Another incident happened a couple of weeks later on another cardiac arrest out in a remote area with a BLS department. Miller had taken plenty of time to check and test the monitor but the crew before him had used up the defib Gel and didn’t restock it. He hadn’t noticed this during check-out. On the arrest, when he went to defibrillate, he tried to squeeze as much as possible out of the tube but it wouldn’t be enough to conduct electricity or buffer the heat. 

For some reason he decided to perform a precordial thump* instead. It was an accepted practice at the time, but when he did it, the family freaked out. There was pushing and shoving, someone was put in a full-Nelson. It wasn’t good. Patient care didn’t get done till the police arrived.

One other time he’d run out of EKG patches after many calls and neither he or his partner restocked the monitor. The run ended up being critical. More phone calls were made.

Within three months, Miller had seven clinical issues that required follow up by the Emergency room PLN and the medical director. All of the cases centered around his use of the cardiac monitor. Each case ended in the death or injury to the patient either in the ER or later during their hospital stay.

One day, Miller dropped off a patient upstairs on the med-surge floor of a local hospital. Afterwards he went down to the ER to use the restroom. When he emerged, he overheard a staff member yell out that a cardiac arrest was coming in. Another person answered back “Oh, I hope it ain’t Killer Miller!” There were some chuckles but they all died down when he rounded the corner. He walked out of the ER, not making eye contact with anyone. 

Well, the name stuck. He officially had a bad reputation. But he wasn’t going to settle for it. He started taking extreme measures to ensure future success on cardiac arrests. His monitor battery stockpiling went nuclear. He received a reprimand after the Guy-in-charge-of-supply caught him with a stack of eleven extra batteries on the rig.

Miller took up the practice of exchanging his LP10 for another ambulance’s LP5. This wasn’t necessarily frowned upon, but the trouble started when he drove off the lot twice with an extra monitor stolen from another ambulance. Again, management would reprimand him as other crews could not go in service without one. 

One day we all showed up for work and the cops were there. Miller was in the back seat of one of the police units in handcuffs. I guess the Guy-in-charge-of-supply had reported several LP5’s missing from the storage room. Whatever, things get misplaced all the time, but with Miller’s recent behavior, Howard’s began to have their suspicions.

But then, a couple of cities over, a Fire crew responded to a thrift store for a reported “person down” only to find “That Killer Miller guy” already there, with his own monitor, and looking like he was about to shock the patient. On the subsequent phone call, the Captain stated, “He wasn’t even in uniform, he was wearing sweats.” Then he asked the manager, “Do you normally let your medics take their gear home?”

So obviously this blew up. The police were involved now. The company dropped the theft charges, but Miller was suspended by the local Emergency Medical Authority. He kept his state cert, but he wasn’t allowed to work in the county anymore. To let him preserve some of his dignity, management allowed him to resign. 

He was in the wind.

The timeline for Lance “Killer” Miller is a little sketchy after that. Someone said they saw him while on an LDT* in the Orange County area. He was running as a third man on a CCT interfacility unit, wearing sneakers. A few years later, there was another rumor that had him enrolling in PA* school but eventually failing out during the cardiology module. About five years later, a guy from Goodhew said that they transported him on a 5150* hold to some emergency room in Riverside County. 

Fast forward to the early 2000’s. There was a new hire that was related to a guy that was married to Miller’s little sister. They said Miller lived in a small back-house on their property in rural south of Fontana. One day he told his family he was going hiking in Forest Falls. The family noticed he was loading “one of those defibrillator things” in the hatchback of his car. 

Apparently, he had a stockpile of various models of monitor/defibrillators on a worktable in the garage. He’d been collecting them over the last couple of years, possibly via auctions on the internet or by other illegal means. Engraved into the garage tabletop with a heat gun were the words “Shock, shock, shock, everybody shock.” He had driven off towards the mountains. But he never came home.

