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

Right on Schedule

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It has been said that there are two rules in EMS; Rule number one, is that some of your patients will die. Rule number two, is that you can’t change rule number one.

Another pronouncement, this time authored by yours truly, is that; “Anything can happen, at any time, to anyone.”

That all sounds a bit morbid though.

On a (slightly) lighter note, I have begun to notice that some types of emergencies occur at particular times of the day. I have listed them below, and would point out that whilst the reason is clear for some, others are a complete mystery.

 

0100   Late night is the perfect time for a fight to break out between, well, whoever is still up.

0300   Very often Chest Pain (Heart Attack) will wake the patient up in the wee hours of the morning.

0500   This is undoubtedly an auspicious time for pregnant ladies to give birth in their homes.

0700   An unconscious patient at this time of day is normally an “X”, having died in his sleep.

0900   Hectic time of the morning and ripe unfortunately for a MVA – Car vs. Child.

1100   Construction sites are getting into the swing of things & someone is bound to get hurt, badly.

1300   Your average teenager will now faint, having walked in the heat, and not drunk all day.

1500   A social worker comes to visit an elderly patient & finds them ‘locked behind closed doors‘.

1700   Attempted suicide – been planning it all day and makes an effort – but fails miserably.

1900   The very young & very old are being fed supper – someone / somewhere might choke.

2100   Actually it’s rather quiet at 9pm.

2300   This is an apt time for parents to find their kids having either Febrile Convulsions, or Stridor.

 

Like I said, some of these are approximations, and others are dead on. (Mind the Pun).

And you’re probably saying, “That’s disgusting, how is he making light of such serious matters?”

Answer, I most certainly am not. I take what I do exceptionally seriously. But there has to be a respite from the depressing talk if we are to be able to continue to do what we do.

I denounce in the strongest terms EMTs who shmooze and joke around outside a failed CPR for example; and yes, it does happen. Not because they are bad people – they’re not. These guys are dedicated and hard working. It’s because having seen it a thousand and one times, slowly but surely, sensitivity wears thin.

Case Study: There was a particularly messy CPR recently; the lady was very skinny – the compressions had broken her ribs, which in turn punctured her lungs, causing blood to rise up the endotracheal tube and make an awful mess. She eventually died, and while the Doctor was filling the death certificate in the house, one of the other members of the team went downstairs to complete the other forms. He switched on the engine of the ambulance, sat in the front seat, rolled down the window, and popped in his favorite ‘top of the pops’ CD. The music was loud, the tempo spirited, and the bereaved family was on the balcony of the first floor apartment.

There was nothing fundamentally wrong with what he did. He couldn’t have been expected to bury his face in his hands and weep; he would be crying all day every day. By default, he had no other choice but to give the CPR his every effort – and once death was declared, go down and eat his favorite snack – or – listen to music.

BUT

He should have closed the window!

Please understand that 98% of the calls I respond to are by their very definition – Sad. And that’s the best case scenario.

Worst case scenario, I am despondent for hours afterwards, unable to get the image of the patient’s face out of my mind. (That’s why I try not to focus on the faces anymore.)

Even the small percentage of calls that are happy – births; are also often laden with stress and tension.

Bottom line:

Take the job seriously, but find time, and lots of it, to be happy, joke around, and seek humor in any rotten corner you can find it.

The Doula

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“Good Morning! #54 to your Ambulance please,” said the tired voice over the intercom.

Several things though – for starters it wasn’t the morning. 05:00 is in middle of the night. Secondly, the voice most certainly did not say ‘Good Morning’, nor did she say ‘please’. That was just me trying to make Control seem more human. They’re not. They are lean mean working machines, functioning under immense pressure for 8 hours at a time. It’s true that a shift can sometimes pass with only a handful of calls. It’s also equally probable that during a particularly fateful morning, the dispatcher can talk a distraught mother/father/child through a home birth and/or a CPR – sometimes in the span of a few minutes.

