All ALS all the time?

There are those who believe that the idea of "all ALS all the time" is the best policy for providing EMS to the masses, and believe it or not, I'm not here to debate that fact even though I am a BLS provider myself. There are also those ALS providers out there who believe that BLS providers should not be able to make a determination about whether a patient needs ALS care. Surprisingly, I'm not here to talk about that either. Rather, let me tell you a story:

We're called for a 27 y/o female having an asthma attack. Our crew is fast today, and everyone is assembled and we're off in the ambulance in record time: 4 minutes after the initial call marks our arrival on scene. Walking into the lobby of the building, I find the patient sitting in a chair, barely moving any air; she states (barely) that she has a previously diagnosed case of childhood asthma, but doesn't have an albuterol inhaler. A quick listen to the lungs, and she has wheezes on the exhale; also a tinge of cyanosis to her lips. This is not a healthy person. My partner starts a more detailed workup, and I get on the phone to medical control for a request to administer nebulized albuterol, which we carry on board. The request is approved and we begin administration of the medication and start prepping her for transport.

My next call is for ALS backup. Stair chairing and getting her out the door has already run us through a couple minutes and the 1st dose of albuterol is almost already run dry to no relief to the patient. I'm back on the phone to Med Control and get an order for "continuous albuterol administration -- no dosage maximum," which is technically not in protocol, but I'll worry about my two unit dose maximum when I get there. Move onto the stretcher and loading into the back of the ambulance, I see a FDNY rig quickly approaching from down the street, "Good," I think, my ALS has arrived. The two guys from the FDNY rig get out and walk up. Judging from the confused look on their faces, I know the question to ask them.

"You guys ALS?"

"No.... what's up?"

"Asthma.... bad. You guys know if they have ALS en route?"

"I don't think so."

I hesitate a second, thinking, and my thoughts reach the same conclusion as the FDNY EMT's who urges: "you guys just go, don't wait."

My thoughts exactly. Already a third of the way through the second dose of albuterol, and no change in the patient's status. She's still struggling valiantly for breath. 'This is probably my second worst asthma case I've ever done,' I think. The worst one ended with the patient intubated... luckily for the patient, I suppose, she won't, and can't be subjected to that today... at least not in the field.

I'm driving so I hop into the cab of the bus. I take a second to bring up the hospital notification number on the phone, hit the SEND button, hit the sirens, put the truck into DRIVE and we're off. I tell the ER what we're bringing them. Conveniently, we're only three minutes out. Arrival in the ER brings our rush into the trauma room and the "Green team" descends on our patient. Finally, quickly, she gets some advanced treatment and interventions. A happy ending to a frantic twenty-minute procedure of getting the struggling patient to the hospital, quickly and alive.

By the way, at the end of it, when my crew of three were bringing in another patient a little while later, a now freely-breathing young women in hospital gown gave us all hugs and thanks. Guess BLS isn't so bad after all. But the conclusion of the story is, this is the second time in a month when I thought I needed ALS and didn't get it. All ALS all the time is well and good, but how about all ALS when you need it, all the time? In a city like New York, you'd think that ALS would be available when needed. The facts of the matter are that FDNY*EMS does not use EMD dispatch, and does not work with the voluntary and volunteer organizations operating in the City limits. How many lives have been lost because advanced care was not sent where it was needed? How many patients received ALS for whom an accurate determination of need was not established by the dispatcher? How does the public allow shabby, poorly-run systems to continue to exist?

In the Navy

When I first started working as an EMT, I had just got certified and was working for my local volly fire department during a summer home from college. We got called to the "Better Spaces" home, an 'assisted living' community for people suffering with Alzheimer's. I think most of you remember your time in this position, you didn't really know what you were doing: you had your training to guide your actions, but no experience.

I'm running lead on this call for a 86 y/o male with a fever. I've got the Chief, who is decidedly hands-off for this one, and another college-aged firefighter, not trained in EMS, except that he picked up the art of taking vitals somewhere along the line. We do first-response, and the Hudson ambulance service reports a delay in the time of arrival of their rig. In fact, when I start talking with the guy, he's appears fairly healthy and we find him in the dining room (how the staff found out he had a fever in the middle of dinner, I will never know) sitting calmly at a table.

I introduce myself and start the routine I was taught in class.

"Hi, I'm a EMT with the fire department, how're you doin'?" I ask.

"Oh, I'm good! I'm feeling pretty well, and I'm just sitting here eating dinner.... what do you want?"

"Well, we were called here for you because you have a fever."

"Ah. I see," A puzzled look on his face, "I really feel fine. All of this is probably not necessary."

"Well, my partner here is going to check you blood pressure and pulse if you don't mind."

"..."

"You alright?" I ask as he seems to have momentarily blanked out. He blinks and I ask about the vitals again.

"What...... oh. Yeah, sure, whatever you need. Why're you guys here?"

I feel like I may have answered this question already, but.... seeing as we're in a home for Alzheimer's patients.... "Well, the staff called us because you have a fever, apparently. I'm going to take your temperature now, OK?"

"Sure," he replies, and I stick a probe in his ear: 100.2 F. Geez, I don't know what all the hubbub is about. Well, with baseline vitals unremarkable, EMT-Basic training states to begin OPQRST, and obtain a SAMPLE history.

"When did your fever start?"

"I have a fever?"

"Ummm, yeah." A staff member fills in the blank that they routinely take temperatures every evening before bed. I see. "And when did you take his temperature?" I ask the staff member. Blank stare answers that question. Right then, so proceeding right along...

"Does anything make it better or worse?"

"Make what better or worse?" asks my patient.

"Your fever."

"What fever?"

'Oh, Lord' I think. I look over at my Chief, who is happily engaged in conversation with a young blond nurse in a flowery frock. Firefighter partner has started wandering around looking at the artwork in the dining room.

"Have you felt sick recently?"

"Nope, I'm healthy as a horse!"

Skipping the rest of the history of the illness, I remember I need SAMPLE and AVPU.

"Do you know your name?"

"Sure, I'm Jim."

"Do you know where you are?"

"I'm at home."

"Do you know the day of the week?"

"Yeah, today is Sunday."

'Well, that's not right,' thinks I, seeing as it was Wednesday.

"What's the date?"

"Oh, It's October 14th, 1943. Speaking of dates, I had a cute, little one last night...." he smiles and winks, "yep, got me some shore leave for the weekend and had a little hook-up, if you know what I mean!"

I'm speechless for a moment... I start to open my mouth and I shut it. "What do you do?" I ask, stalling.... somehow I know asking for his allergies and past oral intake, etc., won't get me too far.

