin condition improved, vitals remain the same.
Differential diagnosis: suspecting sepsis, ruling out stroke.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: UTI.
(pictured: 12 lead of the patient showing possible STEMI)
LSA Alpha 2 w/ EMT A. Cantu-Call No. 2:
Nature of call: intoxication.
Events: mcallen pd at a stripes with a homeless male.
Mental status: COAX4, GCS15.
Chief complaint: chest pain, 2hr onset, left side, non radiating, 10/10 and not new.
Signs/ Symptoms: skin turgor positive. Obvious discomfort
History/ Allergies: HTN, gastritis.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: Lung sounds-clear, Vitals-BP-106/66(80) heart rate 96 BPM, Respiratory rate-16 BPM, SPO2 96% RA, blood glucose-132, EKG-nsr, 12 lead- inferior stemi (lead 3/avf).
Treatment: iv access and fluids. ASA. No nitro due to possible inferior stemi and BP.
Reassess: no new c/c or symptoms, vitals remain the same.
Differential diagnosis: dehydration, HTN hx causing 12 lead abnormalities.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: No heart attack, hospital EKG machine showing cleaner 12 lead. ER Dr. see's my 12 lead and understood my treatment plan.
(pictured: walking into the ER)
LSA Alpha 2 w/ EMT A. Cantu-Call No. 3:
Nature of call: chest pain.
Events: responding to Alamo from McAllen. Feeling ill x1 week, seizure episode after onset, visit PCP reporting high sugar, no other abnormalities.
Mental status: COAX4, GCS15.
Chief complaint: right side pain and numbness.
Signs/ Symptoms: dizziness, fatigue.
History/ Allergies: seizures, anxiety.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: Lung sounds-clear, stroke assessment- VAN neg, Vitals-BP- 143/92 (109) heart rate 102 BPM, Respiratory rate-20 BPM, SPO2 99% RA, blood glucose-125, temp: 97.7f oral, EKG-sinus tach, 12 lead- wnl.
Treatment: blanket, emesis bag, IV access, zofran.
Reassess: no new c/c or symptoms, vitals remain the same, hear rate normalize, ekg-nsr.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: patients vitals on the monitor, abnormality on respiratory)
LSA Alpha 2 w/ EMT A. Cantu-Call No. 4:
Nature of call: fall.
Events: trip and fall. Neg LOC.
Mental status: COAX4, GCS15.
Chief complaint: neck and back pain, weakness post fall
Signs/ Symptoms: various abrasions present.
History/ Allergies: htn, heart stent, blood thinner use.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: trauma assessment- abrasions present, Lung sounds-clear,, Vitals-BP- 118/78 (92), heart rate 78 BPM, Respiratory rate-20 BPM, SPO2 99% RA, blood glucose-137, temp: 98.8f oral, EKG-nsr.
Treatment: collar, IV access.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: taking patient to the unit)
LSA Medic 11 w/ EMT D. Zuniga-Call No. 1:
Nature of call: sick person.
Events: covid pos x2 days, x3 dizziness spells and x1 syncope with fall before calling 911.
Mental status: COAX4, GCS15.
Chief complaint: none
Signs/ Symptoms: hiccups and paleness.
History/ Allergies: HTN, DM, cholesterol.
Airway: wnl.
Breathing: wnl
Circulation: wnl, exempt skin condition-pale.
Assessment: Lung sounds-clear, stroke assessment- VAN neg, trauma assessment-no signs of trauma, Vitals-BP-175/87(116) heart rate 80 BPM, Respiratory rate-20 BPM, SPO2 96% RA, blood glucose-199, temp: 96.3f oral, EKG-nsr, 12 lead- wnl w/ LAD present.
Treatment: rewarming procedure, higher ac temp, IV access and fluids.
Reassess: no new c/c or symptoms, vitals remain the same, BP decreased- 164/84 (111), Temp increase to 98.8f, skin condition improved.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: walking back to the unit after lift assist and obtaining refusal)
LSA Medic 11 w/ EMT D. Zuniga-Call No. 2:
Nature of call: fall.
