Silly American

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“Silly American!” I thought as I ran towards my bike. My screen read;

“Allergic reaction – 20 Year old male – conference call with 100/Police”

“Conference call?!” you ask.

“Why should EMS call Police?” you wonder.

Answer = Silly American.

Ladies and Gentleman of the United States, United Kingdom and the Philippines.

The number for the ambulance service in Israel is 101.

Not 718 230 1000 (Yes – that too has happened before.)

Not 100. Not 102. Not 112. Not 911. Not 999. Not 000 (thumbs up easygoing Australians).

Fun Fact: Did you know that the emergency number in the Republic of Djibouti is 351351. The absolute paradigm of simplicity, I couldn’t have come up with an easier number myself.

Our dear patient, bless him, had called the police complaining of an allergic reaction to an unknown substance. The police confirmed that the substance wasn’t white and powder-like, and then moved onto the next step in their crisis algorithm – call EMS.

They now have our number written on yellow-stickies all over the office, ever since that uncomfortable incident when they mistakenly called environmental protection – long story.

Eventually, the conference call was put into motion:

 

POLICE: Hello, is this EMS?

AMERICAN: No, it’s still me!

EMS: Yes, we are here as well.

POLICE: Go ahead please Sir…

EMS: I am not a Sir, I’m a madam!

POLICE: No, no, the American.

AMERICAN: Guys, stop fooling around, I can’t breathe!

EMS: Where are you?

AMERICAN: At home.

EMS: Where do you live?

POLICE: He is from America.

AMERICAN: I’m in Hebrew U.

EMS: What happened?

POLICE: He took a substance that was not white and powder-like.

EMS: Please let the American answer!

AMERICAN: I am having an allergic reaction!

EMS: Do you want an ambulance?

POLICE: I don’t think so; he called us.

AMERICAN: I need help, I can’t move my lips, they’re stuck!

POLICE: Stuck! Let me get FIRE on the line…

FIRE: Wassup boys?

EMS: Good!

POLICE: Great!

AMERICAN: Help !!!

 

I was eventually dispatched and ran towards my bike.

I try to start it – the engine stutters.

I try again, this time whispering Psalms. The engine roars (meekly) to life.

I love my bike and my bike loves me, but we are reaching the end now. We have already been through one heart engine transplant, and recently there have been some recurring health issues.

It’s been an amazing journey; the highs, the lows, and everything in the middle. I refer of course to the steep inclines and valleys of Jerusalem, which are quite frankly partly to blame for the relatively short life span of my bike. That, and the incessant accelerating and braking which is typical of this line of work.

My very kind Boss at United has offered countless times to give me a new updated model, but I refuse. I would like to continue riding it, “until death do us part.” Besides, the new model is larger, heavier and faster – qualities that I simply don’t need.

I weave in and out of midday traffic and finally reach my secret shortcut to this address.

Not so secret; there’s another ambucycle right on my tail. He knows, that I know, that he knows the secret path. I think I see him smirking under the visor; not for long though. Lo and behold, the opening of the path is 80cm wide. My wingspan (yes, I pretend to be a plane) is 87, but if I retract my mirrors, I am a very slim 77cm – exactly trim enough to make it through. The freshly frowning guy behind me has a new fancy shmancy model and doesn’t fit, no matter what he tries. I land at the location, glance over my starboard wing and notice him taking the long ring road.

Old School – ONE

Hot Shot – NIL

I take my equipment, speed up the steps, and make one of the most embarrassing mistakes of my career. I open the door, see the patient’s face, and shout “WOW!”

His lips were just that big – swollen to fivefold their regular size, because of the reaction.

“Whaaths whong?” he thays, “Whhy you thouwting?”

I apologize, ask him a bunch of questions, take his vitals; and this is what I gleaned.

He is not allergic to anything.

He doesn’t know what he ate (In his words – the school lunch has no humanoid name.)

He was sleeping and felt his lips exploding, but no other signs of a reaction on his person.

His vitals are Pulse:85 – BP:135/70 – O2 Sats 97%

All within normal ranges.

But his tongue is starting to swell, and that is no good. I put on an oxygen mask and open to 10lpm. I rummage in my bag for IV equipment to start a line, but then glance back at him and notice something odd. His lips are now more like a beak; yes a beak, as in a bird, and the mask is dangling a centimetre away from his face.

“What’s that you ask?” – “Did I take a picture and whatsapp to the masses?”

No, I certainly did not. I never ever ever do that.

Old School – TWO  Hot Shot – NIL

The Natan arrives and listens attentively (yeah right) to my hand-over. The signs and symptoms are a bit conflicting here. On the one hand, he has a clear reaction + swelling (bad), but his BP isn’t dropping (good). The paramedics decide to open a vein and then transport on Urgent to the ER.

