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.

In an Emergency…

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Do’s and Don’ts of talking to an ambulance driver or any member of the EMS services, who has come to help you, because you have called an emergency number and initiated emergency medical protocol, because you were of the opinion that an emergency was taking place; that something dangerous or bad was happening to yourself or a loved one.

I can’t say emergency enough, and you’ll soon find out why.

So when I come to your house in under 120 seconds, body sweating, adrenaline rushing, heart pumping, breathe gasping; having run down 4 flights of stairs to get to my bike, sped over at lightning speed, ignored many a traffic law, climbed up four flights of steps, carrying a 15KG bag in my right hand, heavy helmet on my head. And all because I have been told that someone at that address is in the need of emergency help.

Don’t tell me the following;

 

EMT: What’s wrong?

PATIENT: Two weeks ago…

 

PAUSE: Actually, two weeks is great. Normally with the kids its two weeks, with the adults it’s more like;

 

PATIENT: In 1963, I had a triple bypass. In 1969, I had a polyp on my vocal cords. In 1978, I had an ingrown toenail – but that’s not all.

EMT: Oh No?!

PATIENT: No way, it got worse; the nail got infected, spread to my foot, and I almost had to have it amputated.

EMT: “I’m sorry to hear that,” I say whilst taking off my helmet and getting comfortable on the couch.

PATIENT: Let’s fast forward now to 1990 – Which is when I went to my Doctor. He is amazing – do you know Dr. Nadler, he is just the sweetest man. So sorry to hear about his wife. So I called him and he said…

EMT: (Into Radio) “No need for further assistance” – “Patient stable and awaiting basic transport to hospital”.

PATIENT: Stops talking and impatiently awaits my full attention…

 

Onto pediatric cases, which, never fear; are just as glorious.

Either they hand you the baby as you come into the threshold of the house. Baby is blue or choking or unconscious, or convulsing.

Or,

The parents start blabbering, and honestly – I don’t know which is worse.

 

EMT: What’s wrong with your baby, Madam?

MUM: Well, it all started two weeks ago…

EMT: (I look for a chair.)

MUM: She was coughing so we took her to the Doctor. Do you know Dr. Nadler, he is amazing. Such a gentle man. So sorry to hear about his wife…

EMT: Very sad…

MUM: Anyways, we took her to the doctor and he said he thinks it’s just Viral, so we took her back home. But then two days later she was still coughing, so we took her to the Doctor.

EMT: The same Doctor.

MUM: Yes, of course – I would never go to anyone else.

EMT: (Takes out a chewing gum from breast pocket) Ok – what next?

MUM: Am I boring you?

EMT: No, No, do please, carry on.

MUM: So the Doctor says, go for an X-ray, so we go and the X-ray comes back negative. And then she got a temperature, and he thought it could be an infection, so he starts her on medication. And then we were thinking that we should do the test with the blood, to see the…. You know – the cells…

And we just got back from the blood test a few minutes ago, and I had just put in a load, and then…

 

REWIND: Back to the Bypass man from ‘63

 

EMT: Let me just interrupt you for one second to ask;

Why did you call me?

Why am I standing here now, in my Pajamas at 03:00?

Something MUST be bothering you NOW.

I want to know, desperately, in what way, can I assist you?

What lifesaving measures can I initiate NOW to help you?

If you are not going to tell me what the problem is NOW – not what it was then, nor what your problem WILL be soon – then I cannot help you.

PATIENT: Oh – why didn’t you say so – I am having Chest Pain!

EMT: Thank you!! I’ll take your Vitals, put on some Oxygen and do a 12 lead ECG!

The END.

Twenty Seven

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The first thing I noticed, as I ran into the dark, dank and dirty building, was a bloody handprint on the wall of the stairwell. Not just one – but several. Some quite faint, others frighteningly clear. I ran, swiftly but cautiously, until I reached the 5th and top floor. The smell hit me immediately, strong, metallic. Seconds later my eyes beheld the most horrible devastation of my young career.

Blood.

Everywhere.

All over the bed, the floor, the walls. And in the middle of the room, Unit #66 doing compressions on a man that was, for all practical purposes, Dead.