Events: 75 year old slip and fall without injury at 4am.
Mental status: COAX4, GCS15.
Chief complaint: none
Signs/ Symptoms: none
History/ Allergies: n/a-refused.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: n/a-refused
Treatment: lift assist.
Reassess: n/a-refused.
En-route: n/a-refused.
(pictured: arriving at a free-stand ER)
LSA Medic 11 w/ EMT D. Zuniga-Call No. 3:
Nature of call: assault.
Events: at 6am, head slammed on to a tree and fence. Neg LOC.
Mental status: COAX4, GCS15.
Chief complaint: head pain 10/10.
Signs/ Symptoms: Obvious traumatic injury and feeling like fainting.
History/ Allergies: none.
Airway: wnl.
Breathing: wnl.
Circulation: wnl.
Assessment: trauma assessment- abrasions to face and laceration on the nose present, Vitals-BP-79/42(54) heart rate 66 BPM, Respiratory rate-12 BPM, SPO2 99% RA, blood glucose-85, EKG-nsr.
Treatment: bleeding control, iv access and fluids.
Reassess: no new c/c or symptoms, vitals remain the same, BP increased- 97/64 (75).
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: patients 12 lead and vital signs)
LSA Medic 11 w/ EMT L. Gaytan-Call No. 1:
Nature of call: diabetic problems.
Events: patient walked to local store when symptoms began. Reports x 3 days not able to urinate and x2 days ago seizure with a fall.
Mental status: COAX4, GCS15.
Chief complaint: GBW and back pain.
Signs/ Symptoms: bilateral lower ext. pain and numbness.
History/ Allergies: DM, seizures.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: Lung sounds-clear, stroke assessment- VAN neg, Vitals-BP- 157/89(111)
heart rate 86 BPM, Respiratory rate-20 BPM, SPO2 99% RA, blood glucose-249, temp: 97.1f temporal, EKG-nsr, 12 lead-elevated t waves, no other abnormalities.
Treatment: IV access and fluids, NS.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: EMT Gaytan checking blood glucose on the patient)
LSA Medic 11 w/ EMT L. Gaytan-Call No. 2:
Nature of call: sick person.
Events: chronic pain worse today.
Mental status: COAX4, GCS15.
Chief complaint: lower ext pain.
Signs/ Symptoms: swelling present.
History/ Allergies: DM, HTN.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment:, Vitals-BP- 175/78(111)
heart rate 84 BPM, Respiratory rate-20 BPM, SPO2 99% RA, blood glucose-110, temp: 98.4f temporal.
Treatment: none.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status, ABC’s/ vitals signs. Repeat until we arrive at the hospital.
Conclusion: ER Dr. tells patient he can't do anything for chronic pain, only their PCP can.
(pictured: arriving at the hospital and unloading the patient)
LSA Medic 11 w/ EMT L. Gaytan-Call No. 3
Nature of call: sick person.
Events: patient not wanting to go to dialysis.
Mental status: COAX4, GCS15.
Chief complaint: GBW x1 day onset.
Signs/ Symptoms: lower ext swelling.
History/ Allergies: DM, HTN, ESRD.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: stroke assessment- VAN neg, Vitals-BP- 187/88(121) heart rate 80 BPM, Respiratory rate-20 BPM, SPO2 96% RA, blood glucose-139, temp: 98.3f temporal, EKG-nsr,
Treatment: IV access.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: critical info written down on the back of an EKG paper)
LSA Medic 11 w/ EMT L. Gaytan-Call No. 4:
Nature of call: sick call.
Events: mother reports witnessing 1 year old with a seizure duration 2mins w/o trauma. 7 diapers a day. Denies vomiting and diarrhea.
Mental status: wnl, GCS15.
Chief complaint: n/a
Signs/ Symptoms: hot to touch.
