Thursday, June 27, 2019

Check Yourself After Wisconsin LODD

Last month Appleton, Wisconsin Firefighter Mitch Lundgaard - father of three young children - was murdered by the patient he had helped save from a narcotics overdose moments prior. The assailant wounded a police officer, then grabbed a random woman to use as a human shield before LEOs righteously turned him into worm food.

We owe it to our fallen brother to learn everything we can from this well documented incident, to take stock of our current bad habits, and enact meaningful behavioral change to prevent this from ever happening again. The following is an excerpt from an email I sent to my crew following the release of the above body cam footage:

Please study this video, especially the portion showing the patient care leading up to the attack (shooting starts around minute 26). Some things I took away from this were:

 - No one searched the patient, despite their apparent working diagnosis of a narcotics OD. Please consider this email a written directive to search your unresponsive patients. Removal of the weapon while the patient was unresponsive (and thus incompetent to ensure its safe handling and storage) could have saved the fire fighter's life, and prevented the injury of the other victims. An implied consent search of the unresponsive patient is part of your physical assessment and can reveal clues about what lead up to their condition (e.g. pill bottle, heroin kit, medical alert jewelry, insulin pump, suicide note, hidden injuries).

 - The patient was given enough narcan to fully return him to consciousness, thus giving him the opportunity to refuse transport, attack responders, and flee. While I used enjoy the thrill of pushing enough narcan to wake somebody up, I now consider this to be bad medicine. The side effects of narcan include flash pulmonary edema, ventricular fibrillation, and sudden death. It makes people vomit. Some people who overdose on opioids are unstable and violent. The safest option for you and the patient is to guide interventions by capnography. Place these patients into the recovery position if appropriate, apply an appropriate amount of oxygen with the proper device, and administer small doses of narcan PRN or not at all to maintain normal SpO2 and ETCO2 while transporting to the hospital.

- This patient was acting squirrelly as hell. The responders failed to pick up on this and were way too relaxed around him. I noticed one even had his back to the patient for a long time. Please be attentive to this type of patient. If not for your safety, then at least for their safety to help ensure they don't trip and fall, and to immediately respond to any worsening in their condition. Please do not ignore your limbic brain when it picks up on something suspicious, even if you can't immediately articulate why you feel that way.

- The attack went down fast. A gun in your bag on the truck, and a ballistic vest stuffed behind a seat somewhere are too far away to save you.
I personally have fallen into the bad habit recently of only wearing my vest when I go to calls that sound shitty. This is a stupid behavior, and delegates too much of my personal responsibility for my safety to a dispatcher somewhere who doesn't give a damn whether I live or die, or how my wife will pay the bills after I'm killed. Considering that Lundgaard was shot in the back, a vest may possibly have saved him.

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