De-Gloved Feet

De-Gloved Feet

While working as a Paramedic in Oakland, occasionally I would end up without a partner for my unit. Usually on these days I was given the choice to either go home with 4 hours of pay, or take an “out of service unit” and drive around to the various hospitals in the area and collect the backboards that would get left whenever a unit dropped off trauma patient. I hated having to do this so I would look for every opportunity to avoid having to waste my day schlepping backboards around all day. Every once in a while they would pair me up with an already in service unit and we would end up a trio of Paramedics, but occasionally they would send me out as a solo medic. The idea of the solo medic was to have a roving source of Advanced Life Support help that could respond quickly to lend a hand if a really nasty call came in. At the time there was a county policy that once a call for an ALS unit went out as the county provider, we had 8 minutes for a Paramedic to arrive in order to satisfy the county contract. Even though I was a solo medic, if I arrived on scene first I wouldn’t be able to transport, but I would be able to start treatment and my arrival would stop the clock. As long as I stayed in zone, I could go where ever I wanted and do pretty much as I pleased. If I heard a call that sounded particularly juicy where my help might be needed I would head in that direction and see if they called for additional help. Because I wasn’t a full unit I wouldn’t get calls myself, but just help out other units. Occasionally an EMT unit would decide that they needed to upgrade to ALS, or sometimes a Medic unit would need an additional pair of hands or run out of a particular medication or supply that I could deliver. For the most part it was pretty calm. But there was one time in particular where that was definitely not the case.

I was out as a solo medic, and was feeling pretty bored. Dispatch had asked me to meet up with a unit that had an EMT student for the day that wanted to go home. I met up with the unit and was headed back to the Barn to drop off the student when I got a dispatched to a call. I hadn’t heard anything about the call because I had been monitoring the “North” channel (Oakland ALS only). Apparently the “Green” Channel (EMT channel) was going nuts because of a particular call.

An EMT unit was dispatched to a call to pick up a patient who had a doctor’s appointment. When they arrived at the patient’s house, no one answered the door. Before leaving they tried the door and found the house open. When they went inside they found the patient lying in bed, dead. Apparently the patient had died in bed, and the EMTs were the first ones to find him. One of the EMTs was a Paramedic working as an EMT awaiting his final accreditation, and the other was in Paramedic school, so they had at least some idea what they were doing. Upon finding the patient dead, they did what they thought was right and called dispatch over the radio, to announce a “1055” (patient found deceased) and to call for the Coroner. “Marge” was one of the Paramedic Supervisors at the time (apparently the idea to promote the most useless and questionable employees extends to Pre-Hospital providers as well). She heard the 1055 call and decided to investigate. When she arrived on scene she walked into the house and freaked out on the EMTs. Marge started screaming at the EMTs that because they were EMTs they were not allowed to declare patients deceased (which is incorrect btw) and demanded that they start CPR immediately. Because she was the only Paramedic on scene it was going to be up to her to run the “Code” by herself (A big mistake given her skill and mental prowess). So while EMTs did CPR on the dead guy, instead of intubating or starting an IV, or hooking up the monitor, or any number of things that Paramedics are trained to do in a Code, she continued to yell at the EMTs. Eventually it occurred to her that the guy was probably dead (quite dead in fact) and that she was going to have to either act to finish the code and declare him dead, or transport his body to the hospital. Usually upon this realization most Paramedics will throw in the towel, cease efforts, and declare the patient dead. Instead she decided she needed to “Make Base” (contact the base hospital over the radio to confer with a Doctor to get advice for a complicated call). Marge had it in her head that she needed to get permission from the base doctor to declare the patient dead (even though other Paramedics seem to be able to do this on their own quite well). Because her radio wouldn’t get reception in the patient’s basement where this was all going on, she made one the EMTs go outside to radio for a second Paramedic (me) so that she would have help. She felt she needed a second Medic on scene so she could go outside herself to make the call to the hospital (Are you confused yet? Yeah, so would most Paramedics)

So I arrive at the address to find the scene a zoo. Marge was outside trying to radio the MD, and the two EMTs were trying to do CPR on the dead guy in the tiny little space on the floor between the bed and the wall. While I tried to assess the situation and figure out what the heck was going on, the EMTs filled me in on as much of the story as they could. The space they had been doing CPR obviously wasn’t the best place to do CPR, much less run a code, so I decided to be bold and get to work. I told the EMTs to stop CPR for a sec so I could move the patient out of the crack and more into the room where I could do some work. I grabbed the patient by the ankles and gave a heave. To my complete surprise I fell on my butt as I lost my grip. It felt as though I had pulled his socks off when I tried to move him. So I tossed the “socks” aside and got up for a second try. But when I looked at his feet, they looked gross and meaty. I looked back at the “socks” on the floor and realized that they weren’t socks at all. It was the skin and flesh from his ankles to his feet. I had de-gloved his feet.

It wasn’t a nice thing to do to a guy, even if he was dead, but seeing as how I was going to have to finish the running the code since it had been started I wasn’t going to let a little thing like having no skin on his feet stop me. I carefully picked him up around his knees this time, and had the other two EMTs help move him further into the room. I attached the monitor and it showed asystole, which to me was a big relief. I intubated and then tried looking for a vein. Maybe it was his lack of blood pressure since he was dead, maybe it was how long he had been dead, but there was no way I was going to get an IV, so started putting the meds down the tube. According to the protocol I only had to do two rounds of drugs before being able to declare the patient dead, so I didn’t take long. I was letting the monitor record the requisite 3 minutes of asystole and I walked outside to figure out what Marge was up to. She was still on the radio with the MD trying to explain what she wanted the MD to do. The MD on the radio was quite confused and kept asking her to re-explain parts of the story in order to figure out what part of the story he had missed that would have prevented her from handling the call herself without contacting base for permission to do something that she should have been able to do on her own. I interrupted her conversation, to tell her I had “called it” and that since it was still her call that she was going to have to clean up the mess. I finished my paperwork and packed it in.

A couple of years later I ran into one of the EMTs that had been there to get a few little bits of the story that I hadn’t known at the time. For one, it turns out that the patient had been dead for at least a week, although it he didn’t look like it. The decomposition of his tissues was what made his skin break down to the point where his skin slid off his feet the way it did. I also found out that because of what happened that day, Marge had gotten the two EMTs fired, even though they had done nothing wrong. I also found out that not long after that, Marge had rolled her supervisor rig on a freeway off-ramp, which resulted in her getting promoted out of a field supervisor position and into a district supervisor position. The wheel keeps turning.

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