"I'm a hand on an ocean going tug," he replies, "we're in port for a week, so I thought I'd look up some gals that I know."

The grin on his face is contagious and tragic all at the same time. I can't even begin to relate to the patient. Here is a man who has lived his whole life, and now, nearing the end, the doors of his memories for the past 70 years are shut. The only memories accessible to him at this moment places him the morning after a one-night-stand he once had, with a person who now probably has grandchildren of her own, and yet, it seems like it was just yesterday. In a sense, the reality he's living at this moment is almost better than the reality that actually exists. The triumphant attitude of a virile young man facing the adventures of youth has to be far superior to that of a frail, elderly gentleman, stuck confined to four thin walls with locks to keep you inside - the smell of urine and sponge baths always prevalent. Is this the way the brain keeps us sane, in response to conditions that would surely drive us insane? Is this the way a body, barely able to respond to the demands of life, much less the enjoyment and full expectations of it, cope with the disappointment of a machine worn well beyond the limits of its construction? Alzheimer's is a terrible disease, I've been told, robbing its sufferers from their faculties. And yet, this smiling, talkative soul in front of me, older than my own grandparents, is enjoying life just as fondly as he ever could.

We chat a little more about things and wait for the ambulance to show up. When they arrive, the medic doesn't bother asking for a report from me. In and out. Jim is loaded onto the stretcher for another unnecessary ride to the hospital that Medicare or his insurance company will have to pay for. The assisted-living community I learn later has no medical resources, so for any ailment, no matter how small, 911 is dialed and EMS is summoned to transport its residents to the ER.

I've seen enough of this home to know that most of those who live here aren't nearly as active as my patient today was. Many go through the day barely aware of their surroundings. I've taken calls here where the patient, after falling down in their room, with copious bleeding from certainly painful injury to their arm or to a leg, can barely comprehend the simplest questions, or even tell us if there's any pain at all.... the only indicator yelling or screaming when a site is touched or pressed upon, or maybe not. Yet.... what is happening in their minds? As the world progresses and time continues around them, what reality and what present are they interacting with? Is it possible that they're in a better place? As a patient is picked up, bandaged, and carried to the ambulance, are they vividly reliving their time on shore leave?...smiling, winking, laughing, and enjoying the art of living.

Cool! A nifty map!

With the help of a great site created by Phillip Holmstrand, I was able to plot and map the locations of every 911 receiving hospital in Manhattan, as well as specify the trauma centers (in orange). This is a screenshot of the map created and an interactive version can be found by clicking the image. Enjoy!

Ooooooh...pretty....

I just wanted to put this up. Good ole Fair Lady. Excuse the unskillful removal of license plate numbers and name. It is a nice truck though, isn't it?

The Maze Known as a College Campus

As a New Yorker, I'm fairly accustomed to finding my way around the city easily enough. And while I'll admit to the small difficulties every once in a while, like where exactly do I get off on the Canarsie line to transfer to the Crosstown Local (and by crosstown I mean Brooklyn/Queens); in Manhattan north of Houston is easy enough to find: The numbered streets go East/West, the numbered avenues go north/south.

I bring this up because a most amazing phenomena occurs every third or fourth day as I look out the 9th Floor window of my apartment onto Amsterdam Ave, and my college campus beyond it.

"So what is this strange occurrence?" You ask.

"Why, it's an FDNY ambulance traveling north on Amsterdam Ave., slowing as they approach the intersection and the gates to the main entrance to campus, then gradually stopping. In fact, they look....lost! You can see into their vehicle as their poor heads search the area, turning left, right, up, down. The the driver takes his foot off the break pedal and the FDNY rig pulls a U-Turn in the intersection, slowly, and starts heading back south."

Three minutes later they're back again. Same routine. They know that they're not in the right place, but probably close. They travel north this time, past the wrought iron gates, but once again, back they return, fruitlessly traveling north and south, pulling U-Turns while, I can only assume, their patient waits -- panic slowly setting in, until a campus Public Safety officer walks up to them, listens, gives directions, and off they zoom to save the day. This is where my ambulance service comes in. Our ability to excel in our service to our community of 50,000 students, faculty, visitors, and staff lies very much in the fact that we can respond directly to a location much faster than ye standard Citywide ambulance.

For example, this is a photo of a building on campus:

When yada-yada person calls into the 911 system and says, "Hi, I'm whoopie-wheepie, and I'm having a heart attack, and I'm in Shapiro Hall at The University." Citywide EMS dispatch will send all sorts of folks over, who will promptly not know where to go for several minutes at least. On the other hand, when same person calls x99 and contacts campus' Public Safety, we get the call, and we know exactly where Shapiro Hall is. In fact, we even know to ask for a clarification since there are actually TWO Shapiro Halls in existence. Thus, we hop in our truck, off and away, and establish patient contact in a much more efficient fashion than would otherwise be attainable through the municipal system.

Though this efficiency does not come easily. We require of our new Drivers that they memorize almost every location for each named building on campus, a list of about 100 places, each with it's own physical address, and some buildings with multiple addresses, as well as multiple buildings with a single address! What fun!

I've been working on a document for several months now, and tonight we are presenting it to the rest of the corps. It is essentially a standardized route listing for each possible location on campus. Here is an excerpt:

Schapiro Center
PRIMARY - Access through Peters Hall entrance on X St. Take your first left and walk past loading dock to the giant Freight Elevator. When returning to vehicle, remember that only the freight elevator reaches this level, and not the regular passenger elevators.

(2) – Access through entrance to Schapiro building on X St. requires changing elevators at Campus level. Beware, the first set of elevators are very slow.

(3) If responding to a call above the above the 7^th floor in Shapiro, try going through Mensche Hall Sky Bridge. Access is given by the 10^th floor of Mensche Hall. Use this is you like parking in the grove.

As you can see, there is a Primary route of access, and two alternatives. This may not make any sense to you, but by referencing other landmarks on the campus, this allows for a more streamlined approach to access to locations. The next steps will be distilling this down to something that anybody can use, especially for FDNY fire and EMS, NYPD, and anyone else who may be conducting emergency responses to our campus. Hopefully, in providing the municipal agencies with a listing of buildings with their corresponding physical addresses, and the best way to get into them, we can make this maze of a campus much safer (even if it means loss of business to my volunteer ambulance service)! Now, anyone know how to get FDNY to listen?

Why send an Engine company anyway?

Dispatched to a call for a "22 y/o female fell down the stairs with a head injury," I think first "Woohoo!" as the tones go off, then "Hmmm, this might be interesting," as the dispatch comes across. Little did I know how interesting.