The second they left, the diagnosis popped into my head. He had probably gotten a bite from a spider or another creepy crawly. This explained the very local swelling, and normal vitals.

Old School – THREE  Hot Shot – NIL

I drop by two days later to see how he is doing. His lips are now down to double normal, and he actually kinda likes the new look.

The ER did some tests, gave him tons of anti-histamine type meds, and sent him back home.

POLICE: Home to AMERICA, you mean.

EMS: Shut up!

FIRE: Do you still need us, or can we go back to sleep?

Conflicting Reports

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T’was early evening in the Shmeel residence, and the hero of our story was doing what he does best: bath time. Kids screaming, bubbles flying, beeper beeping, baby crying, and water splashing; pretty much a normal day.

“Beeper beeping?” did I hear you say.

“Indeed I did. And wouldn’t you like to know what it said.”

“Indeed I do sir; please sir, what did the beeper say?”

“Ah well, said the hero; you shall just have to wait and see.”

 

And so began the bedtime story, I was telling my kids.

I often tell them of my escapades, and the stories always have a wonderfully bright and happy ending. My oldest has begun to question, why, if every story is so joyful, how is it that I often return from a call looking a bit discouraged.

I’ll delay telling them the whole truth and nothing but the truth as long as I can.

In the meantime, the escapades have a weightier purpose. My true intention, far beyond persuasive entertainment, is to instill in my family essential values and critical life tools.

I pray that the tales impart thankfulness, a joy of life and living, an appreciation of being, and gratitude to our Creator for His interminable and infinite kindness. I hope to impart to my kids that even when the going gets tough; especially when the going gets tough, the answer, beyond the lights and sirens, is faith and hope.

I have been there, I have done that, and bear witness that our abilities are severely limited, and that salvation will come but from a connection with the Divine.

Back to our story.

A unique feature of EMS over all other professions or pursuits is that you never, ever, know what the next minute might bring. Sometimes there are three calls back to back in the early morning and then silence for the rest of the day. Sometimes you get weekly furloughs and then an MI, PE and GMG within half an hour. What this means for emergency personnel, is that we need to be prepared to get interrupted at any time, in any place, and during any given activity, to go and save a life.

Particularly popular places to be when a call comes in include: la toilette, the WC, el inodoro, the bathroom, tas tualetas and die toilette. The volunteer can be undressed, partially dressed, or almost dressed. Getting a call when you are absolutely ready for it, is rare. I know someone it happened to once, but even then, he forgot his glasses at home and spent the better part of 5 minutes trying to find the entrance of the building.

Back to our story.

This particular call found me with my hands full of soap, giving my son a bath. Kneeling next to the bathtub, I felt the beeper vibrating in its holster. I had a feeling the call was in my jurisdiction, so I quickly dried my hands and fumbled for the beeper; I was right.

“MVA – Car vs. ‘Child on bike’ – Minor Injury.”

These calls are common in our youngster-rich neighborhood, but thankfully most conclude with only minor scratches and bruises. In any event, an accident involving a child and a car needs immediate attention, and so I deputized my wife for bath duty:

By the power vested in me by the State of New York, I hereby pronounce you ‘woman in charge’. You may now give the kids a bath.

I got to the scene to find a kid standing on the side of the road, pale-faced and crying.

The conflicting reports began. Conflicting is too timid a word; the story was downright odd.

The taxi driver seemed very annoyed, “The kid just rode into the middle of the street without looking! I tried to stop in time but it all happened too quickly.” Then he began to mumble to himself, “Kids nowadays…”

The boy, on the other hand, insisted that he had been riding on the sidewalk and had not been hit by a car at all, but rather had “fallen.”

Something about the boy’s wide brown eyes, and nervous blinking told me that he was lying and desperately didn’t want his mother to know that he had been cycling on the main road.

Furthermore, I have yet to meet a taxi driver that would admit to hitting a little boy on a bike if it hadn’t really occurred!?

I looked the boy over, took some vitals, heard witness reports of the kinematics of the accident and came to the joyous conclusion that the boy would go on to live a long and prosperous life.

The mother soon arrived and excitedly hugged the child, thankful that he would be coming home for supper in one piece. She declined transport to hospital and just before she left, youngen in tow, I silently slipped a pack of winkies into his top shirt pocket. He smiled; grateful for the candy, happy he had survived the accident, and relieved his mother hadn’t told him off (yet).

When I got home, my four year old asked me flippantly, “So, what was it?”

He is an expert on all types of calls, you see.

I told him what had happened.

“Did you give him winkies?”

I assured him I did.

“Good job, Daddy!” he said proudly.

We smiled knowingly at each other as I slipped his pajama shirt over his head.

 

… and they lived happily ever after.

 

Holy Books Everywhere

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The beeper told me that he had a pacemaker;

That means he has a cardiac history.

