On the Way to Paramedic in Northern VA
In my last post I mentioned how, to drive the bambulance, one needed to practice, take a test, and maneuver an obstacle course. What I meant to say was, "in order to legally drive the bambulance." Which, by the way, DTs was not, in this gripping tale.
Alas, legality is the last thing on some folks' minds - if indeed there is anything there at all.
The non-rescue side of DTs' adventures is conducted through a company which maintains "stations", or offices, at various locations.
Few if any of these offices maintain a vehicle bay. This is normally not a problem, unless you are, as was DTs, in a medic unit which contained a handy-dandy drug box. The drugs therein respond dismally to extremes of heat or cold. To maintain a happy temperature for the drugs, then, we leave the units running at all times, to cool them during the summer and keep 'em from freezing during the winter.
This is the Way It Has Been for several years, I'm told. Never a problem. Until one day...
Lounging in the station between calls, watching Emergency! on DVD, The Phone Rang. It was answered by the medic in charge.
"Say, are you guys missing your ambulance?" asked dispatch.
"Not as such, no," said the medic. "A slight twinge and an occasional urge to phone it up, see how it's doing..."
"Check, please," said a not-amused dispatcher.
DTs shuffles into the stairwell to peer out the window. Well, sho nuff!
"Hey," says DTs, "That's great! It's gone! Really amazing! Tell dispatch to do it again!"
"You're kidding," says the medic to DTs. To dispatch: "Talk."
"Well, we got a call from Johnny Law, they found an ambulance at the corner of Fubar and Wombat."
Oh shit oh dear. DTs catches a ride with another unit to bring our wayward bandaid box home. The police seem to have caught the self-appointed valet responsible for our vehicle's relocation, so visions of CSI stuff with lasers and fingerprint dust and junk like that vanished.
We arrive. Neatly parallel-parked, exactly six inches from the curb, is the unit, with nary a scratch. Interior is pristine, no cabinets have been vandalized, all the expensive equipment is still where we left it - 'cept for being Mongo miles away from the parking spot.
How then, DTs wondered, did the law decide that this person wasn't the bona-fide driver? Was he weaving, speeding, wrong-waying down a one-way, playing with the lights and sirens, what?
Turns out, I'm told, the police nabbed "a suspicious male, attempting to burglarize a church, dressed in a short bathrobe and a sombrero." Notice he was not "oddly dressed, including a bathrobe and sombrero." Since he did not have the flair and dashing good looks that is sported by all bambulance personnel, but did have keys that said, "Rescue 52" on the key chain, the cops went "Hmmm."
Now, I didn't meet this fellow, but whatever he was going to find in the church would I think pale against what he had in hand - $30,000 Lifepak, drug box with narcotics, a FREAKIN AMBULANCE... Thank god, "probably couldn't pour water out of a boot with instructions on the heel."
However, I am pleased to announce that there are myriad policies now in place to make sure that it doesn't happen again - locks, drug safes, the whole deal.
And yes, it could have been much, much worse. Just lock up all y'alls own ambulances from now on.
We EMS folk are a well-rounded lot, in many ways. For instance, we not only have to know what to do in the back of the ambulance, but also in the front.
To actually maneuver the ambulance on the streets, with a patient in back, one must (at least in VA) complete a class-and-test known as EVOC, or Emergency Vehicle Operators Course.
Easy to picture. Your instructor is the bad guy from Terminator II. He will sit in the "passenger" seat of the cab (called, in EMS, the "lead seat") while you make the bambulance perform improbable feats through impossible obstacle courses. And he will snarl.
Oh, we all get through EVOC eventually, but until we do, we don't get to drive the big Freightliner Monster Medics, which are big honkin' bambulances weighing many tons - nor any smaller conveyance, if a patient is in it.
Now, if your crew consists of two people, one of whom has EVOC certification (let us designate this person by some acronym, perhaps, oh, DTs), and the other who has not, then it stands to reason that only DTs may drive the beast, which puts his partner in the back. With the patient.
Patient care is what we're all about. But circumstances have conspired, and DTs Must Drive. On this call, we'll be on the road for no fewer than five hours, such is the nature of Time and Space. His partner does a Snoopy dance and sing-song teasing about this.
We trundle up to the proper floor, down the corridor, and outside the particular room of the patient. The door is strangely ajar - usually the doors are wide open. From within, the sounds of anguish:
"WHAT have you been FEEDIN' ME?" a male voice demands between meaty, uh, productive sounds. "WHY am I ALWAYS SH*TTING?" A nurse, her duties performed, hurries from the room.
DTs Who Must Drive laughs. His partner stares dejectedly at the floor.
"WHEN'S it gonna STOP?" asks the plaintive voice.
Another nurse strides from the room. "He's all yours!"
Laughter is such a rare commodity in the hospital...
An auspicious start for a duty night. General tones dropped, and the station south of us is dispatched to an overturned vehicle, one occupant ejected. This is muy serious stuff. We follow the call on the computer aided dispatch (CAD) system, and the radios. An engine company is called to clear an LZ for a helicopter to fly out one of the victims. The nearest first-class trauma center is fewer than ten miles away, but that's ten to fifteen minutes by ground - the victim just doesn't have that kind of time. Both a medic and a basic unit are on scene, so it's unlikely that DTs and his merry band will be needed.
But wait! Station tones drop, and off we go! The dispatcher relays the address as we pass through the vehicle bay and into the unit. The station doors roll up as DTs locates the address in the map book. Further details arrive as the driver rolls the unit onto the apron, hitting the lights.
"Turn left," says DTs, "Then take the first right."
"What've we got?" asks his partner.
"Adult female. Sore throat."
