Nobody calls 911 just to say Hello

Nobody calls 911 just to say Hello

Why It’s All Fun and Games until Somebody Pokes out an Eye

 

Even in the busiest EMS systems in America, there is some down time. The scarcer it is, the more precious it becomes. How you use that time is largely a reflection of the character of the individual, and may even be factored into your yearly re-evaluations during recertification periods.

 

In the very busiest downtown urban zones, there is a minimum of activity until perhaps as late as 3 PM. If you are smart, you inspect and stock your truck, eat, and go back to station to nap and relax ASAP. Downtown stations often run more than thirty calls in twenty-four hours, and usually run all night. Suburban areas, especially if they have large proportions of retired and elderly people, like Tamarac or Plantation, Florida will also keep you running all night running medical calls. Downtown, the trauma of man’s inhumanity to man predominates. In the Burbs, it is medical. Heart attacks (now called coronary incidents), strokes, diabetic emergencies, and acute abdomens round out even rookie medics’ range of experiences in less than a year. This is why we call Florida God’s Waiting Room. In one part of town, The Knife and Gun Club is offering short, lifetime memberships. Other areas specialize in Better Living through Chemistry. Another area may have a Cardiac Canyon, Lined with high-rise mausoleums.

 

Because of the long duty hours, most medics try to make the best use of their available time while on shift. Paying bills or making phone calls for their outside businesses is one of the more typical approaches. Some like to read or study. The profession requires around forty hours of continuing education units to be completed every two years to qualify for recertification. Other medics may choose to study toward Registered Nurse and Physician’s Assistant programs, or pursue one the several degree programs in EMS Administration, but virtually no one is satisfied with who they are at that particular point. Most medics still have not figured out what they want to be when they grow up.

Now, many departments do not allow ambulances to go out at large, unless they are being dispatched to an emergency call. Some dispatchers even send out otherwise non-dispatched units to do “zone coverage” at a particular fixed point to await the next available call. You hear a lot of senior medics refer to “back in the day…” as they smile and reminisce. Well, back in the day, you could take an ambulance anywhere in your zone by telling dispatch you were 10-8, doing zone familiarization. Before the advent of GPS systems and onboard computer maps, this was a legitimate concern for medics and EMTs who needed to know the quickest routes to and from anywhere within your zone, and a great excuse for exploring.

 

This could include side trips to the end of the airstrip at the naval base to watch touch-and go landings and take-offs of fighter jets and other military aircraft whose personnel had flight quotas to fulfill. Ambulances and fire trucks are generally admonished from being seen in the parking lots of bars, and especially strip clubs, but a fire alarm or bomb threat can generate more municipal workers than you even knew could be on the payroll, and you can be sure they will be quick to respond, but slow to clear the scene.

 

Jeff once worked for a municipal service that covered a motel that featured a performing dolphin. Local legend had it that the trainer was the former male lead for the TV series Flipper that was shot in Miami. Jeff and Mark used to take the ambulance to the lodge every morning at the start of shift to eat breakfast and watch the dolphin show.

 

Jeff and Mark had been partnered for over six months, and were nearly finished the three-month rotation they were scheduled to serve at this station, which they shared with the sheriff’s department. Jeff was hired approximately six months earlier, and still had not worked a single “code blue” (cardiac arrest) since his arrival. Jeff’s initial hiring had been ballyhooed a bit too much for his liking. He had just left a very   busy urban state-of-the-art municipal 911 system, in favor of a more laid-back county system that catered to the interests of their considerable tourist industry. Comprised of a series of small seaside resort communities, it was originally staffed by volunteers. Later, it was run by one of the three hospitals within the county before developing into a countywide 911-dispatched system. Many of their medics had little serious critical care experience, which only fueled resentments and suspicion towards all new arrivals.

 

Although Jeff badly needed the “vacation” aspect of his new position, doldrums and boredom had begun to set in. Mark, Jeff’s partner, and EMT\Driver was also a commercial fisherman, and no stranger to the pleasures of cannabis sativa. Jeff was no stranger either, but to Jeff, as a medic, work was work and play was play although he had turned his head for the first several months and ignored his partner’s indulgences, Jeff had never smoked dope the same day he worked, and rarely smoked it the night before., but with little to challenge him, next to no supervision, and little chance of discovery, he decided maybe it was time to relax and unwind a bit. He was in the throes of his fifth divorce and suffered regular anxiety attacks. He figured it would be a great way to kick back during one of their typical two-hour breakfasts while they watched the dolphin show.

 

Mark was completely taken aback when Jeff had requested “a hit”, and cautioned Jeff to “take it easy” and further warned him “look, man, this is some really strong shit, and I don’t know if you can handle this weed. You better take it easy…no more than one toke…really.”

 

“Fuck you man! Jeff quipped. I was smokin’ East Asian dope when you were still in grammar school sneaking cigarettes in the bathroom. Trust me; I can handle anything you got.” With that, Jeff perfunctorily took two very deep drags of the proffered joint, sat back, and blew smoke rings back at his partner.

 

Of course, thirty seconds later, the alarm tones sounded over the radio summonsing the ambulance to a cardiac arrest. They looked at each other and just laughed. This was a bit of a kick in the nuts, but they had both been around the block enough to fake it for whatever was awaiting them.

 

Indeed. On arrival, they first discovered that their stretcher would not fit down the hallway where the victim lay, due to bundles of magazines piled floor to ceiling along one wall. There was barely enough room for a single person to walk, due to the bundles of National Geographic, Scientific American, and similar publications.

Great! Just the sort of job to keep the volunteers out of the way while we do our magic.” so while Jeff and Mark went down the hall with their gear, the firemen set out to do enough housecleaning to get the patient out, once she was stabilized and/or ready for transport.

