other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Sunday, May 10, 2009

More Than One Patient is No Fun

It just figures.

I've been complaining recently about the lack of variety on the evening shift. The only calls we handle, it seems, are cardiac ones. I can't wait for the end of the year, when I'll have an opportunity to go back to the night shift, so I can deal with drunks, and brawls, and car crashes, and shootings.

A couple of weeks ago, a woman was shot to death in the Back Bay. This was the so-called Craigslist Killer case, the one in which a BU medical student allegedly shot a prostitute who'd advertised her services via the Internet. Since it happened shortly after 10 p.m., I probably would have responded. But I didn't, because it happened on my night off.

And then, last evening--also on my shift--a pair of Green Line trolleys collided between Government Center and Park Street stations, sending some forty-six people to various hospitals. I would have responded to that call, too, and since the accident location isn't far from my EMS station, I would have been among the first to arrive.

But I didn't go to that call, either. I'd been given the night off, for military duty.

Truth is, I wish I'd responded to both of those calls. Not because I have any great desire to jump into newsworthy stories, because I really don't care about any of that. Work for a big-city EMS agency for a while, and you'll see yourself on television and in the newspapers. It comes with the job. But after a while, you find yourself ducking away from the reporters and photographers, because you no longer feel like being involved.

I regret not being there for a much simpler reason: it would have been something different. A call that for once didn't involve chest pain or difficulty breathing.

There would have been a downside, of course. Calls involving multiple patients are a lot of work. Chaos is inevitable. Some EMS personnel would take this a step farther, referring to such incidents as "circuses"--or worse.

We responded to Logan Airport once, where a man had suffered a head injury. It was an international flight, and we had to wait for a while as the plane taxied to the gate. When we finally got on board, we discovered that our patient had indeed injured his head. It had been split wide open, all the way down to the bone, from one ear, across the top of his head, to the other ear.

The plane, we soon learned, had flown into a severe downdraft, plummeting 5,000 feet in a matter of seconds. The patient had been standing up in an aisle at the time. When the plane went down, he went up, slamming the top of his head into the ceiling.

As we treated him, a flight attendant called our attention to another patient, at the opposite end of the same row. He'd suffered an identical injury. His head, too, had been split wide open.

Somebody tapped me on the my back. It was a third passenger, also with a head injury. Then a fourth came forward, and a fifth, and a sixth. Finally I announced, "Everybody injured, raise your hand!"

Eighteen hands went up. My partner and I would need some assistance.

In caring for patients on airliners, we sometimes ask the flight attendants to keep the other passengers in their seats while we evacuate the patient. Other times, we let the healthy passengers leave first, to give us more room to work. It all depends on circumstances.

This time, we asked the crew to "deplane" (in airline parlance) the uninjured passengers. We didn't have much choice. Alone with my partner and a handful of airport firefighters, we couldn't possibly remove eighteen patients.

At a scene like this, triage tags are used. They look a bit like baggage tags, with a string for attaching it to the patient. Each one has a series of color-coded strips--red, yellow, and green to indicate severity; black to identify patients with no chance of survival. You rip off three of the strips, leaving the one that applies, and you attach it to the patient, giving everyone an idea of just how urgently that patient needs to be transported.

Someone had the wise idea to use a catering truck to evacuate the patients from the plane. Normally these trucks are used to lift hundreds of dinners to the plane's galley. On this day, though, they carried a different cargo--injured passengers.

In the end, everyone seemed to make out all right. It took a while, but eventually everyone went to a hospital. Fortunately, the patients seemed to understand that we were working as quickly as we could. Nobody panicked, and nobody became unreasonable.

These kinds of calls generally go much worse. On the plane, everyone needed to be immobilized for neck injuries. But only the men with the split-open heads were bleeding severely. Imagine walking into a mass-casualty incident where eighteen people are bleeding to death. Where would you begin?

My colleagues who responded to the MBTA subway crash last night went through this same process. They triaged the injured, tagged them by priority, called in reinforcements to help with immobilization, carried the injured to ambulances, and shipped them all off to hospitals. Meanwhile, other colleagues of ours--the EMTs who work in the EMS communications center at Boston police headquarters--worked the radios and telephones, determining which patients should go to which hospitals.

So, in a sense, I'm glad that I didn't have to deal with the chaos.

But I still wish I'd been there.


Anonymous MichiganEMT said...

I used to work for a Casino in Detroit. One day we had a cardiac arrest call. We were able to successfully shock him. We called a private ambo for transport. The crew asked me to go along in case the patient went into arrest again. As soon as we loaded the patient and cleared the casino, the paramedic in back with me went into a severe asthma attack. Now I had two patients to tend to! Thankfully, Detroit Receiving Hospital was only three miles away. This hasn't happened since, but I like to think that I earned my "trial by fire" badge.

11:08 PM  
Blogger Fibro Witch said...

Oh man, that reminds me of a visit to Las Vegas for a Safety Engineering conference. A older man had a heart attack while on the floor playing slots. He had collapsed, and the people around him including his wife just kept playing away.

I knew the Safety Directer of the casino and got to watch the EMT's security staff and Vegas police department get the man and his wife off the floor. She would not leave the slots, and was almost arrested. He said people frequently refuse to go with loved ones to the hospital, the need to gamble is so intense.

Sad, but true.

7:02 PM  
Blogger TS said...

Fibro Witch:

Wow! That's cold!

10:14 PM  
Anonymous MichiganEMT said...

Got one better. While working the same call I posted earlier, the man's wife, daughter, and grand daughter were with him. While I was doing CPR, waiting for the AED, his wife got his wallet and gave me the ID. Then all three left the scene. I had assumed that security removed them to spare them the trauma. We waited at the hospital for 45 minutes for the family to arrive, but they never did. Instead, they stayed at the casino and gambled with the money the wife removed from her husband's wallet while getting the ID. Damn!

11:17 PM  
OpenID Dr. Jake said...

Next time you're on duty, comment to your partner about how quiet it seems to be.

You'll have as many patients as you can stand.

12:30 PM  
Blogger brian said...

Know exactly how you feel...Hate to miss a big call...

This is my take on it:


1:35 AM  

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