Sunday, December 20, 2009


Back in the day, the K.B.F.P.D. was not an ALS provider. All ALS services were provided by a locally owned private ambulance company. Kind of an archaic approach to EMS, but that's the way it was.

One afternoon, we were dispatched to a reported person with a foot injury. We responded with three personnel, the captain, an engineer and myself - a tailboard firefighter. Although I usually don't miss riding the tailboard, I often enjoyed it back then, especially on a nice afternoon such as this.

We arrived on scene at a run-down single storey house. Several teenaged girls were hanging around the front porch. Another young lady, about 14 I would guess, was sitting in a sofa, which was on the porch. All of the young ladies were near the same age, judged by appearance, and were of various ethnicities.

There were other similararities as well. They were all dressed nearly alike, wore their hair in a similar fashion and all talked like the local gang-banger wanna-bes that populated this declining neighborhood.

The young lady who was seated on the couch was a little more vocal than the rest. Her language was like the others, except that she seemed to use a little more profanity than the rest and was a little louder. I overlooked these quirks, as she was our patient, the one with a nail stuck in her heel.

An 8d box nail if I had to guess. It was protruding from the center of her heel and it did not appear to in very far. As EMTs, our treatment options were limited. The pt. did not appear to be in any distress, had no underlying medical problems and had good vitals and presentation.

She really did not need to go in an ambulance, though she did need to seek medical attention. Through the profanity, local dialect and extreme bravado, we were able to determine that her mom was at work and could not be reached. This was before cell phones were widely in use. Apparently, there no other adults who could be responsible for her either.

As this was likely this pt. was going to have to use the ambulance, my captain reduced them to code 2 and had them continue in. The ambulance soon arrived and we advised them of our findings.

The medic began talking to the patient and was greeted with the same tough-girl attitude and profanity that we were. Understand, it wasn't directed at us, it was just a lifestyle statement. I can't say what was going through the medic's mind, but he remained very calm and professional as he outlined to his patient and to an astonished engine crew his planned course of treatment.

"OK Joy, here's what were going to do". The medic said. "I am going to count to three. When I hit three, I'm going to pull out the nail. I'll put a band-aid on it and that will hold you until your mom gets home. Then, she can run you to your doctors or the ER and get a tetanus shot".

I am ran through my mind all of the BLS protocols that were being violated. Of course, I had no clue what the ALS protocols were.

The medic knelt in front of the pt and gently lifted her leg so that he cradled her lower leg under his arm while he grasped the nail with his right hand. "One". "Two".

On "two" he pulled on the nail strongly enough that his pt. jerked forward several inches. The results were almost instantaneous.

Result #1 - The pt. screamed and made an instant transformation from tough gang-banger wannabe to injured child.

Result #2 - The medic visibly paled as he heard the scream, saw his pt. jerk and came to the rapid realization that the nail was in a lot deeper than he thought. This condition worsened as he realized that there were witnesses.

Result #3 - The nail remained firmly embedded into the bone of the young lady's heel.

Of course since this procedure was a miserable failure, the now sobbing pt. was loaded into the ambulance and transported to the county hospital.

This event would have never occurred if it happened today, or even in the last 15 years. Back then, the ambulance medics were the absolute medical authority on scene and we would never think of questioning their authority. Now, even if we were still a BLS only provider, we would have put the brakes on such a bonehead move.

As we were never approached about this event, my guess is that he got away with it. Hopefully he learned something from it. I know I did.

Thanks for reading,


  1. Don't know what the current protocols are for you, but where I work, the only time we can remove any impalement is if it interferes with the ability to breathe. Stuff like the nail would be stabilized with bandages. There's no difference in BLS/ALS protocols for us.

    Then again, I've no idea what our protocols would have been back when this originally occured. But I can agree that even now, what some medics say or do is treated as the gospel, depending on how good of a medic they are. Then again, I know a few folks that would try this stunt today, if given the chance to dodge a transport.

  2. So couldn't he have given her a little local first? Would that have been against the rules?

    Still wearing your dang sandals??

  3. There was so much wrong with this.

    The BLS (and likely ALS) protocols only allow us to remove impaled objects from the cheek and then only if the airway is compromised.

    The consent and abandonment issues were present back then as well. The only appropriate course of action was to assess, stabilize if needed and transport.

    And yes Mrs. Bunker, a pair of leather slide-on sandals were on my feet when I first read your comment - Steve Maddens I think.

  4. Interesting one Capt. while we as nurses can encounter the same type of situation- it's often the oppossite effect between old/new generation.

    A patient will have X tube pulled or X organ falling out. Us old, crusty nurses are looking for a surgeons number or trying to catch one before he leaves the facility and some new, graduate nurse will say ,"Ah, we did those in clinicals ALL the time- here, let me show you..."

    PS, is it true there was a time when funeral home rigs were used for ambulances?

  5. Boy... It's a good thing a fire medic has never done anything this dumb since those days. That would be embarrassing.