Sunday, September 16, 2018

A Discussion on When to GTFO

I swear like a sailor in public. It's bad. But I try to keep this website mostly PG-13, so I'll continue this story under the assumption that you either know what it means to GTFO, or you will quickly look up the definition and then continue reading.

Several years back I responded as a medic in a chase car, along with the fire department in an ambulance, to an adult woman having seizures. The fire department ambulance arrived first on scene. Upon my arrival a few minutes following, I found every crewmember of the fire department ambulance inside the home attending to the patients. Patients, plural, because the patients husband was also on the ground having seizures by that point.

I can't remember who - if anyone - taught me this, but when I see two people down with the same signs/symptoms, the cause is environmental until proven otherwise. I left the front door open and immediately walked across the room to the back doors and opened them in order to ventilate the scene. Since the fire fighters weren't dead yet, I figured I had a moment to investigate.

The fire fighters attending the patients told me they found both patients seizing when they arrived. They did not know any other details. The male patient had awoken by that time and told me that they had just returned back from vacation. He denied drug use.

Just then the rookie fire fighter walked up from downstairs looking like death warmed over, stating that the whole basement smelled like gas.

With this information, I ordered everyone to evacuate the house. It was time to GTFO. We grabbed the patients and carried them out as fast as we could. I placed them on high flow oxygen and we screamed them in to the closest hospital, about 30 minutes away. My Lifepak 15 with would not capture pulse oximetry except for one brief reading showing a SpCO in the 40s on one of the patients.  They had been poisoned with carbon monoxide.

After dropping off the patients, one of the fire fighters complained to me of having a headache. "Shit," I said. "I have a slight headache too, but I can't tell if it's just my imagination." We tested ourselves on the Lifepak; in fact we had been poisoned too.

I grabbed some spare O2 tanks from my station and met the fire fighters back at their station. We sat on high flow oxygen and played Xbox for hour or two until our readings returned to normal. My chief at the time later chastised me for treating myself and the fire fighters for our CO poisoning, rather than take a significant portion of emergency services resources out of service to become ER patients for the same treatment. Bless his heart.

A week later the fire department made a PR visit to the patients' home to install CO monitors. In their press release they conveniently left off the part about me saving the lives of like 4 fire fighters who didn't clue in to the presence of a deadly environment hazard. They didn't even include the name of my agency. Bless their hearts.

I use this story to teach new EMS providers several things:

1) Keep your head on a swivel and know when to GTFO. 

2) Read the environment, not just the behavior of other providers on scene. It is possible that everyone else is wrong. Don't allow yourself to be caught up in the groupthink. 

3) Although it might feel personally satisfying to scientifically test how many inconsiderate ass fire fighters have to drop dead before they figure out that the room is full of deadly, invisible, odorless poison gas, you should probably still do the right thing and let them know to GTFO too.

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