Beggars can’t be choosers

Stopped at a light a block from the freeway. Some lady rolls down her window.

“How do you get back on the freeway?”

“Err, just make a U-turn. It’s right behind you.”

“NO! It’s all backed up!!!”

“Well, I guess you can take surface streets that are parallel to the freeway and get on at the next on-ramp. That way.”

So she needs directions but doesn’t want ours, and has the balls to complain about it. Does she want us to drive her silly ass to her destination too?

We saw the freeway a few minutes later; it wasn’t even that backed up.

Are all Europeans this nosy?

We’re in an affluent neighborhood for chest pain. Clearly there’s a lot of commotion when an engine company and an ambulance show up, and some neighbors have bolted out to their front lawns to see what’s up.

Ten minutes later, the patient’s in the ambulance, and we’re finishing up a 12-lead when someone knocks on our back door. A man with an European accent is standing there.

“Excuse me, what is going on? The whole neighborhood is curious about what’s happening.”

“Are you family?”

“No.”

“Then I’m sorry, there are privacy laws that keep us from telling you anything about him.”

That is the truth. Besides, even without laws, why would I just tell some random stranger, especially one who’s nosy enough to actually approach the ambulance, about the patient?

“YOU AMERICANS ARE SO FULL OF SHIT!” He yells as he walks away.

The other right

We’re going up a main street code 3. I’m driving. Everyone moves to the right. Well, everyone except this one car in the left lane who chooses to stop right there. In front of us. Blocking us.

I could drive around this car on the right, but you never know when these idiots wise up and realize they should be moving to the right. Well, should’ve moved to the right. Like before we’re right behind them. At night our lights are very conspicuous. It would suck if the driver decides to move to the right as we’re passing them on the right. Unbelievable amount of paperwork. Especially after I crack the driver’s head open with a portable oxygen tank.

So, we just stop right behind the car, lights and the siren FULLY ON, and we sit there. You know, trying to make a point. This goes on for a good 15 seconds.

Perhaps my partner M is a little bit cranky. The next thing I hear is her passenger door opening – she’s getting out. She’s probably dying to chew someone out. I reach over and grab her arm, and pinch her inadvertently in the process.

“Ow!”

“Get back in. Don’t be silly.”

I’m not afraid that anything’s going to happen to her if she goes up to the car and gives the occupants a piece of her mind. In fact, I think it’s going to be pretty funny to watch. But I also think people eventually realize the difference between left and right. And we should at least try to maintain some good public relations.

The car pulls to the right.

Wrestle

Code 3 for the unknown.

A car is stopped with 2 police cars behind it, just off the freeway. The engine company is there as well. Apparently the male passenger had a seizure in the car on the freeway, and his son exited and called for help. He’s still in the passenger seat, seatbelted in.

A police officer meets us after we park in front of all the vehicles. He’s a bit amped. I’ve run with him before; not my favorite officer. The other officers on scene don’t feel compelled to bother and nag us. In fact, our agency and this department get along great.

“You need your gurney and straps. This guy had a seizure and he’s getting combative.”

(Before I continue, I have to state here that I am a near-fanatic supporter of police officers, no matter what they do.)

I hate being told to bring the gurney. It’s like me telling him to bring his gun. The gurney is never immediately needed anyway. There’s always something else to be done first; a blood pressure, some gauze, a bunch of assessment questions, something besides the gurney.

“Well if he’s getting combative, why don’t you just close his door?” Makes perfect sense to me.

Many people are confused after a seizure and some become combative; it’s just part of the package, the postictal phase. Some bite their tongues, others pee their pants. They chill out after a couple of minutes. Patience is a virtue. I honestly hope this officer wasn’t planning on wrestling this guy out of the car and to the ground. Not exactly a good PR move – “Officer Handcuffs Seizure Patient. Patient Urinates on Self.”

“What if he doesn’t calm down?” Now the officer is simply hoping I’m wrong because I subtly pointed out that he’s an idiot. He’s not new and this can’t possibly be the first seizure he’s seen. I hope he handles more critical situations with a little bit more discretion and much improved judgement.

“He will.”

A few minutes later, the patient is calmly resting on the gurney in the ambulance as we do our work. My partner points out that the officer is still standing near the back of the ambulance watching us, as if he wants something. Maybe he’s still waiting for the patient to jump up off the gurney and fight us.

Can’t swing a dead cat…

USA today had an article dated May 21, 2006 on paramedics, well, too many paramedics… A new study found that survival rates for out-of-hospital cardiac arrest were higher in cities with fewer paramedics per capita. This mirrors USA Today’s findings, first published in their special report, “Six Minutes to Live or Die,” in 2003, that called into question the national trend of putting firefighter-paramedics on fire companies.

The reason, at least the one stated publicly, that fire apparatus are carrying paramedics is to decrease the response time for paramedics in medical emergencies. Fire stations are everywhere, and it’s extremely impressive on paper to have ALS capabilities in less than 4 minutes on every medical call. In cardiac arrests, especially ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), it is absolutely essential to have a defibrillator on scene within 4-6 minutes for the patient to have any chance of meaningful survival with limited disability.

However, the majority of 911 calls for medical assistance are not cardiac arrests; instead they are for such minor medical problems as cut fingers, ‘flu-like symptoms, homeless alcoholics, baby spitting up, etc. This is not to discount such requests, but certainly an ALS engine response and an ALS ambulance response is a bit of a waste of resources, like arresting, without evidence, a teenager who wasn’t driving for a hit-and-run that no one saw. In tiered systems, calls deemed to be not life-threatening are handled by BLS units, simply because there is no need for ALS personnel who can be better used on more serious calls. In other words, save the paramedics for the good stuff. Paramedics would be thrilled to be able to avoid calls that any taxi can take care of.

Now, some have suggested that the use of paramedics on fire apparatus is motivated by self-interest. Fire departments have – along with powerful unions and excellent public relations machinery – big budgets. But years of public education, prevention and enforcement, coupled with modern construction techniques and strict building safety codes, have so dramatically reduced the number of fires that fire departments don’t have much to do these days. Simply put, in order to justify their budgets, they respond to medical calls to bump up their call volume, which, for the reasons stated above, isn’t necessarily a bad thing, especially in VF/VT arrests. Fully 70-80% of a typical fire department’s responses are for medical assistance, and the other 20-30% are not all for working fires.

The other problem with ALS fire apparatus is more subtle and wasn’t easily envisioned before it actually happened. In some regions, a paramedic license increases enormously one’s chance of getting through the ultra-competitive firefighter recruitment process, so some of these paramedics may not have the right motivation to begin with. Also, many  firefighters are firefighters because they want to respond to fires, not medicals. As a result, some firefighters view medicals as something they’re forced to do by their management, and we all know what happens when you have to do something you don’t want do. This is a source of tension between ambulance crews and ALS fire crews. (I personally don’t care as long as everyone’s nice to each other.) Add to this the longstanding fact that EMS is extremely trying on your patience most of the time anyway, and sometimes quality goes straight out the window.

Back to cardiac arrests and having so many paramedics that you can’t swing a dead cat without hitting one on medicals… The defibrillator needs to be available within 4-6 minutes of the onset of cardiac arrest, but it doesn’t have to come with a paramedic. So why not have BLS fire apparatus (and their very short response times) equipped with defibrillators respond to cardiac arrests, followed by an ALS ambulance? As it turns out, the EMS systems with the best survival rates do exactly this, and they have been doing it way before these specials and studies were produced.

Should I call 911?

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.”