History/ Allergies: none
Airway: wnl.
Breathing: wnl, except respiratory rate 56.
Circulation: wnl, except skin-hot/flushed.
Assessment: Lung sounds-clear, pupils- perrl, Vitals-BP-good strong central pulse, heart rate 160 BPM, Respiratory rate-56 BPM, SPO2 99% RA, blood glucose-139, temp: 100.0 axillary, EKG-sinus tachycardia.
Treatment: Tylenol based on weight, iv attempt and blow by o2.
Reassess: clinical presentation improved, Heart rate decreased to 149 bpm, temp decreased to 99.5f, other vitals remain the same.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
(pictured: EMT Perales securing IV site for me)
LSA Medic 7 w/ EMT R. Perales-Call No. 1:
Nature of call: sick call
Events: patient outside in POV of the nursing home reporting feeling weak x1 day and vomiting x18 post getting a “diet shot” yesterday.
Mental status: COAX4, GCS15.
Chief complaint: GBW and vomiting.
Signs/ Symptoms: nausea.
History/ Allergies: none.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: Lung sounds-clear, Vitals-BP- 115/89(97) heart rate 80 BPM, Respiratory rate-20 BPM, SPO2 100% RA, blood glucose-104, EKG-nsr.
Treatment: IV access and fluids, LR.
Reassess: no new c/c or symptoms, vitals remain the same.
En-route: N/A due to a cardiac arrest inside the nursing home. Pt care given to Alpha 1.
(Pictured: EKG evidence of ROSC obtain for a brief moment)
LSA Medic 7 w/ EMT R. Perales-Call No. 2:
Nature of call: cardiac arrest.
Events: While attending call No. 1, Alpha 1, Mcallen FD and Rescue show up on same scene for a cardiac arrest inside nursing home. As per rescue, Medic 7 taking over arrest. Nursing staff report 79 year old, dialysis done yesterday and no DNR.
Mental status: COAX0, GCS3.
Chief complaint: n/a
Signs/ Symptoms: dialysis access to arm, poor clinical health appearance. No signs of lividity present.
History/ Allergies: ESRD, heart problems, demential.
Airway: clear.
Breathing: absent.
Circulation: absent.
Assessment: monitor-Asystole, Vitals-BP- none
heart rate none, Respiratory rate-none, SPO2 none, blood glucose-107, LS-clear.
Treatment: CPR, BVM, IV, IO, NS fluids, intubation, capnography, high flow O2, Epi x2 , 12 lead showing elevated t waves.
Reassess: monitor-PEA to NSR-ROSC, etco2 40mmhg, heart rate 90s. Resp rate- 12bpm supported, BP not obtain due to cycling issues.
En-route: ROSC lost soon after transporting. CPR and BVM continued until arriving at hospital.
Conclusion: another two rounds of ACLS performed before doctor and family called off the effort.
(pictured: walking back to the unit after vitals and refusal obtained)
LSA Medic 7 w/ EMT R. Perales-Call No. 3:
Nature of call: fall
Events: patient trip and fell outside and was helped by bystander up and into Pts apt. Refusing transport but agreeing for vitals.
Mental status: COAX4, GCS15.
Chief complaint: left elbow pain, 2/10 pain level.
Signs/ Symptoms: left elbow abrasion.
History/ Allergies: dm2, stroke, htn.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: vitals- wnl except blood glucose-289.
Treatment: N/A refused.
Reassess: NA refused.
En-route: N/A refused.
Conclusion: Pt advised to call 911 again if their condition changes.
(pictured: unloading pt at the hospital)
LSA Medic 7 w/ EMT R. Perales-Call No. 4:
Nature of call: fall
Events: 90 year old Pt trip and fell at gas station. Neg loc and blood thinners.
Mental status: COAX4, GCS15.
Chief complaint: left hip pain, 5/10 when moving or standing.
Signs/ Symptoms: traumatic injuries.
History/ Allergies: copd, aortic aneurysm.