The community SAR* team in Forest Falls found him floating semi-vertical in the upper pool under the Big Falls. His bare feet were visible sticking sideways up out of the water. He had on uniform pants. He was barechested with the LP5 strap around one shoulder. One of the spiral cables of a defibrillator paddle was tangled in a figure-eight around his neck and left arm. The other paddle wrapped around the wrist of his right arm. The heavy monitor rested softly on the rocky floor, holding his upper body under. EKG patches floated on the edges of the freshwater pool like white lilypads 

There was a long strip of EKG paper zig-zagging lazily across the rocks like a Christmas tree garland. It trailed from the body up the face of the cliff for about 100 feet. Looking at the strip, the rescuers identified seven times the defibrillator was used… but not over rhythms you were supposed to shock. Then, after the seventh shock, the rhythm became a ‘flatline’. Amidst the many blunt force wounds on his head, neck and torso, there were several scorch marks found across Miller’s chest. This confirmed what everyone was thinking, 

Apparently he was making sure the monitor was discharging appropriately, but he was the load tester. I believe like many others that he was constantly reliving those seven calls where the monitor failed him. He tried to fix his previous mistakes, to change the outcome, to prove that he was still the master of the monitor.

Using the timestamps on the monitor strip, the coroner confirmed the time of death to be 3:02 in the morning, about six hours before his body was discovered. Now what I can’t confirm is this: They say that every night at around three AM, the ghost of Killer Miller wanders around San Bernardino County, turning on cardiac monitors… making sure they work… still obsessing over the device that made his life miserable and his death so painful.

So if you are still on nights, trying to relax in between calls and you hear a beep followed by an eerie light in the back of the unit. Don’t look! It’s probably Killer Miller trying to figure out the LP15. Until he does, he’ll be sitting there seated on the bench seat staring mindlessly at the screen, pressing the same sequence of buttons hoping for a better outcome.

Rest easy my friends. Everyone has “bad calls.” Don’t relive yours. You can’t fix them, but you can learn from them and just move on to the next one. If not, my next tale will be about you.

*Glossary of terms used in EMS.

EMS - Emergency Medical Services. Amen.

COR radio - Carrier Operated Radio. A 2-way radio communication device about the size of a toaster oven and weighing five times as much. I has a analog telephone receiver you talk into but with a push-to-talk button in the middle of the handle. We were cool like Johnny and Roy.

Bagging someone - Using a Bag Valve Mask device to provide ventilation for a person with failing or absent breathing. Not a nightclub term.

P.A - Physician Assistant. What Paramedics become when they are tired of being ‘under’ the nurses and only want doctors to tell them what to do.

LDT - Long Distance Transfer. You get to take a patient far out of the area and you can go to Roscoe’s for some chicken and waffles or somethin’. Always fun unless you are off in an hour or you’re really drowsy.

Precordial thump - It’s when you strike the patient in the chest with the butt of your closed hand hoping to simulate a low energy shock. Before you do it, you have to witness a change on the monitor from a stable rhythm to a deadly, shockable rhythm. You don’t just get to do it for fun.

3 o’clock in the morning. - Okay, you elitist day shift people… and guests outside the community.. our current-day LP15 monitors are literally programmed to turn themselves on and perform a self-test every day at 0300 unless they are in use. Scary, huh?

SAR - Search and Rescue. I was told back in the 90s that there were trained, volunteer SAR people living in Forrest Falls that had pager and would respond from their homes to incidents in the area.  

5150 - A 72 hour hold written by the Police when someone is a danger to themselves or others. It’s not just Van Halen’s first album recorded with their new singer, Sammy Hagar.

Shock, shock, shock, everybody shock, little shock, big shock, shock, shock, shock. - A little rhyme someone made up to memorize the treatment sequence for Ventricular fibrillation. The “j” stands for joules. Three stacked shocks at 200j, 300j, and 360j. Then give Epinephrine, shock at 360j. Then give Lidocaine, shock at 360j, and then use Bretylium if the Lido didn’t work. Then just keep on shocking as you give the medications in the appropriate intervals.

Disclaimer 1: This is a work of Fiction. Any resemblance to anyone living or dead is purely coincidence. If there is an actual Killer Miller out there, (I think there is) sorry, it was the first name that popped into my head while trying to scare a trainee with this purely fictional story.

Disclaimer 2: This is not a teaching document. Treatment standards were different back then. And also probably where you live. So don’t freak out, Nerd.