So, I did my EMS ambulance ride time today. Although I knew
it would be unpredictable, I figured it would be somewhat similar to my Life Line
ride time with the helicopter – a lot of waiting around and a few calls…hopefully
without the motion sickness. I was assigned to ride from 10am-8pm with two
female paramedics. At the beginning of the day, I mentioned I
knew nothing, so everything would be new. Even if we didn’t have an "interesting" day, I would still know more about how things worked than I did before. First
off, learn the lingo. Every area in medicine (and in every profession, I’d
venture) has their own way of talking and definitions of unfamiliar words.
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With that being said, I'll give you the DL on the lingo I heard used most commonly today.
First, codes. Now when I hear codes, I think code blue as in
CPR, start chest compressions stat. Or code orange, seal off area because of
dangerous chemical spills. Or even code silver, shooter in hospital. But in EMS
lingo, a code is the way one leaves a scene to head to the hospital. Code one
is not as emergent. Code three is lights, siren, and speed because the patient
should have been at the hospital, like, yesterday. There is no code two. Don’t
ask me – they didn’t think it made sense either.
Next, priorities. There’s a graduated level of priorities
based on the information dispatch was given in a 911 call. If there is
possibility that the patient has no airway maintained, can’t breathe, or the
heart has stopped beating (or dispatch is unable to ascertain the nature of the
patient’s condition via the call), then the truck responds priority one. Again, this indicates lights and siren since
it’s the highest priority. The priorities become less severe the closer you
count to five. There are five levels of priority total. The paramedics
explained that codes and priorities seem opposite at first. You may respond to
an urgent priority one patient, but
leave the scene code three (most
urgent). However, a non-urgent call takes, say, a priority four status and, therefore, they would leave the scene code one. Got it? Good. Moving on.
Third, districts. Springfield has two privately owned EMS
operations – Cox and Mercy – and each responds to calls made in certain
districts. For instance, Cox covers anything Battlefield and south plus
everything between Division and Kearney. Mercy covers calls made from
Battlefield to Division and everything North of Kearney to the surrounding
areas. They split the calls on Battlefield depending on if the location is on
the north or south side of the street. I asked specifically since I live on
Battlefield. Even though they respond to patients in these areas, they can take
patients to any hospital within reasonable distance, so patients in those
districts aren’t forced to use the hospital of the EMS providers who respond.
Fourth, posts. When an ambulance isn’t on call, the paramedics
report to dispatch and indicate they are free to take an assignment. Dispatch
then gives them a call or a location at which to post – a.k.a. hang out until
needed. To my knowledge, there are three (if not more) posts in Springfield for
Mercy medics. Post one is the ER ambulance bay at the hospital, post two is a
clinic near Kearney and Glenstone, and post three is headquarters located on
St. Louis Street. Posts two and three are nicer accommodations, with leather
couches and television. When there isn’t a truck stationed at post three (HQ),
then they pull a “free” truck from another post to cover the entire city from
that location. Then when another truck becomes available again, the truck that
was pulled is usually sent back to the post from which they just came. At least
that was the case today. It seemed like there was no rhyme or reason at first
to why we were constantly going back and forth between posts two and three, so
I asked, and that was the explanation they gave to me.
After getting some of the lingo down, I was able to follow
the conversion and assignment reports more easily. I hate being lost in the
lingo, so I definitely didn’t hesitate to ask questions right away. Besides the
terminology, there were several other things I learned which really enlightened
me to the way EMS functions.
Organization. The first thing I observed as I walked into
the ambulance bay at headquarters was one of the paramedics with which I was
riding (let’s call her A.) cleaning out the truck. The other paramedic (let’s
call her B.) commented that A. was a neat freak, so the truck would be spotless
on their shift. (Which was fine with me since I’m a tad of a neat freak myself
and can appreciate a fellow kindred spirit.) B. pointed out how the truck was
arranged. Everything they needed they could keep on their stretcher – monitor/defibrillator,
airway bag, and med bag. The truck was stocked with meds, IV supplies, oxygen,
gloves, and all the materials of the medical trade that may come in handy. Like
alcohol wipes and emesis buckets. There’s a pilot chair in the back as well as
a bench seat/makeshift 2nd patient bed and a side seat. There is
also a driver and passenger seat up front.
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| In the back of the ambulance at the beginning of the shift. |
Shifts. I happened to catch a ride-along on a 10-hour shift.
However, most shifts are typically 12 hours. (County EMS shifts are 24- or 48-hour shifts.)