The FDNY*EMS system is an entirely separate entity from the FDNY Fire system (and entirely separate from Fair Lady). They have different radio systems, different dispatch networks with different computer systems, different chains of command, and they don't even talk to each other. In fact, surprisingly, they also have different 10-Codes, which despite NIMS, both organizations are completely married to, and I would be surprised if "10-84" changes to "Arriving" anytime in the next 25 years (Nevermind that arriving is easier to say with one less syllable than 10-84).

Despite this, when the Citywide EMS system gets swamped, like it did last night, FDNY*EMS starts sending Engine companies to the serious medical calls. Since we're unaffiliated with FDNY completely, there is also the possibility of a dual dispatch if someone calls the University's Public Safety emergency line directly, and also calls 911, this also occurred last night. We arrived on scene to find the engine company, with their crew of CFRs, already tending to the patient. I dropped my partner and a Probie off at the front door, and went to stage the ambulance a little farther down the street. NYPD and Public Safety were also already on scene. After parking, I grab a stair chair and head into the building about 30 seconds after my partner entered. After I enter the foyer, I pass a firefighter who says, "You're going to need a backboard." I drop the stair chair, do the twirl, and head back to the the rig. Things progress nicely from there. My partner and the Probie do a nice job stabilizing C-Spine at the foot of the staircase, and we secure to a backboard.

I got the full story eventually from a friend who told me that the patient tripped at the landing on the top of the stairs and rolled all the way down to the bottom, head over heels. About 20 feet. Technically this is major trauma criteria, so even though the pt was negative for AMS, and PE revealed over some abrasions to her head and bruising to her arm, I called a notification to the trauma center, and we hustled to the hospital.

After we clear from the call, my crew sits together for a quick post mortem review. This is when my partner tells me that when she first arrived on scene, the FDNY firefighters had a 4x4 out and were pressing it against the pt's head. No manual stabilization of C-Spine, no collar out, no backboard. This suddenly struck me as odd since it was an FDNY firefighter that had originally told me that the pt would need backboarding to begin with. So, basically, the FDNY crew knew what needed to be done, but didn't bother doing it.

New Engine

As promised, I now go into the details of the new engine that I discussed in the last post. It's funny, I joined my local volunteer fire department so I could do EMS, but I found that I also began liking the fire services as well. Crazy world, who would have thunk it?

This engine is a brand-spanking-new, Pierce pumper with a 500 gallon tank outfitted with a Waterous fire 1250 GPM fire pump, and all the bells and whistles.... I mean that literally, the department actually ordered the truck with bells and whistles, which can be seen mounted on the front fender in the picture below. We tried out these bells and whistles, but you actually can hear them over the mechanical or electrical siren or the air horn. It's a full foot taller than our other, older Pierce Quantum, a 1999 model. This new truck replaces our trusty, well-used Pierce Dash, circa 1980, and is now designated E-411, and is also our FAST truck.


I spent an afternoon over break, helping get the new engine into service. Basically there were five guys there, the three college students, and the two chiefs. We transfered hundreds of feet of hose: hand lines, supply lines, and everything else from the 1980 Dash to the 1999 Quantum, and from the 1999 Quantum to the 2007 Quantum. Fun times, eh?

After moving the hose, we moved the tools, radios, and everything else, and finally, we were good to go. as mentioned, I got to ride in it that very evening towards an MVA, on it's very first call. It's a nice piece of equipment, and hopefully, it will provide several decades of service. The pictures included here are from the Pierce plant in Wisconsin, just before the decal work was put on, (and saving me the trouble of re-anonymizing the images through Photoshop) right before it took its trip to its new home in Upstate New York.
(click to enlarge images)

Hometown Happenings

Well I've been back home this past week for Spring Break, and had the chance to run about again with my local Fire Department. First though, I should mention that I coulda/shoulda posted about an event that happened two weeks ago, but due to some of the implications legal and whatnot, I'll refrain from doing so for now. However, I'll give you a keyword: RUM RABBITS! When I mention this keyword again, refer back to this post to give yourself a timeframe when I do write about the events that occurred.

It's been a busy week here at home. My town of about 20,000 is essentially a suburb in Upstate New York. Not unexpectedly, the type of calls we get here are different from the calls down at school in Manhattan. For example: no substance abuse calls. However, this was a three wreck week with three MVAs (together with a structure fire last week, a car fire this week, and a variety of medical calls: including the ever-joyful recurring trip to the local home for persons suffering with Alzheimer's.)

The first MVA occurred on a clear, sunny, morning with dry roads. A 79 y/o female lost control of her car on a winding road by the river and drove across the lane of oncoming traffic (thankfully missing everyone) and into the grass, trees, and shrubbery on the opposite side of the street. Tones went out on the pagers and I responded from home. I live almost exactly a five-minute drive from the fire house, so after hopping out of bed, into my clothes, driving to the station, donning my turnout gear, I had missed the first-out rescue truck. Luckily (or unluckily, depending on your point of view) many of the department's members work during the day and therefore can't respond, so I was the second person into the first-due engine and got to play officer. We left the station on that piece with a crew of two. Arriving, I see a mostly unharmed vehicle, I'm asked by the Chief, as one of the few EMT members of the department to help with the medical aspect. I walk up and see that the crew of the rescue rig are already maintaining C-Spine, with a member in back of the sedan holding stabilization of the driver. There is only one patient. Another EMT is conducting the PE and so I start the paperwork. Overall, she's not badly injured, but due to the MOI (and the fact that he car's no longer drivable), we ship her out via the commercial Hudson Ambulance company (the fire department is strictly first response, name changed) to the local hospital. Since I had arrived on the engine, the rescue packed up and left, and I got to stay and now play Fire Police, directing traffic around PD and the tow as the vehicle was removed. 20-30 minutes on scene and we're done. Not a difficult call at all.