"You're shitting me," his partner says. "We're going lights and sirens, people are panicking to pull over, we're gonna blow some red lights and make people stop on green - if they're paying attention - for that?"
"Let's pray we get there in time," says our steely-eyed Hero.
"Yeah," says the driver, "With the chopper busy, it's all on us. Straighten your shoulders, DTs - they have become stooped with the Weight of Terrible Responsibility. I'll grab the Lifepak when we get there."
Could it have been "something"? Sure, if the sore throat was the result of Drano gargling. By all means, we make the bambulance go with blinkies and woo-woos, just in case. But one acquires a feel for these things, and it was what you might have guessed - what we in EMS refer to as System Abuse.
Now, kid calls are never system abuse, even if it's simply a scraped knee that First Time Mom doesn't know how to dress. I love it when kid calls are for "nothing". It beats hell out of when it's a kid call for "something". And we carry little plastic fireman hats we give 'em, which is always fun. But we're talking about adults here.
Case in point, from the transport gig. We're dispatched to Hospital X to take a patient home. Our patient is quite large. Each of her legs was bigger, and weighed more, than me. Best estimate from the hospital is 520 pounds, and it ain't glandular. We load the patient into the ambulance and two ambulances (one for her, the other with personnel to help lift at the destination) are heading to her home.
"How far are we from Hospital Y?" she asks. "I should probably go to Hospital Y. My other doctor is in Hospital Y. Can you take me there?"
"No ma'am," says the attending. "We're taking you home."
I'm having chest pain," says the patient. "It's radiating all through my right arm." Ping! "radiating" pain is a possible symptom of a cardiac problem. But who says "radiating"? She knew the buzzword - but got the wrong arm. We pull over anyway and the medic from the other ambulance climbs aboard. As he climbs in, the driver from the ambulance comes over and tells me this patient was taken to Hospital Z just two days ago. Hmmm.
"I hear you have some chest pain?" the medic asks skeptically.
She senses he's not buying it. "No, it's my kidneys, they really hurt."
"Kidneys," says the medic.
She stares a second, then quickly says, "No, it's my hernia. I have a hernia. I should really go to Hospital Y."
"Ma'am," says the medic, "Your doctor said you were well. His orders are to take you home." He gets back into the first unit, and to the home we continue.
"I have to pee," says the patient. The attending says there's no way he can lift her to place a bedpan, she'll have to hold it. No, the patient lets go with about two liters of urine onto the cot while maintaining a smirking eye contact with the attending. This is payback for not taking her to Hospital Y. When that doesn't seem to faze him in the least, she lets go again five minutes later with another liter or so. Strong yellow urine is dripping down the cot onto the ambulance floor. She seems to be working on a bowel movement.
We arrive at her home, and DTs enters to see how many steps, and if we need to move furniture to facilitate the cot coming in, and so forth. The couch onto which the patient will be placed has half an upside-down pizza on it. DTs asks the husband to please clear the couch, then moves it to a better position. For a moment it seems I've knocked over a cup of coffee onto the floor, but it's just a wave of disturbed roaches fleeing the vicinity of the couch.
Six of us manage to get the patient inside and settled on the couch. The children are happy because mom is home again. One of them brings a third of a cake in a plastic container from the kitchen and holds it up in both hands, an offering to us the nice ambulance guys for bringing his mom home. We politely decline, but it's such a sweet gesture. Everything he's been taught says food makes grownups happy, so it's the most loving gesture he knew, and we respect that. Mom meanwhile is already complaining to hubby about the kids, the house, where's food? We leave.
I hear she dialed 911 that evening and was taken to Hospital Z again. Food on time and someone to wipe you when you crap yourself, no kids pestering you while you try to watch your "stories" on TV. If you can't afford Cancun, call EMS and let Medicare buy you a little vacation.
'Cuz that's what The System is for, ain't it?
What, you ask, do these things have in common? Why, they tell you what time of day it is, naturally.
Take roosters. Conventional wisdom has it that when they crow, 'tis morning. When the lunch whistle blows, it's lunchtime. These unscientific phenomena toll the time, in an imprecise and general way.
DTs covered a shift for a friend the other evening, and didn't turn a wheel, but almost did, and all because It Was Time - time for Rounds, that is.
A well-known but not well-thought-of nursing home in the region dialed 911 at about 02:30. We heard it over our station address system, as we hear all dispatches in the county, even though no response from us was required. There was a patient in said home in room number X, "Oxygen saturation below 60%, difficulty breathing." This is a very low level of oxygenation, with dire consequences for the patient if untreated. Off goes a nearby station's EMS crew, to the rescue.
Five minutes go by, and another tone sounds. Same home, room Y (where Y is the room five doors down from X), for an "elderly male patient, temp 104 F, diminished LOC." Yet another emergency. To the rescue then, next-closest bambulance (but not us).
Is a sinister, masked-and-caped figure darting from room to room in this facility, visiting ill on all? Not a bit of it - it is a Care Giver, making Rounds - passing from room to room, noting problems and dialing 911 as each is encountered. At least, this is my guess.
Ah, that facility. DTs was minded of the time, as a fresh-faced EMT still in school, when he was called into that fine place for a diminished LOC patient. On entry we noted a patient gray of face, looking in fact terrible. "Airway here, I'll check pulse," exclaimed Our Hero, but the facility LPN accompanying us stopped us with a wave. "Oh, not him - he died this afternoon. Your patient is in Bed 2."
Brrr. Meanwhile, tones sound again as the low-saturating patient is now a Code - the call goes out for higher-level Medic response, an Engine crew for manpower (either CPR or bambulance-driving)...
We are all attention, and yet are not called to this establishment. Either everyone else residing there was in a fine state, or the LPN went back to the nursing station to relax without finishing Rounds - understandably, as it had been quite a trying morning so far.