Memories of Family Practice II - The Clinic and Ambulance Emergencies

Memories of family practice II - The Clinic and 

Ambulance Emergencies

The Clinic

It was my first day in what I have indicated I am calling family practice. I had access to two examining rooms at the north end of the main floor of the health center on the east side. This mostly faced an open field with a grove of trees beyond. The centre portion of the building being the inpatient units and the far end being the emergency/minor surgery room. Across the hall was the administration office of the practice where all the records were kept and a receptionist and stenographer sat. At the end of the hall was a staircase to the outside and the basement. Below us was the laboratory and x-ray facility and below the hospital was essentially the dining room room, kitchen and laundry facilities. When I began my time here, because the elevator was also at this end, this end of the building served as the ambulance entrance as the entrance to the basement was ground level. The main entrance at the emergency room/inpatient area at the other end of the building was up a flight of steps.

Ambulance Emergencies

Indeed, our centre was fortunate to have an ambulance and even more so to have a dedicated and trained team of volunteers to use it. Much of the credit for this efficient program went to the centre’s Educator, Joy Pritchett Sheridan. She began the year I arrived to teach the volunteers First Aid, CPR and then what was then called First Responders, later Emergency Medical Responders. Besides making forays into the countryside in response to emergency calls, the ambulance was frequently used to take medical, obstetric and surgical emergency transfers to Portage la Prairie where there was a General Surgeon, or all the way to Winnipeg.

There were times, because of the nature of the call, that a physician was required to monitor and help the patient and team on these trips. One that I remember well was on the day the ash cloud from Mt. St. Helen’s descended on the prairies. Visibility was poor and it was hot. We had a pediatric emergency to deal with, epiglottis. This can result in sudden closure of the airway, in which case a breathing tube would have needed to be inserted. We made it though. Of my memory serves me correctly, the child was actually Joy’s little son. Another time was when our office receptionist was in labour. Progress was not optimal and then it became more of a risk situation when stool or meconium was detected in the birth canal, indicating feel stress. We might have had to deliver and suction en route but we made it to the Women’s centre In Winnipeg on time.

Of course, all these transfers and to be made as rapidly as possible. Just as important was the communication groundwork necessary with the team to whom we wished to bring the patient so they were ready for us. With obstetrics for example, if it looked like a Caesarean Section was necessary, the time it took us to get to Portage was pretty much the time it took them to get a team and the Operating Room ready, so that worked well. Generally, the receiving end was co-operative, but sometimes one had to use some pressure. It was occasionally somewhat annoying when I, a graduate certified Family Physician, had to try to persuade a trainee resident on the phone at the other end that the trip was necessary. Sometimes one had the sense that they, in the big city centre, thought they knew best, even when these folks often had less experience and were still in training!

Overall, our ambulance team did a great job. Rarely, we would get a call from the other end saying that the patient had not made it, which was not necessarily the fault of the drew. Sometimes we just could not stabilize a patient well enough before having to send them off if there was any chance for them. One really troubling such incident was when a young man had smashed his motorcycle into an obstruction at high speed in the wee hours of the morning. Initially, we did some assessment including some X-rays showing obvious fractures, but it was evident more help was needed. The young man was intoxicated and restlessly uncooperative too. It was disturbing then too receive a call from a Brandon orthopedist this time to say the young man had not made it. His behaviour had been a sign of blood loss and decreasing oxygen.  There had been too much internal blood loss.

At that time, emergency trauma training was only beginning and I often was aware of my lack of adequate training in this area. We never had blood to transfuse and even putting in so-called big bore ‘lines’, intravenouses, to pour in fluids, was not something I was trained to do or felt comfortable with.

Farming accidents were the cause of other emergencies. Rural medicine practitioners were well aware of some of the dangers and the pressures farmers were under, particularly during seeding but especially harvest times.  Climate and weather often made for small windows of opportunity to get these things done and farmers tended to take dangerous shortcuts at times. On one occasion, an older farmer came in with the ambulance. Heavy grain had been clogging his machine and in an effort to get the combine pickup working ha had gotten too close to the pickup without turning it off. It had pulled half his body in before a co-worker stopped it. The pickup prong marks were patterned across his abdomen, a sure sign of pending infection.  We dispatched him to Winnipeg as quickly as we could but we sensed his fate was already sealed.

One particularly obnoxious bit of machinery was the Power Take Off (PTO) at the back of farm tractors. This was a device that rotated at high speed from the tractor transmission to engage implements being pulled, such as hay balers and combines, that required the propelled motion the PTO would provide. There was provision to cover them from the top and sides but this was sometimes deemed to be in the way and removed and again, there was often that hurry. I think it was on my first ‘on call’ after starting ‘work’ in Gladstone, a sunny summer evening still, when a farmer rushed in with his young son’s leg all wrapped up. Power Take-Offs function like an augur or screw sometimes and his lower leg had been pretty much stripped to the bone. All we could do was clean it and rewrap it more sterilely before sending him onwards. His leg was never the same, but it was saved.

I remember one sad incident where the ambulance team had responded to a motor vehicle accident. One victim that arrived at our facility was an infant that had been in the arms of its mother in the front seat. Not long after that changes led to all of that being unacceptable - infant car seats appeared, and if you wanted to seat-belt strap it into the front, it had to face backward. Needless to say, the infant’s skull was crushed - I will never forget the sensation of handing that head; it was a tragic case of DOA.

 

On the return trips where I had gone along, we were often tired but happy with the success of our trip. It was always great to stop for breakfast - why are emergencies always at night? - and the pancake breakfast at the Husky on the Trans-Canada/Number 1 Highway near Headingley hit the spot. Sometimes the crew would let me sleep on the stretcher in back as, like as not, a full clinic day was waiting on arrival back at “Seven Regions”. It did feel a bit weird to sleep on an emergency stretcher in an ambulance though.