Number two didn't actually happen in our fire protection district -- The town is split into three such districts: District #1 (clever name), District #2, my territory (equally clever name), and Magical Heights (name changed, except the 'Heights' part). This one was a more interesting call. Initially, my pager announced the dispatch, which it shouldn't have since it was alerting District #1. I was just about to reset the pager, when I hear "...two car collision with multiple injuries, multiple calls coming in. Repeating for District #1..." "Uh oh," I think, "could be bad." As apparatus start to arrive on scene, it sounds even worse. I decide that the we're probably going to get called for mutual aid on this one and I change out of my PJs, and head to my car. As I'm leaving my home for the station, I hear: "OK. We've got four patients. Send out tones for addition manpower from District #1 to the scene, put Medflight in the air, tone out District #2 for assistance in extrication, call Hudson Ambulance and give me two additional ambulance on scene, ALS if they have them, but we'll take a BLS, and put Magical Heights on standby in their station to cover the town for fire and medical." I hear first the call go out for the additional District #1 manpower, then my tones drop, then the call goes out for Magical Heights. Aside: note that District #1 is a paid, professional department, while we're volunteer, and that their paramedics already had two district-owned ambulances on scene (and all their on-duty personnel). It's now about 9 PM, and I'm the second person in the station. I start the rescue rig and run to don my turnout gear. I'm riding in back, and we're out the door about 3-5 minutes later. It's a relatively long drive, ~8 minutes, since we have to go across town. We also sent one engine to establish a landing zone for the 'Bird' at this time, but my truck goes to the scene. By the time we arrive, some District #1 medics have already rapid extricated and sent an ambulance off to the hospital for a trauma-arrest. This patient is the first and only death of the evening. The scene is pretty bad: A full-size pickup had ignored a stopsign at an intersection and is T-boned by an oncoming small compact car. Due to the velocities of the vehicles and the circumstances, the compact acted as a wedge and slid under the pickup, causing the truck to roll and adding to its momentum. The truck, however, never completely rolled over since a three-foot wide metal utility pole impeded its rotation when it was at about a 45 degree angle, causing the cab to collapse in on itself and "squishing" the passenger's head between the truck body and the pole, ultimately causing her death. I couldn't believe the status of the pickup when I saw it: The entire bady and frame were actually visibly and uniformly bent in the middle, to the tune of a good 15-30 degrees, such that the floor of the truck was almost touching the surface of the road when it was set back straight, regardless of the height of the wheels and axles; this being a large truck whose strongest characteristic is supposed to be the frame itself. Unreal. The two passengers of the compact were relatively unharmed and that vehicle did not require extrication. Extracting the driver of the pickup was fairly easy since that side of the truck was largely intact. The door was popped off, and the patient was fairly OK, though in the end he was flown to the Regional Trauma Center, because of the MOI and because the chopper was already on scene. Once again, the crew of our rescue truck did some Fire Police: closing down the roads surrounding the scene while the site was cleaned up and PD conducted their investigations. We returned to quarters after about an hour after initial arrival.

MVA #3 happened last night during the blizzard that swept through Upstate, leaving behind about 18" of snow in my town. One of our department's members actually was driving behind the vehicle involved in this one and told us the complete story. Through my town, runs a fairly large state highway, two lanes of traffic in each direction and a center turn lane. People were traveling at reduced speed due to the snow, but apparently not slow enough. My comrade-in-arms stated that she was watching this car slowly lose track of the lane markings in the road, and watches as the driver gradually drifts over to the left. At the time of the accident, he was actually driving almost exactly in the middle of the turning lane. Cresting a small rise in the road, the car collides with an oncoming snow plow approaching in the opposing direction, one of the big mothers owned by the state. The blade of the plow hits the left side of the car, spinning it and destroying almost all of the front end. We're toned out and due to the snow and the distance of the station, I proceed slowly to the fire house, actually displaying my blue light, which I rarely do (irregardless of the title of this blog!). Ironically, I have to pass the scene of the accident on the way to the house, but such are the rules of the department. Expectedly, I miss the first out rescue, but again, I am the second person in the first due engine (a different one from MVA#1, and a brand new one that arrived in the past week, post on that to come). I again get to play truck officer. We make it off the apron, when the Chief radios us to remain in quarters. Not an easy thing to do: turning this new beast around, and not wanting to take a chance, we do the great circle routing of going three right turns through a development to get us back home. Second bit of irony for the night, we come within about 300 feet of the accident scene before we hit the street that will allow us to start heading the right direction. Nonetheless, we sit back for the ride and enjoy the comfort of this new piece of apparatus, basking in the knowledge that I got to take it out on its first call as a fully equipped piece of fire suppression goodness. The patient was able to RMA and this was a close call that could have easily been a whole lot worse.

Not a good week for E(me)rgency Services

The results came back from the Accident Review Board and I've been suspended from driving for a two-week period. The worst part was the 'serious talk' from Lucy McGillicuddy who, I remind you, is *rum-pum-pum!* years younger than myself. Could have been worse, could have been better. I guess the moral of the story is that everyone makes mistakes (yes, even me!) and there are consequences to those mistakes. At least my mistake caused no permanent damage to Fair Lady's vehicle and no one was hurt.

Can't say as much for FDNY's Engine 123. This happened yesterday. Again, good thing no one was hurt. We will all learn from our mistakes.

Read This!

http://www.neenaw.co.uk/index.php/ambulances/174/weeding-out-the-snifflers/

Ho Boy! I'm in trouble...!

Responding to a call of a "head injury" today, I was driving the ambulance to the scene and proceeding blinkies and woowoos down a narrow side street intersecting Broadway. The time is about 11:45 AM. Traveling about 10 miles per hour, there was a backhoe off the right hand side of the street. Just as we're passing the construction crew: Pop! and a jolt. I glance in the mirror and don't notice anything out of the ordinary so we continue on our way to the scene, just the next block over.

My partner is teching the call, so I take a quick look at my rear axle. Verdict? Slashed tire. Still drivable, but definitely not pretty. I pop into the lobby of the building, where the patient is sitting on a bench. A small cut to his forehead, and he's not complaining of any other ailments. We RMA and now the fun can begin. I need to place a call to the Director (Lucy McGillicuddy), and the Operations officer. They ain't happy. Not one small bit.

I call us out of service, and the cogs start turning to get the vehicle serviced. It's too far for us to drive to the truck shop, so they have to come to us. I usually meet another Crew Chief at 3:00 and she covers me for a couple hours as I attend to some business about this time every Wednesday. I'm informed by her that she would be keeping the keys and radio until shift change today.

"Huh?" I think. Another crew chief (we're just having a big ole party today!) walks up.

"Nice job on the rig, polarbear," she quips.

"Yeah, great. That backhoe just walked into me, I swear! There was nothing I could do!"

Next thing I know the Director walks up to the three of us.

"So, I guess you suspended me for the rest of the day, huh?"

"What? No. Where'd you get that idea?" he says.

"Well, you took me off call. That's a pretty good indicator."

"You're off call. You just got into an accident, common sense would say that you can't be on call for the remainder of this shift. There's just too many liability issues. There'll also be an Accident Review Board soon."

"You realize I'm scheduled for two shifts this weekend," I remind him.

"Oh, yes. I know."


Ooops. How bad did I screw up!?

My first code...

It's finally time for me to tell this story.

