On the Way to Paramedic in Northern VA

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Tuesday, November 22 2005

EMS Radio is a funny thing. There are those in EMS who will at a moment's notice jump into a burning building to rescue a trapped occupant; will without hesitation slide down a wet embankment to begin extricating those in an overturned vehicle; who will, in fact, waltz into someone's home, walk right up to a complete stranger and (if it's relevant to their complaint) ask them, with all due gravity, when they last pooped, and what it looked like.

And yet, when it comes to picking up the microphone and pressing the PTT (Push to talk), these selfsame folk will freeze up and stammer incoherently.

It all has to do, I am convinced, with the Audience. Until a year or two ago, all radio traffic was conducted on the same channel used to dispatch calls. This meant that whatever you said would boom into the fire station bays, where one's in-house compatriots could hear every utterance, and comment on same upon one's return. Naturally, then, The Need To Sound Cool is paramount, and if there is any doubt about Sounding Cool, stage fright sets in.

The coolest Sound is not the Radio DJ Sound. Older folk might remember Wolfman Jack - emulating his style on EMS Radio would not be Cool. Indeed, shouting or allowing the least bit of tension into the voice is never Cool. Instead, adopting the verbal persona of a bored airline pilot with a Midwestern accent is considered closer to Cool, no matter the situation:

"Aaaambulance 502 to Prince William," one drawls.

"Go ahead," says dispatch.

"Dispatch, checkin' out our right window, there, we're noticin' a gas station explosion and fire, probably gonna need some water on that. And - yep - there go one or two folk on fire, might consider sendin' a medic as well, if it ain't too much trouble. To our left, there's a lovely sunset."

Now, the situation is somewhat changed as we have, on the rescue side, a relatively new (last year or two) radio system with many features, including multiple channels. Dispatched calls come in over one channel; normal traffic other than dispatch occurs on one of several, alternate channels assigned by Dispatch. Thus, while our EMS Bruthuz in the station hear the initial call, they do not necessarily hear the consequent back-and-forth between our unit and the dispatchers.

This would, one might expect, lead to more, ah, "freedom of expression" on the radio. Alas, it does not.

The new radios each send an identity code to dispatch; if we get truly strange on either the unit radio or the portables, they will know who it is and, thanks to an also-new GPS, know where to go to hunt us down like dogs.

One may however run into situations in which the proper responses are unknown, and that gives one a chance to wing it.

A little while ago, County dispatch found themselves with radio trouble. Since we in the bambulance were at an attempted suicide call, staging for PD and doing nothing otherwise, they decided to use us to do a radio check.

Dispatch comes over the radio. "Ambulance 502, 5-4-3-2-1, how do you read?"

The Lead EMT turns to me. "What? What do we say?"

"I don't know, never had 'em do that before."

"Well, we have to say something."

"Say, 'I read you five by five'."

The lead EMT clears her throat, gets Midwestern, and drawls to dispatch: "Dispatch, we read you five by five." To me: "What the hell does that mean?"

"I have no idea. I think someone said it on the movie Aliens."

"ALIENS? DTs, you moron..."

On the other hand, private ambulance service radios are not broadcast across an entire county, and there is sometimes a little room for play, when for example it is 03:30 and we've run umppity-two calls already.

Medic 9: "Medic nine to dispatch, we're clear our last call."

Dispatch: "Okay, Medic 9, clear 03:30."

"My, but the dispatcher sounded bored."

"I think he sounded more tired than bored."

"Well, if he's bored, he's still sharp. If he's tired, then..."

Medic 9: "Dispatch to Medic 9."

Dispatch: "Medic 9."

Medic 9: "Medic 9 here, go ahead."

Dispatch: "Medic 9."

Medic 9: "Go ahead, Dispatch."

There is quiet. The Nextel chirps and we answer, "Medic 9. What do you want?", to which Dispatch, thoroughly confused, replies after a moment, "We don't know."

Still and all, Fun with the Radio is usually a big no-no, as in theory the FCC is listening in and can yank one's transmit license, leaving our units with nothing more useful than Mr. Microphone. Ah well.

Friday, November 11 2005
Who Goes There?

Returning from a shopping trip with my two strapping sons, they pointed out an engine racing into a nearby townhouse development. Moments later, an ambulance shrilled in behind the engine.

"Look, Dad!" said Good Guy #1, "There's a fire!"