Four shifts run all the time starting at 6, 6:30, 7, and 7:30 (morning and
evenings). Then there are 9AM-9PM and 10AM-8PM shifts. There are two partners
to a truck: either a paramedic/EMT or paramedic/paramedic. Usually, the teams
are consistent…so they are not constantly switching partners. As B. pointed
out, this makes it great if you work well with your partner or miserable if you
can’t stand each other. I loved how she mentioned that her EMS co-workers were
like her family – some closer than family. But there is also some discord at
times when working styles, personality, or personal preferences clash – like
which radio station to listen to or how to treat family members of patients on
scene.
Cost. I’ve always been told – even before I started working
in the ER – that it’s expensive to call for an ambulance ride. So, I specifically
asked how much it would cost if I was self-pay. Apparently, people weren’t
lying when they said it would be expensive. First, there’s a base BLS (basic life
saving) charge – $600-something per a certain amount of time. Then if the
paramedic interacts with you at all, there’s an ACLS (advanced cardiac life
support) charge of $900-something per certain amount of time. If you need
intubated or any airway assistance, the cost goes up significantly because an
ACLS II charge is added. And on top of all that, there’s a dollar per mile
charge. For Mercy, it’s $16/mile – at least initially. I’m not sure if it goes
up if the distance increases or not. The BLS and ACLS charges also go up
exponentially if the distance is large – like from here to Kansas City instead
of across town. All that to say, ambulance rides are expensive. So, unless you
are truly dying or need the assistance of sedation, find another ride to the
hospital and back home.
Challenges and Advice. Being an EMS responder is tough work.
There’s a huge range of emotional extremes. Among handling horrific traumas,
feeling threatened by psychotic patients, and taking non-urgent transfers back
home, it’s easy to face emotional whiplash or burnout. After responding to
calls involving kids or working a death, most people will need to take a step
back, breathe, and regroup in order to move on to the next call. The responders
never know if the next call could be the best call of their professional life
or the worst one that changes how they function for the rest of their career.
The shifts are unpredictable – crazy busy, boring monotony, exhilarating, frustrating
procedures of changing post to post or transporting patients who abuse the system.
Patients can be super sweet or incredibly ungrateful. In addition to the
emotional difficulties, the nature of the work is physically exhausting.
Throughout their day, paramedics and EMTS are constantly lifting patients – and
not always bed to stretcher. They often receive calls for morbidly obese
patients (400-600lb range) who have fallen and EMS is sent to help them get up
or come to the hospital for their injuries to be treated because no one else
can lift them. Not to mention the exhaustion working 12-hour shifts can create.
These are some of the challenges of the job. The advice B.
offered is to come into the position with some street smarts. Many times you
have to be able to read your patient before you put them with yourself in an
enclosed area. If law enforcement felt threatened enough to use handcuffs, by
golly, the patient needs to stay handcuffed or be transported in the back of a
police car. If a patient is strung out on K2/bath salts and the police can’t
handle them, pre-medicate the patient before loading them in the back of your
truck. If you feel threatened as a paramedic, don’t hesitate to brace yourself,
yell “brake!”, and let the patient go sliding out the back. Better they be hurt
than you dead. Her other advice: take a break when you’re too overwhelmed or
emotionally paralyzed to function safely. Sometimes you need to take a step
back before you can continue. That’s ok. Sometimes it’s hardest to recognize
your own limitations – but even paramedics and EMTs are people. They’re not
super-human or deity. Sometimes there’s not a thing they can do to save someone’s
life and they know it.
So, that’s what I learned.
Here’s what I Experienced: two hospital-to-nursing-home
transfers, a nursing home to Cox South ER transfer, and one home-based call from
residence to Mercy ER, as well as quite a bit of down time at the posts,
watching the US Figure Skating Championships on T.V., and a trip to Subway. Our
routes included Springfield and two other cities in the surrounding area. By
7:30PM, they were “EOS” (end of shift), we headed back to fuel up and log
miles, and then returned to headquarters – ending where I had started that
morning.
Conclusion. The daily life of EMS responders is completely unpredictable.
They have been puked on, physically and verbally abused, thanked for saving
someone’s life, and responsible for delivering
babies on the side of the highway and extricating patients from car crashes;
all of these situations with minimal support, supplies, and often in an
enclosed space. And yet, they keep coming back to work. What I learned today: just
as is true for other medical positions, EMS responders deserve our gratitude
and respect. Perhaps, more so than others do.