My first code happened when I was home from school for break about nine months ago, though it seems like longer than that. At first, as I was trying to remember the exact details, so that I could write them here, I had difficulty recalling the time of year, and the order of events. However, as I dwell on them, I now surprise myself by just how much I do remember. I know it was the summer since it was a warm sunny day, it must have been between 3 and 5PM. Those were the hours that I would consistently hang out at my volunteer fire department after my internship at the chemical plant. The call came out as an elderly person having fallen. I remember because I was chatting with the Asst. Chief, Jose we'll call him, and the tones dropped, and we both took the ten steps into the bays and got into our truck. He drove even though he's the ranking officer, so I sat in the officer seat. Our truck for routine medical calls is an older E-One box mounted on a newer 1997 Chevy 2500 frame, with a duramax diesel. The cab seats five, and the box holds all manner of small rescue tools, including a jump bag, heavy-duty first aid kit, suction, AED, etc, etc. It's got a nifty (and broken) stem light, cribbing, high-angle rescue gear, fire police equipment, and more. R-410. We took off with just the two of us.

Our system works such that the local volunteer FD (us) provides first response BLS service to about half my town. The other half is serviced by the paid fire district. We contract out to a commercial ambulance company who does our transports and ALS. The nice thing about this arrangement is that we always have ALS coming to us. The downside, of course, is that we don't transport, though that can sometimes be a nice thing. Depending on how busy the service is, they can run a little slow. Today was a mediocre day. They certainly didn't beat us to the scene, which when that rare event happens they rub in our faces, but they weren't the 30 minutes they've been known to pull (extraordinary for a mostly suburban part of the state).

As we're driving down the highway, it wasn't especially congested, about forty-five seconds after our departure from our house -- maybe two minutes after the call came out, our Fire Police Lieutenant gets on the horn (as I would find out later, he lived next door to the patient) and informs us "410-C to Fire Control, be advised that this is a full arrest. Full arrest! Put an expedite on [Generic Ambulance Service]!"

Fire Control: "7-5. Full Arrest acknowledged."

410 (us): "410 redirects." Suddenly I find myself propelled against the rear of my seat as I watch my Chief floor the gas pedal. I look up from the PCR I was starting and stare out the window.

Jose asks me, "Polarbear, did you hear that?"

"Yeah," I reply meekly.

Out of nowhere a police car approaching from the opposite direction turns across the highway in front of us. Blinkies and woowoos. We follow with a right hand turn ourselves. I now realize that that was a very nice coordinated and skillful piece of driving by the officer and my Chief for neither of our vehicles to slow down as we took that turn. Of course, Chief cut the turn short several feet so that we sliced out a nice portion of lawn.

We followed PD all the way to the scene, the Chief barely able to manhandle our larger truck and maintain sight of the far more agile police cruiser. We end up parking on the lawn of the neighbor across the street from the patient's house. I open the door just as I spot the police officer starting to race into the house, AED in hand. The medical equipment is on the passenger side compartments of our truck, so I yank open the cabinet's metal doors and grab the suction, AED, and jump and airway bags. Chief rounds the corner of the truck and we both run up the slight hill into the patients house. Elapsed time is probably no more than five minutes from the time of the initial call. At this point, I seem to be moving without thought. Acting but not comprehending.

The patient has fallen in the kitchen and I am greeted by the sight of our Fire Police Lieutenant, who is also the only advanced provider in the department (EMT-I, New York 'I', not NREMT, so like NREMT-I/85 or whatever they're called). His name will be Red. Red and PD (whose name I actually don't know) have just finished cutting the patient's shirt and applying PD's AED pads. PD hits analyze. Beep beep beep. Analyzing rhythm. Beep beep beep. Analyzing rhythm. Don't touch patient. Stand-by. Beep beep beep..... Enough already! Just let me hit the shock button. Beep beep beep. No shock advised. @%#$!!

We start to resume CPR. The BVM and O2 are broken out. My Chief points out that we need to take PD's pads off the patient since they're incompatible with Generic Ambulance Service's Lifepak 12. I rip off the pads, and apply new Medtronic pads, and power up our trusty old Lifepak 500 (Which I neither know whether it is trusty or old). We run through the routine again. I know, I know. Should have done a couple minutes of CPR, but hey, what's the harm. I hit analyze. waiting waiting waiting. "No shock advised. Start CPR." @%#$!! Again!

As Chief starts pounding and Red handles the ventilations, I find myself without a job. I will soon learn that Jose likes chest pounding, and as this story will play out, he was probably the one pounding away all the way until the MD called time of death at the hospital 30 minutes from now. Oh yes, this story doesn't have a happy ending. I remember a few days later after Jose has downloaded the AED traces into the computer, the nice steady rhythm he was producing all on his own. Anyway, I was without a job for a moment and just as I was thinking that someone should have thought of three-man CPR, I notice a nice steady distention of the abdomen. I look a little closer and see Red pumping the BVM at a rate close to 40 breathes per minute, full bag, and over the course of about a quarter of a second. Sweet! I'll play airway coach.

"Nice and easy" I say to red.

Immediately you can see the anxiety and tension come off his face (remember, he was on scene by himself for several minutes doing one-man CPR) as his training kicks in again. He immediately slows down the breathing. We all take a second to expel the air out of pt's abdomen, and resume once again. I think, what can I do to stop this form happening again. We reposition the head, I slide in an OPA, and Red vents. At this point, a couple more members of the FD have arrived, some in their personal vehicles and a couple in the department flycar. One member picks up the PCR I have long abandoned. I apply cricoid pressure. Someone asks, "Anything I can do." Jose pounds away. Where the @&!$% is ALS?!?

Turns out ALS is another 3-5 minutes. Must not have gotten the message that this was a true MEDICAL EMERGENCY! The first man from the Generic Ambulance Service rig is a kid, a EMT-B, definitely younger than me, and the look on his face was priceless. I can still remember it today: Stunned silence. He literally stopped moving. Someone had to grab the drug box and tube kit he was carrying and out of his hands and place them on the table. He basically stood off to the side for the rest of the call. ALS provided from GAS was slightly better, walking in to the room and starting patient care, but certainly not taking control. Someone suggests hooking up that nifty Lifepak that she bothered bringing into the room. Good idea! All this time we haven't have a shockable rhythm. The Lifepak-12 goes into AED mode (I really know nothing about these things. I didn't even know that was a choice). No shock advised. @$%%@&! What's the point of these bricks if they're not going to deliver 300 Joules of life-saving electricity when you expect (and want) them to? CPR is resumed. The medic, an AEMT-CCT (that's NREMT-I/99, I think), begins attempts to start a line. This provides me with ten minutes of amusement.

