Anatomy of a night call

When a calls comes in at night, the tones go off and all the station lights come on. However soundly I’m sleeping, I wake up.

I walk to the apparatus bay, get dressed, and get in the rig. I’m so tired I try to close my eyes for a couple more minutes as we drive to the call. It’s poor-quality sleep but I do it anyway. I tell myself that the call will soon be over and I can go back to sleep. I remind myself that I can wait until the morning to do the paperwork.

We get there, and we take care of the call. As professionally as we can. And with a smile.

We get back to the station, but now I’m not quite sleepy anymore. So I do my paperwork.

I get in bed, but I can’t sleep right away. Eventually I do, if I’m tired enough.

Then the tones go off and all the station lights come on again. However soundly I’m sleeping, I wake up again.


I’ve been away from blogging for a while (and you can see the gaps in my archives; most of those posts are still in the draft section), and apparently in my absence a lot of things have been happening, from the emergence of countless elaborate and well-written blogs to new media projects.

Filmmaker Julie Winokur and photographer Ed Kashi made Firestorm, a documentary that follows LAFD’s Station 65 as they navigate this broken health care system, also known, inexplicably, as “the best health care system in the world” to some people. Now, I know this topic gets people all worked up, but I want to emphasize that I don’t write this blog to be political. That being said, whichever party you belong to, if you cannot see that the health care system in the US is broken and/or are unwilling to do anything about it, then I simply cannot agree with you.

Anyway, here’s the trailer:

Chronicles of EMS

Generally I don’t spend much time thinking about work when I’m off, but this stuff is impressive. Thaddeus Setla and Justin Schorr have been trying to bring together EMS professionals from all over the world through the use of new media. In particular, please watch the following 20-minute film:

Chronicles of EMS – The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

It’s also interesting to see some really old faces from years ago in this new circle.

Thanks, you guys.

Little things matter

I’m putting Red Dots on the chest of this tiny little lady for a 12-lead. She speaks no English at all, but she motioned earlier that she has chest pain of some sort, and it appeared quite tender when I touched it.

I turn away for a moment or two, and my partner starts to move toward her to snap the leads onto the Red Dots, and she sort of pushes his hand away, motioning that she is worried that the snapping motion is going to cause her pain.

He mentions this to me, and I sigh.

“Gimme that.”

I very gently snap all 6 leads on without causing her any pain.

At first, I’m a little annoyed – does she think we’re brutes or monsters or animals who are going to push down on her chest on purpose knowing that her chest hurt? But then I realize, there are indeed crews like that who are not very much into little details like that.

Our work is very detail-oriented, and it sometimes involves a lot of finesse in many senses of the word, but too often, sadly, when watching other crews, I find myself wondering, “What the fuck are these guys doing?”

Fire station

Worked a unit that’s part of a fire station, a very nice new station. At night the firefighters were sitting in front of station smoking cigars and watching teenage girls stop at the gas station across the street. It was graduation night. People-watching ranks high on the list of preferred activities in this line of work.


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.


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.