"No, son, it's not a fire," replied DTs.

"Maybe someone got shot!" said Good Guy #2 (Ah, television.)

"No, nobody got shot. Probably someone having chest pain."

"Well," they asked, "How do you know?"

Fair question, for DTs did not that night carry either radio or pager - and this was, besides, a different county from that in which he runs rescue, so no such information would have been forthcoming on this incident.

But I gots my eyes.

Now, the Parental thing to do would have been to slide unobtrusively onto the scene and ask a lounging firefighter, "Chest pain. Second floor?" and watch the Worshipful Eyes of My Youngun's bulge when he replied, "Naw, third floor." Second, third - close enough. I still would have garnered Wow! points.

DTs is however professional enough to have kept his unneeded arse out of the way of Working Folk. Instead, I reveal to you the false bottom in the top hat so that you yourself may perform this feat of legerdemain for your own progeny - with the understanding that it is better to Assert Parental Knowledge rather than going and bothering the rescue guys. Also, please don't park (either in-car or with-butt) anywhere in their way to observe the goings-on, as this annoys them greatly. That said, let's begin.

Notice first the Where. If all your emergency pieces and activity are on a road, it is reasonable (and seems obvious) to assume that the incident involves a motor vehicle - an accident involving car vs. tree, car vs. car, or car vs. pedestrian. You may of course slide "motorcycle", "moped", "bicycle", etc. into any one of those roles, but not two - a "pedestrian vs. pedestrian" is unlikely to generate such excitement unless it is the rare and humorous "Death by Public Mosh on a Major Thoroughfare." Certainly, EMS activity can signal "Heart Attack While Driving" - but you'll be able to spot that once we're done here.

Uncommonly you will find it to be a Car vs. Itself, in which case you'll either note flame shooting from the engine compartment, smoke from the engine compartment, or (if you're late to the scene) steam from the engine compartment as the fire guys put the thing out. If you see an ambulance at this type of scene, be prepared to say, "Watch now, the ambulance will leave," as it is rare indeed that people driving burning cars won't step out and thus avoid injury - no ambulance needed.

"Wheres" include anywhere there are People or Their Things, and so to exhaust all the possibilities - fields, parkland, rivers, lakes, etc - is quite a task. We'll stick here with the likeliest of Wheres, the next likeliest being housing developments, hotels, schools - in other words, structures. It is within the Structures class of Where that we may Delight and Entertain The Young, by correctly guessing the problem.

Now, (dealing strictly with Structures here,) the second step in determining what exactly is going on is to notice Who is There?

The Police Rule: If there are no police evident, you may rule out Assaults (gunshot, baseball bat, or otherwise), Domestic Disturbances, or any other scenario involving Mayhem - including Harm to Self. EMS, and Fire Guys especially, like to think they're tough, but we don't look annoyed and say "Quit it, I'm busy" if someone is shooting at us while we work. Conversely, we don't ask PD to come on every call "just in case". Therefore, No Police Cars = No Violence. Police Cars = Violence of Some Sort.

It is in the details, by the way, that one may ruin a perfectly good trick - "Voila, a Dove!" elicits laughter, not "Oohs" of astonishment when, it turns out, you've prestidigitated a rabbit. If you see Police, cover your bases with your kids - say in a deep, melodramatic voice, "Looks like trouble..." and leave it at that.

Okay, with PD accounted for, scenes for the most part have Fire Apparatus and Ambulances. Sure, there are other types of vehicles pulling into some scenes, but it's up to you to explain the Ice Cream Truck, the Bus load of Nuns, and the Horse Trailer, 'cuz I can't. Be creative.

If you see a single fire engine, your most likely bet is Smell of Smoke (someone smells dinner burning), Investigation (smoke alarm on the fritz), Outside Gas Leak (tree planting gone horribly wrong), Hazard (burst pipe causing water to run out the electric sockets) or other Potential Danger to Property.

If you see a single ambulance, you may safely wager Abdominal Pain, Obstetrics emergency (baby a-borning), "general illness" or a simple injury of some sort.

You understand now why Cybil was so vague... And remember, an ambulance (or engine) may be en route to the scene, so don't guess too quickly.

It is in combination, both Engine(s) and Ambulance(s), that we truly may dazzle the uninitiated. And here I use "engine" to mean any fire piece. Just because it has a big ladder on it doesn't mean they needed a big ladder on the call, that may just be the piece they were in when the call came.