About 4-5 minutes into this attempt one of our kindly volunteers inquires as to whether he could be of assistance in tubing the patient. Medic, surprised, nods and points to the tube kit. Our heroic volunteer, whose day job is work as the head respiratory therapist at a local hospital (and an expired paramedic, that's right, full NREMT-P), works his stylet and plastic tube magic, and a tube is in place. Ventilating begins. Jose still pounds away. Tube guy begins ventilations. I once again am obsolete. Red and I run out and grab the stretcher and backboard. The cot won't go up the front steps into the house. The board is brought in. Resp. guy suggests some meds down the tube. Medic lady, still trying to start a line nods and atropine is produced. Jose pounds away. Lifepak, neglected for so long (probably only four analysis provided since we've been on scene, nearing, if not over twenty minutes now) suggests a shock. Wonderful! ZAP! Shocks no longer advised. CPR resumes. Patient is transferred to the board and carried outside and set on the cot. I lift one end of the stretcher along with Jose who has the other end. Medic grabs her stuff. Where is that Generic Ambulance Service kid? The bed is wheeled down to the bus and Jose immediately hops in back and begins to pound away... again.

Off they go. Blinkies and woos. I inhale. I look up. I'm outside.

My head turns a couple times. There are now three police cars. The fire truck I rode in on. A FD flycar, and the FD pickup, and two personal vehicles. Lights blinking. I exhale. I look at the front of the house. Bystanders are around now. Neighbors are milling around. People have heard what's going on. Red comes out of the house, along with the other members of the department. I need to call Fire Control and let them know the situation. Technically, I'm now in charge of the scene, since I rode Officer on the first responding apparatus and there are no real line officers around (Jose off to the hospital, and Red doesn't really count). I realize I don't have a portable and actually turn in my place a few times as if one will magically appear. I see a blue uniform and some stripes, the PD sergeant. I call to her to ask her to radio dispatch and update them (Fire Control and PD dispatch is all one person on different frequencies). Red yells to me and tells me that he still has his portable. He calls in the conditions report. Equipment is put away. I'm the one who has to drive the truck back to the station. I get in an argument with the neighbor whose lawn I'm parked on. I want to back up while he wants me to pull forward. Whatever. I make sure everyone has a ride and call us back in service. Drive. Stop. Reverse into the bay. Close the door. I sit around a little and drink a couple sodas. Jose calls from the hospital and says he has a ride back and we're all dismissed. Good. I get in my car and go home.

Life's Ambitions

I need a place to put this list. Somewhere where it won't be lost, so I can refer back to it, change it, and add to it. Don't mind that it is not strictly (or at all!) EMS related. We'll file it under 'personal' for now.

Things to accomplish in life

-Get my Rescue Diver
-Become a SCUBA Instructor
-Get my Class A CDL
-Get my Private Pilot license
-Graduate medical school
-Take Firefighter I


Things that have been on above list and ACCOMPLISHED!



Things that used to be on the above list that I've resolved will never happen

House MD

I'm not a griper, but I was watching an episode of House, MD, my all-time favorite show on the "Idiot Box" and found the opportunity to bring up an issue.

The main character is quoted in one episode as saying:

"Dr. Gregory House: [to EMT guy who has just tried to give directions] If you wanted to be a doctor, maybe you should have buckled down a little more in high school."

this quote coming as EMS is wheeling a patient into the ED and saying something to the order of "he lost three units of blood en route, he needs a transfusion stat." Not that I would never say something as canned as that, but the response is still slightly off, don't you think?

Another episode has an EMT announcing to a crowded restaurant,"someone call for a wagon to Princeton-Plainsboro [Hospital]?" (Anyone ever arrive on scene and ask if someone requested a [meat]wagon, or even use our EMS slang: bus, truck, rig...?) The actor saying that last line is listed in the credits as the ever-dreaded: "Ambulance Driver."

This line of thought brings about the age-old topics of debate: (1) How do we rid ourselves of the title "Ambulance Driver" and (2) How do we cope with our profession (applicable to the professionals*) and care (applicable to the volunteers, professionals, and everyone else) being portrayed in such a manner, in such public view. We are all highly trained, and albeit paramedics much more so than us simple EMTs, but we all take great pride in our work, and I think we all take just a little offense when we see ourselves placed in a lesser role in life, given less respect than we deserve.

The term 'ambulance driver' probably, and you old timers would know better than I would, came from the point in history when the people who worked on ambulances were just that, 'ambulance drivers.' That casting can easily be seen when one watches such classic TV shows as 'Emergency!'. Those proud L.A. paramedics Johnny and Roy (who, Lord only knows how and why, can perform a trench rescue in nothing but their station blues and not get the slightest speck of dirt on them) would hop into the back of the ambulance just as it was about to be driven off by the... driver. Need I remind anyone that this was 1972. When was the EMT program established? Answer: 1973 with the federal EMS Systems Act. By the way, who was given authority for the development of the EMS curricula and development: why of course, the Department of Health and Human Services! Wait, but then why does it say Department of Transportation on the third page of your EMT-Basic text? Oh, now I remember.

According the Wikipedia, the first organized police department occured in 1667, the first organized fire department happened in Rome (that's Italy! not New York!) in the Year AD 6! EMS, the third branch of the emergency services could not even begin to be considered until the advent of CPR in the 1950's and 1960's. Being more than three hundred years older than the other 'uniformed' services, has its disadvantages: No NFPA, no PBA. I attended a lecture this past weekend about the safety of ambulances by Nadine Levick at the National Collegiate EMS Foundation's Annual Conference (I'll post about the conference itself.... later). Did you know that ambulances are only one of two types of vehicles on the road today that are exempt from federal safety standards. This ain't a good thing. If you dig around her website there are some spectacular images of what happens when an ambulance gets into an accident.

Essentially, no one is looking out for us prehospital care professionals, us EMTs, paramedics, etc. We have no strong unions (my friend works for a commercial outfit: their union, the teamsters. Another transportation related group). No lobbyists. The NFPA exists solely for the protection of firefighters. When they come out with a new regulation regarding building construction, it almost automatically becomes part of a municipality's local codes. How about a similar organization for EMS? Nope. Nonexistant. If you work here in New York City for FDNY as an EMT or paramedic, you are allowed to take the test and then accept a promotion to become a firefighter (No more EMS work). That's right, the career ladder clearly shows that firefighter is above EMS. Frustrating huh?

So all of this brings us around to our initial question. (1) How do we rid ourselves of the 'ambulance driver' stigma? and (2) how do we appear more professional than we are often portrayed?