The beeper told me that he was 58 years old;

That means he was too young to die.

The beeper told me that it was 07:00am;

That means he was probably dead.

 

What I didn’t know, was that his widow would be inconsolable.

What I didn’t know, was that he would end his life, as he had lived it – with virtue.

What I didn’t know, was that he had several young children, who were now orphans, bereft of a father.

 

 

I was still sleeping. It was Shabbat (Saturday) morning. The Beeper beeped, and I instinctively took it off the night table, whilst simultaneously looking at my watch.

My first thought was, “7am – no problem – I have to get up soon anyway.”

“What!” I hear you exclaim in disgust, “Someone is in distress; how can you think of sleep.”

If you consider my thought process immature, negligent even; you would be wrong. The truth, is that I am not a superhero. The brutal truth, is that I am a human being with all the base behaviors and incivilities that are part and package of Homo Sapiens. I, too, am sleepy and have difficulty getting up in the morning. I, too, would much rather turn over and let someone else take the call.

But it was seven am, and my alarm was set for seven thirty, and I am pleased to report that a spirit of decency prevailed, and I jumped out of bed. Literally jumped; something that very few people (outside of EMS) have ever experienced or are proficient in. It is an awakening and shock that is fueled not by the knowledge that you have a meeting downtown at 9, but by the understanding that someone, somewhere, is relying on you to save their life.

And you are already 60 seconds late.

I pulled on my pants, radioed “Unit #18 en route,” and ran down to my bike, two steps at a time. The address was 100 seconds away.

Yes; distance is measured in seconds, when someone is unconscious.

I turned onto the main road, saw that the right lane was closed for some reason, and immediately decided to drive (the wrong way) down the left. I pressed enter on the beeper and reread it:

“58 year old male – Unconscious – Has Pacemaker.”

Bad news.

Many, if not most of the calls for unconscious patients in the early morning are for people that have passed away in middle of the night. The spouse awakens, turns to their partner, notices something is amiss, and calls us. The ‘better’ possibility is that the patient woke up and then collapsed. If the cardiac arrest is ‘fresh’ the chances for survival are significantly higher.

I turn onto the street and immediately notice the son flailing his hands. I get closer and can hear the mother screaming from the first floor window.

Bad news.

I park, grab my AED from inside the seat compartment, and then my equipment from the box at the back. The son is a bit calmer now. He knows he has done all he physically can to help his father. He runs in front of me up the stairs, turning his head only to tell me that his father is 58. I think what he means to say is; do everything you can – and more. My Dad is too young to die.

He joins his mother in the kitchen; to support – to pray.

The duo waves me toward the room; the other kids are sleeping. Control had tried to guide resuscitation over the phone, but mother and son had felt inept.

The door is open to the study, and inside an immense amount of Holy Books (Sefarim). I gently lift the man to the floor and assess.

I radio for assistance and start compressions. Moments later, I am joined by three others.

“No shock advised.”

Bad news.

The Natan arrives and with it plentiful fresh hands. There are now too many people inside the small room and I decide to leave. I make it to the front door and meet #46 on his way in. He looks at me questioningly.

“There are too many people inside,” I explain, “That’s why I’m leaving”.

Suddenly, there is a scream from the kitchen; the son calls for help. His mother has fainted, in the broader sense of the word. There is nothing we can do to help her medically; we stay to offer emotional support.

Ten minutes pass and the head Paramedic from the ALS team wants to talk to the wife. He asks about her husband’s medical history and signals us to leave the room.

I wonder why he was bothering her with an unnecessary interrogation. Perhaps it’s part of the process – perhaps it would help her, to talk. She explains how she had last heard him shuffling around the house at 5am, heading towards his study.

The son catches my eye as I attempt a second exit.

He knows now – he can’t be fooled. He is mature for his age – he will have to be.

There was only one small source of solace in this unspeakable tragedy;

I had found him, sitting at his desk, a sefer open in front of him, having passed away while learning Torah.

For a religious Jew – this is a most honorable way to leave this world.

May his memory be an inspiration and a blessing.

Explosion at the Western Wall

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It was a terrifying sight.

 

I knew why I was there and what needed to be done and yet I found myself shocked, and advancing – but only in slow motion.

Utter devastation, and in such close proximity to the holiest place on earth.

In the background, the Western Wall (Kotel), eternal and proud.

In the foreground, the shell of a bombed out bus; black with soot, smoke billowing from where windows once were. Charred body parts lay strewn haphazardly across the plaza; dozens of victims lying in pools of blood, near death – or worse.

I blinked.

Thank G-d, it was only a practice drill for an MCI, Mass Casualty Incident – known in Israel as an “ARAN”.

In this instance, the simulation was of a terrorist attack; more specifically a suicide bomber that had detonated on a bus.

“Practice! Practice! Practice! –  Aran! Aran! Aran!” came the calm voice over the radios.