I was still new to this madness – my human instinct kicked in before my EMS instinct did and I took a step back, instead of forward. I was in the hallway now and in the corner lay the murder weapon in all its revolting glory.

Fingerprints + Murder weapon = Open and shut case.

But that wouldn’t bring the 30 year old man back to life.

I’m getting ahead of myself; let’s start from the very beginning, a very good place to start.

“Violence in a ‘hostel’ in the center of a residential neighborhood – details sketchy – screams heard – approach with caution.”

#66 radioed that he was en-route and I went as well, not because I expected a real emergency, ‘violence’ is often a non-starter – I guess I responded out of plain curiosity.

The report from the scene was as bad as it was quick in coming.

“Stabbing – Traumatic arrest – CPR in progress – requesting Blues NOW!”

My first thought was; do I have gloves in my pockets?! I always keep gloves in my pockets, even when not on call and even when abroad. You never know when you might get involved in a sticky situation.

Gloves – Check.

Courage – not so much.

I found the address easily, although I had never been there before.

Turns out, Hostel was too innocent a word. The squalid building was 5 stories high and located in the center of a normal residential, peaceful neighborhood. Inside however, was anything but peaceful. The residents were mostly Druggies; walking around aimlessly, completely unaware of what was going on in the ‘penthouse’. Actually, they were even oblivious to what was going in their very perimeter.

As I ran up the steps, I thought how absurd it was that the authorities allow a place like this to exist – in this area especially. But no time for reflection now, gotta get upstairs and try to save a life.

We would later find out that both the assailant and the victim were Arabs. Muslim Arab vs. Christian Arab, that is. But because the evidence pointed to a drug deal gone bad, the case was classified as criminally motivated and not nationalistic. Money was owed, tempers flared and the young man was stabbed.

The Intensive Care ambulance finally arrived and with it a semi-retired Russian Doctor. His team began Advanced Life Support – I was doing compressions at a rate of 100/minute, whilst the Doc started counting.

Counting stab wounds that is.

He began poking his finger around the deceased’s body and in heavily accented Hebrew, called out, in a loud clear voice.

One – Two – Three – Four – Five – Six – Seven – Eight – Nine – Ten – Eleven

I turned my gaze from the CardioPump and looked at the Doc. This had to be some form of twisted Russian humor. He couldn’t be serious. But the expression on his face told me he was. I looked back at the chest and focused on the wounds. The lacerations were like nothing I had ever imagined, and certainly not what Hollywood leads you to believe. No body fluid spurting out of machete style gashes. Just lifeblood, oozing slowly out of button-hole size incisions.

The hemorrhage was bad – the internal damage was worse.

Meanwhile the patient was intubated, and thereafter Medic #1 started looking for a vein. It was a futile attempt. The victim had lost too much blood, and his veins were impossible to find. Medic #2 took the initiative and decided to insert a B.I.G. A Big or Bone Injection Gun, in laymen’s terms, is a spring loaded, gun type device that shoots a small metal tube into the proximal tibia to create a route of administration for medications. I fished out the blue colored adult BIG from the ALS bag and handed it to #2. He fired, but something didn’t go exactly as planned and it got stuck. He needed ‘tools’ to fix it, so I handed him my Leatherman and begged him to keep it clean. Why was I carrying a multi-tool to an emergency medical call? Because I had been called to fix things in the past, and learnt the hard way that EMS needs to be prepared for any eventuality.

The Doc was still prodding;

Twelve – Thirteen – Fourteen – Fifteen – Sixteen – Seventeen – Eighteen – Nineteen – Twenty

It was absurd; the insane murderer, in his psychotic rage, had stabbed his victim (at least) 20 times!

Police suddenly descended en-masse. Blues, Yasam, and even Forensics were on scene and each went about his own business. Blues cleared the scene of onlookers, Yasam stood around looking important, and Forensics was gawking at the knife on the floor.

The Doc continued his miserable refrain

Twenty one – Twenty two – Twenty three – Twenty four – Twenty five – Twenty six – Twenty seven

 

Twenty Seven.

 

Time of death – 13:49