The answer to both questions, I believe, are simple and obvious. We work hard. We provide excellent patient care, and we act as the professionals that we are. Through this, we as an industry, and as individuals working as EMTs and paramedics can open the eyes of the public as we touch them through our care every day and earn the respect that we deserve.

Griping fine. (My entire Italian lexicon put to good use)




*Professionals - Do ye volunteers consider yourselves as professionals or merely as workers? Or is professional applicable only to the career guys? Another side issue that could turn into a post, but probably never will.

Leadership

I've got this friend who's goal in life is to become a neurosurgeon. Let's call him Lucy McGillicuddy. Thing is, he could actually do it. He's one of those EMS protégés, you know, the best EMT on the corps. The guy who knows every protocol and every nuance. The guy who could recite 10 NYCRR 800.20:08-ii from memory [interim testing requirements and pass/fail criteria], if only you could somehow trick him to do so -- as you can guess his ego is pretty big (our fault). Not that that's a bad thing, he's absolutely friendly, and he really is an awesome EMT. Smart, funny, clever, etc. He has earned respect and he's dished it out where it's warranted. In a nutshell: you can get engaged in a conversation with him, but often there's a certain point when he says something, and you just have to go, "I no longer have the intelligence to participate constructively in this discussion." He's that good.

Trouble is, he's 19, and he was just elected to be the Director (Chief, for you non-PC folk out there) of our corps. His two-year reign begins.

Being *ahem!* years older than him, I've been trying to, subtlety, show him the administrative shortcuts I've discovered over the years (and get things I want done, done through him!). That is, the back doors that exist to procure the difficult to obtain, and the efficient ways to avoid red tape. He's learning: he's delegating, and he's dealing swiftly with the administration, he's making friends with those who can give. He's also making some good, if small, changes in the way our organization is run.

However, as I'm just beginning to realize, his overall leadership skills are not yet fully developed. He's not a bad leader, just someone who still has rough edges. Small things: like he'll crack jokes when he supposed to be serious, and not conduct meetings efficiently, etc. People have been commenting to me about him, which has triggered this line of thought. Reflecting on my friend's situation has sparked a debate in my head: what makes a good leader? Is it the ability to 'lead the troops'? The ability to recruit and retain? The man who's a friend to all? The one who gets the job done? The one you confide in when you have a problem? The regular guy who has the best skill set? The guy who makes good speeches? Runs good meetings? Doesn't hold meetings at all?

I view myself as a good leader, but I definitely have my flaws. I also realize that it took me at least a year in my first serious leadership post to develop the skills I needed to handle that job. I don't know if the skills I have would allow me to be competent in a different position, or a leader in a different situation.

I feel like the quintessential leader is thought of as the strong-willed person who have gained those he leads' trust. But that's not even close to being complete, is it? I know Lucy will, with time, become a good leader himself, but in this train of thought, I know that no matter who you are, you can also improve your leadership skills (by the by, this sentence you're reading has six (!) commas -- I've got to learn to be more concise!). I've resolved to reflect on the people who I believe to be good leaders, and think about which qualities in particular make those people the leaders they are. In identifying those traits, I hope I can absorb some of them and become someone better than I am.

Icy Day in the City

I had my first ever burn-out, apathetic feeling today. It just crept up on me, and as it was happening, not only did I not try to shake it off, I just didn't care. I let my partner run the call, and when we got to the ER, I basically stood in one corner all through triage, signing the pt off, and completing the documentation.

It was our fourth call of the day on this very icy, very treacherous day in New York. While Upstate got the fluffy white stuff (and feet of it, according to the first-hand report from my mother), down here we got gray, wet, heavy sleet and ice. The tones drop around 6:30 PM for "severe headache" and we arrive on scene to find a 42 y/o female c/o falling 11 hours prior (on her "butt," quoting my partner's PCR), with some dull achy pain in her head and sinuses, no recent hx of illness. Pt is prescribed two type of antidepressants, and denies SOB, LOC, neck/back pn, nausea, vomiting, dizziness, or cx pn. Pt is ambulatory and answering questions without difficulty, A&Ox3.

While this hx is being obtained, I'm mindlessly walking around the room looking at the furniture, peering into the office adjacent, and generally not paying attention. We go through the motions, and before I know it, I'm reading over my partner's documentation and signing off, we get in the truck, and head home.

It took me a while to realize why that call was such a blur, and it shocked me even more to realize my state of mind during it. As a person, I always pride myself on the excellence of my patient care. I follow the protocols to a T, and never take shortcuts. I try to make the patient feel comfortable, and strive to be the best EMT on the corps (and in the city!). I am ashamed and disappointed by my behavior, and worse still, I don't know what brought it on. When I say this is the first time I've felt like this, it is the truth. I've been a volunteer EMT for nearly five years now ("nearly a fossil" jokes the triage nurse whenever we get to chatting about my youth), and I'd never expected to hit a point I hit today.

In analyzing myself, I think today was an especially hard day. The first three calls sapped a lot of my energy, and the continual maintenance of the bus during the storm today added to the burden on my shoulders. I think I just need to put this behind me, and refocus on why I love EMS in the first place. Not just because I'm an admitted adrenaline junkie, but always because I love caring for people, being able to help them through the worst times of their lives. It is also fun, and the challenge of constantly improving on myself in a goal truly worthy of achieving.

I hope I won't see the demon that poked his head out today for a long time, and I won't be remiss if he never shows up again. One can only hope.




To put it all in perspective, I found this cartoon online today. Drawn by Steve Berry, that omnipresent force in EMS humor (JEMS):

Template Change!

So blogger's new blogging system has a new template tool that I decided to give a whirl. While I was doing that, I lost a few of my customizations, so in restoring them, I kinda changed the look of the whole blog and added an important new feature: my email address!!

Let me know what you think of the new look, by commenting or via.... email!... and we'll see if this iteration stays. After all, it's now wicked easy to change templates. Thanks Google, I think.

Achilles

Call comes out as a "Male in the Fitness Center with a torn Achilles Tendon," which is an unusual dispatch for all the same reasons why you think it's an unusual dispatch, compounded by the fact that about 75% of our dispatches have us responding to an "Aided." (Yeah, someone needs to take an EMD class).

We arrive on scene to the University's basketball courts and find a 35 y/o male sitting on the floor by the sidelines, unrmk except that he's extraordinarily sweaty.

"What's up?" I ask.

"I tore my Achilles," the kindly athlete replies.

'Interesting diagnoses,' I think to myself. I also note that he did not say: "I hurt my foot/ankle/leg" or "I can't walk" or "I think I may have hurt my Achilles," but rather a affirmative statement about an injury that occurred less than five minutes ago.