Too calm. But then again she was reading from her computer screen back in the control room. She had prepared for this all morning. Staff meetings, rehearsing protocols, division of roles; I too was there. But then we parted ways; she to her screen, and I to the pre-designated spot just outside the old city walls. We had waited in ambulances, engines idle, for what seemed like an eternity; ready to spring into action at the drop of a hat.

The police had initiated this practice drill in order to test their readiness in the case of an MCI occurring, as they put it, in a ‘challenging’ location.

Challenging, was somebody’s idea of a positive spin on an impossible situation. Traversing the old city would be immensely difficult for emergency personnel, due to the huge amount of pedestrian and vehicle traffic coupled with narrow roads and alleyways.

We drove down towards the Western Wall plaza with lights and sirens blaring, unsure of what exactly lay in store. This was after all, someone else’s performance. We were just EMS extras, doing our thing, so that others could practice doing theirs.

This was all new territory for me; my driver on the other hand was a well-seasoned medic, having responded to tens of terrorist attacks in his career. Unfortunately.

The MCI (aka Organized Chaos)

At a mass casualty incident, the first Medic who arrives on scene is known as the ‘Command #10’ and is effectively the officer in charge of the entire operation. His first duty is to quickly deputize two other personnel.  One is called ‘Medical #10’ and his job is to categorize and direct medical attention to the causalities. The other is known as ‘Parking #10’ whose task is to stop, direct and eventually send the ambulances to the various hospitals.

We were instructed by ‘Parking #10’ to park our ambulance just outside the main gate. (If) A bomb had detonated on a bus inside the compound; it would be too difficult to maneuver the ambulances amidst the chaos. We parked as instructed, grabbed our equipment and ran toward the scene of the bombing. We sprinted up the hill and met with ‘Medical #10’ who directed us to the casualty group we were responsible for. I wore a bulletproof helmet and jacket over my uniform because this was an ‘act of terrorism’; we had to be prepared for the possibility of further detonations. I was sweating profusely under my heavy equipment and the helmet’s strap was chafing me beneath my chin, but I persisted up the steep incline.

As I neared the chaos, I noticed a photographer out of the corner of my eye; the exercise was being recorded to be reviewed later by the powers that be.

The scene that lay before me was horrifying, even if it was staged. Those in charge had done a very convincing job with the Hollywood effect. The shell of the bus was literally smoking, making it difficult to see and breathe.

After the bomb squad had done their initial sweep, we were allowed on board and I noticed the source of my discomfort – a smoke machine under the driver’s seat. Blaring from the radio was dark creepy music, or perhaps chanting – a genre that can only be described as ‘terrorist style’.

The mood was set. The atmosphere was unnerving and chilling.

Moving down the aisle now. (Fake) glass everywhere, seats in disarray, injured (actors) screaming. There were bloodied Madame Tussauds limbs strewn about, various volunteers lying dead, and red paint galore.

Full marks for introducing the concept of terror in a very real way.

We set about sorting and helping the victims.

There were numerous injured, both walking and stationary, scattered about. Each had a paper around their neck informing us of their supposed wounds and vitals. Heart and pulse rate, blood pressure, and a short description of the injury were all listed. We were expected to read the description and then initiate triage.

Triage can be an extremely difficult, even gut wrenching, decision-making process. A medic’s initial duty is to separate the wounded into four different categories:

RED = Immediate: The casualty requires immediate medical attention and will not survive if not attended to soon.

YELLOW = Delayed: Injuries are potentially life-threatening, but can wait until the immediate casualties are stabilized and evacuated.

GREEN = Minimal: ‘Walking wounded’ – the casualty requires medical attention when all higher priority patients have been evacuated, and may not require stabilization or monitoring.

BLACK = Expectant: This category is for the deceased or those whose injuries make survival unlikely.

This last category is hard for responders to accept. We would normally rush to initiate CPR on any lifeless person. Here we are told to move on, to assist people that are still amongst the living. A fatality that needs CPR would be classified as ‘non-salvageable’ because their care would mean that at least one responder would have to treat them and not be able to assist other people that are still clinging to life.

This obviously poses some serious moral and ethical issues for emergency responders who respond to mass casualty incidents, as they must make a determination as to who does and does not receive initial treatment.

We divided the various groups, treated, stabilized, and readied them for transport;

48 Casualties in total – (11 Dead, 6 Critical, 14 Moderate, 17 Mild)

 

• 13:51 – Emergency Call

• 13:55 – First on scene

• 13:58 – 1 ALS, 7 BLS Ambulances

• 14:01 – MCRV, 2 ALS, 13 BLS

• 14:05 – First evacuation

• 14:17 – Last patient transported

 

As I put a severely injured child doll on my stretcher, I looked toward the heavens and prayed that I would never have to do this for real.