This is a good first step. (Another link.)
People can’t rely on their families to ensure their wishes are followed. Many times families chicken out and let us go through an entire resuscitation attempt before producing the Do Not Resuscitate (DNR) form. “Well, why didn’t you say something?” Certainly a lot more paperwork and cleanup now that we ran the code. The fact is, most attempts are unsuccessful anyway.
Or they simply tell us to start the resuscitation, because, well, that’s what they want and who gives a crap what their dead relative wants. As we saw during the Schiavo saga – and without taking anyone’s side – human beings once again demonstrated that they are incredibly selfish. Besides, the dead patient can’t object.
Codes are not pretty. Ever. Nakedness for starters. Loss of bowels. Puke. Defibrillations. Intubation. IV starts, sometimes many attempts, maybe one in the neck. Rib-cracking chest compressions. The “bone gun” in the chest. Not much dignity left.
Code 3 for the unknown medical.
It’s 3am. Locked gate. Dark house. No hint of movement. We verify with dispatch the address. We’re at the right place.
Engine company arrives. Greetings exchanged. We tell them we’ve been here for 3 minutes now. Lieutenant asks dispatch to call the house.
A middle-aged woman comes out. She didn’t call 911.
“Is everything OK in the house?”
“Yes. It’s just my son in there with me.”
“This is 2525 xxxx Street, right?”
“And there are no other people living at this address? No separate apartments? No separate units?”
The son comes to the door. “I think it’s my ex-girlfriend who called.”
“So it’s a prank call? You don’t need medical assistance?”
“Yes, we’re fine. Thank you.”
Code 3 for the diabetic problem.
Man in his 30s on the toilet, having just had some soft bowel movement. Pretty smelly too. It’s all over the toilet. There’s an electric wheelchair in the bedroom. His arms look like he had a stroke or two in the past.
“I just need help off the toilet. And can you help wipe me? I’ve been here since 9 last night.” It’s now 2am. He does NOT want to go to the hospital. Just needs a lift. And clean-up.
Four male firefighters and I look at each other, frozen by the thought of having to wipe a grown man’s butt. That’s why we’re not nurses.
The firefighter/paramedic says to my EMT partner, “Where I’m from, the EMTs get to do this.” Kinda snotty attitude, if you ask me. Paramedics have 10 times as much training as EMTs, but that doesn’t mean EMTs shovel shit everywhere they go.
Thankfully my female partner was cool. In fact, she was the only one in that room who had any idea how to wipe this man’s butt.
“Can you imagine how embarrassing it is to have to rely on other people to wipe your butt? And you guys just stood there!”
My partner is very mature and thoughtful.
Indeed, many of our patients are full of crap for calling 911 for the things they call for, but it doesn’t bother me much. As long as their reasonably nice I’m willing to do anything for them.
What does bother me are my co-workers who call in sick all the time, and you know they’re not sick. It’s always the same people too. Can’t get the day off ahead of time? Just call in sick. Nice day out? Sick. Don’t like the partner you’re working with? Sick. Busy last shift? Sick. Plenty of people don’t even have the decency to give sufficient notice before calling in sick. Quite a few simply don’t show up.
And not a day goes by without someone going home sick mid-shift. Sometimes it’s not even mid-shift. More like mid-hour. The people who are at work end up working harder because fewer units are in service and running calls.
Does my employer do anything about this? No. What employer tolerates this kind of behavior? Clearly it would help if my employer took a stand. That being said, the fact of the matter is simply this: my co-workers lack of any semblence of any sort of work ethic because they’re just lazy and irresponsible. I hate them.
New medics are assigned to work with older medics for at least a few months. One such partner I had a few months ago finished his field training in a very nice part of the county. Then, his first shift on his own, he works with me, in the worst part of the county.
We pick up this crazy woman at the transit station, and she’s cool. My partner is driving us to the hospital. The patient wants to pee. I tell her she can wait 5 minutes until we’re at the hospital. Nope. She gets up off the gurney, takes her pants off, and squats between the gurney and the bench. She pees on the ambulance floor. Well, she had left her fuzzy slippers on the floor, so she’s also peeing on her slippers, which she puts back on when we get to the hospital.
I sigh and pick up our portable equipment off the floor. I see my partner’s eyes in the rearview mirror; he’s puzzled.
Several ambulances are parked in a hospital’s ambulance bay, which is next to the main entrance for anyone who wants to enter the hospital. A car drives up to the ambulances, and a woman gets out and approaches the crews.
“My son is having trouble breathing. Should I call 911?”
All of us are really impressed that we barely move, already correctly guessing where her son is.
“Ma’am, where is your son?”
“He’s in the car.”
One of us bothers to say something. Politely.
“Why don’t you just take him in through the hospital entrance? Right there.”
Hi, I’m a paramedic in a poor urban area with a high call volume.
The county’s EMS (Emergency Medical Service) agency has immediate local oversight of all of its different EMS providers. All of the fire departments in the county have ALS (Advanced Life Support) engine and truck companies. A few of them have ALS ambulances. The primary ambulance service provider operates the majority of the ALS ambulances in the county for the EMS system.
An ALS fire unit carries at least one firefighter-paramedic, and an ALS ambulance carries at least one paramedic. Firefighters trained as emergency medical technicians (EMTs) make up the rest of the fire unit, and one EMT works with the ambulance paramedic. Sometimes there are more than one firefighter-paramedic on a fire unit, just like there are dual-paramedic ambulances.
When a person dials 911 on a landline, the call is routed to a PSAP (Public Safety Answering Point). If the call is for medical assistance, the PSAP dispatcher transfers the call to an Emergency Medical Dispatch (EMD) center, where an EMD dispatcher obtains the nature of the call and other relevant information, provides pre-arrival instructions in certain situations such as CPR, bleeding control, etc., and dispatches the appropriate personnel and equipment. Fire units are “toned out” from their stations, station-based ambulances are called via landlines, and flexibly-deployed ambulances are dispatched via radio.
In general, a code 2 response simply consists of an ambulance response without lights and sirens. A handful of fire departments send a crew on these code 2 calls. A code 3 response consists of a fire apparatus and an ambulance, both lights and sirens. A fire crew is known as the first responder, and they turn over patient care to the arriving ambulance for transport. On more serious calls, the firefighter-paramedic accompanies the ambulance crew during transport. The Base Hospital is available to crews for medical consultation via telephone or radio. In some cases, air ambulances are utilized, usually in more remote parts of the county or during rush hour.
Most transports are code 2, no lights or sirens. The Emergency Department (ED) at the Receiving Hospitals is notified with a brief report prior to arrival. Patient care is transferred to the ED staff, and a Patient Care Report (PCR) is submitted if time allows.
Time to go available.