Easy way to find out the truth about this. I palpate the back of his foot/leg/ankle. Well, let's just say, there certainly weren't no tendon where it's supposed to be. And there was instead a nice squishy hole where there ain't supposed to be one.

Pt --> Stretcher --> Ambulance --> ER.

I always find it amazing when the dispatches turn out to be correct.

Can one man really activate every EMS unit in the city?

It's a cool, sunny day in New York. The first snow flurries of the season (occurring in January!) had fallen the night before, leaving the streets wet, but just the fainted hint of white under the trees. The time is just past 1PM.


BEEP BEEP BEEP BEEP!!!!!

"Fair Lady, Fair Lady! Respond to the School of Social Work for a woman passed out!"

"Ummm, Medic 1 to Base, is the patient breathing?"

"Stand-by Medic 1!"

...two minutes later...

"Medic 1: Patient is breathing!"

"Ummm, thanks. 10-4. Fair Lady arriving."


By the way, in case you haven't yet figured it out, it is going to be one of those calls.

We arrive on scene to find our patient, a 63 y/o female, who was reported to us as passed out and in the lobby, already gotten up and traveled to the 7th Floor. Sooooo.... off we go! My crew and myself get off the elevator, through a couple glass doors to find the patient smiling and yelling:

"Oh you guys! No. No. No. Enough. I'm fine. Go away!"

Definitely one of those calls. My partner (and CCiT -- that is, Crew Chief in Training) approaches the patient. He quickly makes no headway. Intervening slightly, I steer the patient and my crew into a conveniently empty conference room. My partner directs the Probie (did I mention my crew comprises of FOUR people!) to start getting vitals. The patient puts up some fight, but quickly sees reason and lets us check her BP, etc. as my partner persuades her.

"Come on, I don't need this! You guys were here two years ago! I feel fine now," she says.

"Huh?" I think. "What happened two years ago?"

"Oh, I passed out, right over there," she points. "I went to the hospital and they told me I was having 'mini-strokes.' I'm also diabetic."

"Great."

My partner gets the rest of her history. Unfortunately, our patient has gotten even more vocal, and worse, when my partner suggests she takes a ride over to the hospital, she refuses, adamantly. I take the opportunity to pull my partner off to the side and remind him of the presenting problem's link to her Hx. Now, at this point in the game (Warning! Rant alert!) I would normally do a quick finger stick (and so would every other EMT on the planet) and check her blood sugar. After all, she did say she missed lunch today. Too bad. New York City BLS units aren't allowed to carry glucometers.

So instead I tell my partner to call Med Control and ask for a recommendation. Since the patient is under 65, Med Control physicians don't have authority to force the patient to be transported, but I figure what's the harm. I want to take her, but I don't want to get in a fight with the patient. I figure with a doctor's recommendation and the moral authority to pursuade the patient to spend a $50 co-pay, she'd be more willing to go. Little do I know. The Medical Control Doc orders us to transport the patient. Unwittingly, I have now entered a very, very, gray zone.

At this point, the Patrol Captain of the University's Public Safety Department strides in the room.

"Virginia," he begins (Name changed to protect Pt. con.) "you realize that you're on private property. If the Medics" (by the way, that's just the street name for Fair Lady personnel. We're all just EMT-Bs) "want you to go to the hospital, I can..."

I cut him off. I know where that statement is going, and the last thing I want is to force the patient to the hospital. I want her to want to go to the hospital. Besides, I can always call PD. I have a valid order saying I need to take her, I think. It also becomes increasing evident that my chances of convincing my patient to take a ride with us are becoming less than nil faster and faster.

"What do I do!" I think at myself... and in a moment of EMS competency I remember my protocols: "...care can only be transferred to a medical authority with a higher level of care."

Aha! This is what ALS was designed for. Sorta. Well, it'll do the trick regardless. While, I no longer have the authority to RMA, and ALS rig still does. So I get on the horn and call MARS and request an ALS bus to our location. I decide the patient is in the good hands of my partner. I go downstairs and await our backup. 10 minutes later, a BLS rig pulls up. @&%#! I approach. I speak. They speak. I call MARS again, reinstating my request for ALS. I am informed that since I already have a BLS bus on scene, they are the ones who need to request ALS. I remind the nice man on the other end of the phone that I am a BLS bus. The nice man tells me to pound salt. I look at 16-E and tell them what MARS told me. We both roll our eyes. 16-E decides he wants to make contact with my patient. We go upstairs. 16-E talks with the patient. He asks me, "Do you want me to call the Conditions Boss?" Me, never ever having heard of an entity known as the Conditions Supervisor says, "Huh." I seem to be doing that more than usual today.

The Conditions Boss, 16-E informs me, is an FDNY dude who solves situations just like ours. Awesome. I grant him permission to proceed.

"16-E to Central. Request Conditions Boss at this location."

"16-E! No Conditions available in the vicinity. Will you take an ALS unit instead?"

Mon dieu! 16-E looks at me. I nod.

"16-E. Go ahead. We'll take an ALS unit here."

"10-4. 24-U respond to....."

Let's go over the cast currently on stage:

-1 patient, hereknown as Virginia.
-1 concerned friend, female.
-2 crew members, BLS unit 16-E
-1 Public Safety Patrol Captain
-3 random extras, assorted genders, looking through the window into the conference room
-4 Fair Lady crew members

Basically, we're all looking at each other.

Final Act

"16-E! 16-E! Pick it up!"

"16-E."

"Conditions Boss is now available. I've sent him to your location."

Enter 24-U, the ALS unit. We fill them in. We also simultaneously hear the Conditions Supervisor pulling up to the front of the building. I take a quick peek out the window and see:

-Public Safety Patrol Car
-Fair Lady Ambulance (Type III)
-Conditions Car (Ford Excursion)
-16-E Ambulance (Type II)
-24-U Ambulance (Type I)

All blinkies going strong.

The Paramedic goes, "What's your blood sugar?" Patient sticks herself with a meter that I have now determined she has had on her person all along.

Patient: 132

Paramedic: Right. Good! Well, finish your lunch, sign here, and we'll all leave.

Patient: Great!

Handshakes all around.



We all pack up and take the elevator down. As we're leaving, I'm not quite convinced the paramedics did everything they should have, especially since on the way out the door I'm stopped by a coworker of Virginia's. He states that the present incident is actually the second in a row. An earlier episode having occurred an hour before we started this call. I'm concerned, but I shrug, and head back to the vehicle. I've already passed care to a higher level.

What are your thoughts? What would you have done?

Wow!

Hey! it works! My "new" website: clickthrough