Furthermore ‘Control’ staff doesn’t have the luxury of (attempting to) sleep through a night shift like regular ambulance staff does. The three or so personnel in MDA main Jerusalem station stay up the whole night irrespective of the volume of calls. Less calls = more reruns, more calls = less reruns. You get the picture.

Bottom line; they get immense joy in waking us up to go out on a call.

Did I say ‘waking us up’. That’s not entirely accurate. Though when on standby we are technically allowed to sleep (night or day,) the reality is otherwise. Every room has a speaker, which manages to blare out incomprehensible blurbs every 18 minutes, keeping everyone in a unique limbo state between blissful sleep and stressed consciousness. Besides, you need to be in the ambulance within a minute of the dispatch, so;

Bottom line; no restful sleep on shifts – ever.

“J’M #54 – you are going to Ramot, on Urgent, for a paturient woman, 41 weeks, 3-minute contractions.”

Five am is a particularly auspicious time for Matern-a-Taxis and if you are lucky, a home birth. Why in the wee hours of the morning, you ask? I’m not entirely sure. I think it’s partly due to the night being a ‘scary and dangerous’ time, when people seem to have a difficult time differentiating between real and imagined emergencies. By 7am the day sheds light (pun intended) on the matter, and people often realize that things are not half as bad as they seemed before. But when the contractions are coming rapidly at 5am, people are quick to call an ambulance: sometimes not quick enough.

So we make it to the address in about 8 minutes, climb the stairs (an exceptionally pertinent fact), and knock on the door. A burly man opens up – promptly notices that we are a three man team, and promptly closes the door in my face. There was nothing, I repeat nothing, that could hold back the torrents of laughter that engulfed us. Yes we were overtired, yes we were called out in middle of the night to the middle of nowhere, and yes, he had just slammed the door in our faces.

“Why?” you ask. Well we (and you) were about to find out.

He called through the door and said “I am not, under any circumstances, having an all-male team delivering my wife”. Full-stop. “Please send somebody else.”

“But the baby’s coming,” we hear the distraught mother shriek in the background.

30 seconds of silence, followed by 30 seconds of muffled dispute.

The door opens again, and he angrily waves his hand towards the bedroom. I walk into the room to find a lady clearly in the pangs of birth, and her doula clearly in the pangs of, well, some sort of mysterious ritual. She had a waist-pack full of vials, which she quickly closed as we approached the duo.

I asked the usual questions; what number birth, whether the pregnancy was uneventful etc. and found out that all was normal and this was her first baby. “How many minutes apart are the contractions?” I asked the doula. She shrugged and said “3 or so.” I went over the facts in my mind, took another look at the mother-to-be, and decided we would try and make it to the hospital. Firstborns are almost never born at home. The process is just too long and the women too jumpy; so they generally get themselves to the hospital hours, or days, before the actual birth.

Remember those stairs I was telling you about. Now imagine this;

4 flights

230 pounds

3 minute contractions

Angry father

Peculiar doula

05:15

3 scrawny schleppers

The experience was like a bad dream, except much more painful on my biceps.

Two in the back and me in the front, we carried her down the endless stairs on our ambulance chair, and made it safe and sound to the ambulance, at 05:25.

We set out towards the hospital with Lights and Sirens, when all of a sudden…

I smelled…

No it wasn’t a burning smell…

It was eucalyptus, yes, unmistakably eucalyptus. And that’s not all. There was music as well. Amidst the din of my siren, was the sound of Beethoven’s 5th Symphony, blaring from…

You guessed it…

The Doula’s waistpack.

Turns out she had placed droplets of eucalyptus strategically all over the back of the ambulance and put on, in her words, “zee kalming muzikk” so that the whole saga would be more relaxing for us. Yes, not only more relaxing for her client, but also for me. How thoughtful. “We should take this lady on all our calls,” my colleague snickered from the back in English. “I zpeek Inglish yoo knowe” she retorted. Oops.

05:38 we reached our destination.

05:40 our patient was in the labor room.

05:43 the baby boy was in his mother’s arms.

05:44 he wanted to know what that awful smell was.