 

The family stated that they had last seen “grandma” alive about twenty minutes ago (which means forty minutes to an hour). Upon exam, she was pulseless and apnic. When she was connected to the ECG monitor, it revealed what is called an agonal rhythm of less than thirty per minute. This represents the last dying electrical impulses of the heart, and may be either pulsed, or pulseless, but of course, today it would be the latter. CPR was initiated, an IV line was established, and atropine and epinephrine were administered, as the patient was endotracheally intubated. The patient quickly went from sinus tachycardia to ventricular fibrillation in less than two minutes. Now countershock would be administered in a series of three “stacked” shocks of increasing strength with pulse checks in between the shocks. Remarkably, she responded with pulses and a blood pressure, but no spontaneous respirations. In fact, the resuscitation had proceeded so quickly that the volunteer firemen had not yet gotten the hallway cleared. Moments later, the patient went back into v-fib, so lidocaine was bloused and a drip was hung while CPR was initiated again.

 

This particular system still used “The Thumper”, an oxygen-powered mechanical CPR device that performed chest compressions and ventilated the patient. Because of the long transport times and shortage of qualified personnel, this was a real plus for situations like these.

 

Once the hallway was cleared and the patient was loaded and ready for transport, they sped away to the hospital, about sixteen miles away. Enroute, the patient regained pulses and lost them several more times, but at each juncture, the crew performed flawlessly, and the patient responded accordingly, for the exception that she never initiated spontaneous respirations or regained consciousness. Mark and Jeff were determined that they would deliver a live patient to the ER. Never before had Jeff run such a perfect code blue, in spite of the patient’s attempts to die on their watch.

Just as they were entering the hospital ER entrance, the patient’s pulses and rhythm returned. As they raced into the ER, the Doctor, who happened to be the patient’s personal physician proclaimed “What the fuck is this? She is a DNR!!!

It is not altogether unusual that the family should have forgotten to mention that the patient was terminal and had already had Do Not Resuscitate orders signed, but once they were called out, the crew had a duty to act in the absence of seeing those orders. As a result, the crew was instructed to place the patient in a side room, remove the oxygen from the patient, stop ventilations, and let her die in peace.

This was by no means a typical “day in the life”, even for those two clowns, but it does point up a couple of issues. First, this does not represent any attempt to rationalize drug experimentation or usage while entrusted with the care, health, and safety of the public. This can only be described at best as “a very bad idea”. The criminal and moral aspects of their actions could have had dire consequences. That they chose to disregard what amounts to a sacred trust with the lives of others only points up what a sad and sorry state of mind that allowed them to indulge themselves like that in the first place. How they managed to rationalize their bad behaviors only points up how warped the judgment of an otherwise good person who has chosen a career devoted to the care and safety of other human beings can get. It does point out another aspect of the persona of many EMS professionals, and that is the fact that many, if not most of them were risk-takers by nature, especially in the early days. Besides, these same men and women who don’t take NO for an answer also don’t take DEAD for an answer or DANGEROUS as a prohibition.

You can’t live every minute of your life coiled like a snake ready to strike. Somewhere you have to assert yourself just to step outside the paramilitary atmosphere long enough to remind yourself that you are still a human being. The trick is in being able to find your escape in a way that precludes detection. I knew of a female paramedic who once told me she only wore the sexiest bras and panties she could find to wear under her uniform while she was on duty, just to help remind her of her feminine nature, no matter how tough she had to be on the outside. EMS does not, as a rule do much to nurture or comfort its own. It takes no small amount of panache to push the envelope and yet not become labeled a “flake” or a “red ass”.

During the eighties, the subject of “burnout” was a regular topic of EMS lectures and many seminars. CISD or Critical Incident Stress Debriefing was the hot new topic of the day. Although it enjoyed a level of support and acceptance by most of the EMS community as far as lip service was concerned, few people ever willingly sought out help until they could no longer hide the signs and symptoms, which meant they screwed up in some way. In the vast majority of cases, being caught or being forced to acknowledge your dysfunction was the only wakeup call you got, and nobody was immune, not even supervisors or CISD facilitators themselves. Divorce, infidelity, violence, financial irresponsibility, substance abuse, and other forms of compulsive and obsessive-compulsive behaviors ran rampant in many systems until there was no pace left for denial. It can make the most conscientious, and caring human being into a monster in a great deal less than five years.

During his first year in EMS, a veteran fire captain once told him: “You gotta be very suspicious of anyone who runs into a building when the rats and the cockroaches are running out!” The author believes that Zen was his personal coping mechanism for the pain of being human. Zen also teaches you to embrace difficult questions, and to leave no stone unturned in terms of your questioning. No one forces you to do it. When you work in EMS, you cannot afford to look away from even the most gruesome spectacles of human depravity or tragedy. Zen can teach you to embrace your fears. Zen can teach you to question everything, although it cannot give you the answers you seek to the questions you ask, it can help you find them for yourself. The risk is that like Pandora’s Box, once it is opened, there is no turning back and there is no respite once the questions are asked.

This is not to say that job stress was the only issue, either, since so much of Jeff’s life had been lived like living in the eye of a tornado. As long as you keep up with the storm, life can be relatively calm. Then again, there was a time when Jeff first realized that, for once, if he encountered an over dose, or even a dead person lying on the floor, the chances were very good that it was not someone Jeff actually knew personally, which caused a certain calm to settle over Jeff that he had not known in years. EMS tends to attract risk-takers in general, and few can live up to the idealized image that is expected of them. Many were non-conformists who gravitated to a field filled with rigid conformity and uniformity.

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