Airway: wnl.
Breathing: wnl
Circulation: wnl.
Assessment: trauma assessment- left elbow/knee- abrasion present, Lung sounds-clear, Vitals-BP- 109/68(81) heart rate 82 BPM, Respiratory rate-20 BPM, SPO2 89% RA, blood glucose-120, EKG-nsr.
Treatment: bandages, o2.
Reassess: no new c/c or symptoms, vitals remain the same. Spo2 91% w/ 1lpm nasal considering copd hx.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs and continue to provide emotional support. Repeat until we arrive at the hospital.
(pictured: en-route to the hospital with the pt and their helmet)
LSA Medic 7 w/ EMT R. Perales-Call No. 5:
Nature of call: MVC.
Events: car vs motorcycle, two occupants on motorcycle, 2nd unit called for passenger due to MOI and ejection >20ft. Speed >30mph. Helmets in place. Driver not able to move from ground.
Mental status: driver-COAX4, GCS15.
Chief complaint: left hip pain and groin pain, 10/10.
Signs/ Symptoms: various traumatic injuries, feeling sleepy.
History/ Allergies: none.
Airway: wnl.
Breathing: wnl.
Circulation: wnl.
Assessment: trauma assessment-abrasions and avulsions present , Lung sounds-clear, Vitals-BP- 132/80(97) heart rate 60 BPM, Respiratory rate-20 BPM, SPO2 97% RA, blood glucose-123, EKG-nsr.
Treatment: collar, bandages, o2.
Reassess: no new c/c or symptoms, vitals remain the same except BP 101/63(76) decreasing.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs and continue to provide emotional support. Repeat until we arrive at the hospital.
Conclusion: fractured pelvis.
Raw Insight
This photo right here doesn’t illustrate the emotions behind taking it. Appreciative.
After six months away, I sit again in this role—Paramedic AF.
On my very first call back, a pediatric emergency, I performed like I had never left the trucks. The importance of a strong foundation of knowledge and a great work ethic is paramount. This is the shit I promote to whoever will listen. Raw truth.
I did have mixed feelings throughout the shift:
“Fuck this.” “It’s not so bad.”
After the shift ended, someone asked how I felt being back. I said, “I’m ready for retirement,” kinda serious but joking.
Now at home reflecting on the day, one call, one moment sticks with me. This is that moment…
My first call interrupted my check-off: “5-year-old unresponsive.” I arrived on scene ready with all the knowledge to run a cardiac arrest in the worst-case scenario. Now I stand in front of the parents, the patient, and the grandparents inside the house. I begin my assessment. There is no acute emergency in the moment. I know this, but the family doesn’t.
After a thorough primary assessment, we move to the back of the unit. I’m sitting in the captain’s chair when the mother stands up right in front of me. I look up and see raw panic and distrust in her face. She tries to speak but can’t. Her upper body moves in frantic motion.
“What’s wrong?” I ask. She finally gets it out: “I need help to understand what is happening. Is this normal? I need to know if he is okay!!”
I direct her to sit and tell her straight:
“No, this is not normal. But right now there is no immediate danger to his life. That’s good. He needs the hospital for further evaluation. If anything changes, I am here. I’ll make sure nothing happens to him. You have my word.”
Those words are not half-truths. They are solid truth. What flows through me is a great intent to be the help anyone needs to stay alive. “No one will die in front of me” — that’s the motto I keep inside me. Along with it comes anger toward life itself for all the suffering in this world.
I am a paramedic.
I am in a great war against death and disease.
I am the right person for this moment.
She doesn’t know it. She doesn’t have to see it.
She goes back to sitting next to her child, more calm and at peace.
This is the role those of us who choose this field take on. This is why we must be the best of the best. No mediocrity.
We are symbols of light, hope, and certainty in a world full of darkness and misery.
And so this moment sticks with me.
Why it is important to continue what I have been doing for 13 years now.
This is not just a job. This is life.
This is an endless war.