A single engine, single ambulance may be many things, but note - if the ambulance pulls up and stops anywhere near the engine, it is probably not a fire. Fire guys get just as annoyed at Bambulance Folk as anyone else if we're in their way. So, ambulance near the fire truck = the truck is probably there for manpower. Good guesses include chest pain and difficulty breathing. Less likely: the caller told dispatch the person with "leg pain" weighs 400+ pounds. Again, fire guys for manpower.

If you live in a jurisdiction that runs both Basic ambulances and Medic ambulances, you may see one of each. Thus, 1 Engine + 1 or 2 ambulances = medical emergency.

Two or more engines, you can dredge up your "Looks like trouble..." voice again. The ambulances (there will be one, at least, "just in case" for the fire guys) will park far away - perhaps even a block away - from the engine activity. This is either a working fire or the possibility of Something Bad. Say, an inside gas leak.

That's basically it. There you have it. Mix and match.

Three things to remember, though: In your quest to look Knowledgeable, do not rely just on the number and type of apparatus on scene. Neglecting to point out actual fire and smoke, if your kids see it, can make you look silly.

Secondly, if you see multiple Police, multiple Engines, and multiple Ambulances - calmly go someplace else, as that is probably not a healthy place to be just now.

Third, and most importantly - Stay Out Of Their Way. I mean it.

Wednesday, November 02 2005
But They Are All Firsts

They say you never forget your first, and they're right. My first cardiac arrest was many years ago. A pair of friends driving south from Maine or someplace, driver stops to get gas and snacks. Returns to the car to notice that her friend is "still sleeping" but decides this is the Last Chance Rest Area - wake up and go pee!

My crew, in which I was a third, immediately began working the code but the consensus was the passenger could have been "down" since three states back. Still, doing CPR in the back of the medic all the way to the hospital felt like a good and helpful thing to do, at the time.

Recently we received a call for difficulty breathing. Our patient was a morbidly obese male approximately 50 years old, sitting on the edge of a bed. A family member sat next to him, supporting him with an arm around the shoulders. The patient seemed to be breathing normally, both speed and depth of respirations, and without difficulty.

"Hi there, what's going on today?" DTs asks.

"Just give him some oxygen," said The Supporter. "That's all he needs is some oxygen."

"Well, now, lemme just get in there sir, and take a look, okay?" To his crew: "Let's get a quick dexy here."

The Supporter slides off the bed. The patient weakly states, "I think I'm going to go out."

"Sir, what's happening?" asks DTs. No response, the patient stares straight ahead. DTs shines a quick light into each eye, is puzzled by what he sees. "He doesn't have glaucoma, does he?" DTs asks the room, but realizes it's not the haze of glaucoma or cataracts - both eyes are so widely dilated they reflect a dull, green-blue.

Oh shit oh dear, this patient has just entered Seizure Country. Lay him back on the bed, check the radial pulse as I'm doing so - good radial. The bedroom is crowded with furniture and whatnot, a small room. Stays on the bed, then, until we can...

Foam starts pouring from the patient's nose and mouth, looking exactly like he'd just chewed up a handful of Alka Seltzer tablets. Grab suction, roll the patient on his side.

The medic has arrived, and suddenly we have hands enough - suction, bvm, attach heart monitor cables - asystole. Check cables still attached, still asystole, his bladder's let go, toss a pillow onto the bed for my knees and begin CPR, more suction, O2, here comes the reeves stretcher. Stop CPR, roll right, slide the stretcher, roll left, straps secured and we gotta GO.

Tough carry down the stairs - well over three hundred pounds, the stairs are narrow, and Airway and Monitor and CPR are trying to walk next to the patient. Into the medic unit, the patient's bowels let go, try for an IV but the BP is 0/0 and we can't get a flash. ET tube goes in but we get breath sounds left, right, AND epigastric sounds - can't be sure, pull out and drop a combitube. CPR shows good on the monitor, generates pulses but the underlying rhythm remains asystole. Meanwhile, the only IV access is EJ but the patient's rolls of adipose tissue keep creeping up towards the chin and occluding the flow - and finally dislodges it as we arrive at the hospital.

So, a first. Witnessed cardiac arrest. This time DTs was, he hopes, a bit more helpful. Hell, next time we might even get a save - it wouldn't be my first, though.


Posted Wednesday, December 07 2005 17:01  Site Meter