A Shift in the Life of a Volunteer EMT

All---

I've blogged on several occasions about my work as a volunteer EMT.  I tweet about it, too.  I've even written a few flash fiction pieces inspired by my experiences.  One thing I've not done is given you all an inside look at what it is I actually do.  Tonight, I'm only working a partial shift.  I'm covering for another EMT who is celebrating his wedding anniversary.  This seems the perfect opportunity for me to blog and tweet a shift.  Nothing confidential, nothing lurid, nothing controversial.  Just a peak at what it's like serving as a volunteer EMT in rural Indiana.

Keep checking back for updates as the evening goes along!

***

5:45pm - Truck check.  Before we put the amublance in service the EMT needs to give it a once-over.  Most of our volunteers work day jobs and so the ambulance is rarely in during the day.  We usually put our unit in service at about 6pm.  The last thing we want is to get a call at 6:10pm, get out to the scene of an accident and then realize we're out of back boards or oxygen.

So that's how I started my shift tonight.  After work I went home, changed, ate a rudely quick supper with my wife, and then ran back into town to check the truck.  I went through each compartment to make sure the supplies were there.  I checked each oxygen tank to make sure it was appropriately full.  I checked each medicine to make sure it hadn't expired.  I performed some general clean-up to make sure that the back of the truck was tidy and professional-looking.  It's amazing how much of an impact that can have on patient confidence -- and patient confidence is the key ingredient for patient comfort.

Tonight, most everything was in order.  I straightened a few things out, replaced a few nasal cannulas, and that was about all it took.  The truck was ready!

Since we're a volunteer unit, most of the time we respond from home.  That means that we have to be in communication with our team members. It's a little goofy, but I'm a certified EMT but I'm not cleared to drive the ambulance.  I'm actually covering for the drive tonight.  That means that the guy who was going to be EMT is shifting over to driving for the first few hours of the night, and I'm EMT.  That means that he's in charge later, but for right now I'm running point.  I called him, confirmed he was ready, and then called the hospital to put us in service.

Since about 6pm, our basic life support unit has been in service, available for calls.  An hour in, we haven't had any yet.  The county's been quiet as a whole so far.  You never know from one moment to the next.  The rest of the shift is all about waiting.

UPDATE!

7:45pm - We were dual-tone dispatched with a paramedic unit to respond to another nearby town.  Most of the volunteer county units are out of service tonight, which means that the units that are in respond across a much larger area than usual.  The county units like ours provide only basic life support, and so in cases of chest pain or other potentially time-critical highly precarious conditions, a paramedic unit is also dispatched at the same time.  They can provide advanced life support.  (What BLS and ALS each entail varies from state to state in the US.)

I had missed a voicemail from the guy I was covering for. He was back and available, but we went ahead and ran as a three-person crew.  I stayed as EMT since I was on point still.  No sense creating confusion.

As it was, the paramedic unit made it to the scene before we did and they maintained care and transport of the patient.  Sometimes they will do that.  Other time they will ask for the patient to be transported in our truck and they will have a medic ride along.  Tonight, they were in a position to keep the patient and so they did. 

We call that a Signal 9 run -- a "disregard."

We stuck around to help the paramedics if they needed, but there was also a rescue squad on scene.  I held a door open.  Another crew member assisted with lifting and moving the cot.  Our third crew member just stood by in case he was needed. 

Then, we went back in service and returned to the station.  Since I was EMT, it was then my job to call dispatch to get the times for the run.  Just like you have to fill otu paperwork when you're a patient at a doctor's office, we have to fill out a whole lot of paperwork to take care of you.  Or even, in this case, to state that we didn't take care of you because someone else did.

At this point, since the guy I was covering for is back early, I guess that's the end of my shift.

No life-saving for me tonight.  But that's part of being a volunteer.  Sometimes it is very much about saving lives.  Other times it's about not being too proud to stand by and hold a door or grab onto another guy as he carries a cot down stairs, so he doesn't lose his balance. 

It's great when you play a key role in getting someone the help they need to save their life. 

It's just as great, though, when you make yourself available to help however you are needed.
Here's the men and women who are out there saving lives right now.

And here's to the other men and women who are holding doors open for them and schlepping their equipment around.

.Nevets.

The Jade Badge of Courage

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It comes as no surprise, I'm sure, to learn that police, investigators, and emergency personnel all routinely encounter a sort of darkness that most of get through our day just fine without.  It's the kind of darkness that people wear close to their skin or wrap around their heart, that never sees the light of day.  Police, investigators, and emergency personnel don't work in the light of day.  (Metaphorically.)

You can reign in your crazy fantasies here, too.  I'm not even talking about serial killers and shotgun murderers, child rapists, or people with the kind of secret sexual lifestyle that inspires television crime drama.  That stuff is there, and it's plenty dark.  It can also be a bit of distraction.  There's plenty of other darkness.  There's the man who knows his smoking is killing him, and just sort of hopes every trip to the emergency room might be his last one.  There's the lady whose Alzheimer's is so advanced that she can't stop shoplifting and only giggles like a two year-old when she's caught.  There's the guy who always wondered what it would be like to smoke marijuana and happened to smoke some pretty foul grass on a foggy, icy night when he was already tired, and no one knows if it helped him into the lake or not; they just know he ended up in the lake.  There's the girl who is so bored and discontent with her life that she wanders through the park, daydreaming with her eyes closed, not paying attention to where she's walking or who else is around her.  That's all darkness, too.

What makes makes darkness a challenge for people like police, investigators, and emergency personnel is that there is in, in the end, nothing they can do about it.  Whatever they do, it's too late to stop the something from happening.  Perhaps they can stop it from happening again, but they are are the mop up crew for society's spiritual and moral waste water.  Once it's spilled, you can clean it up, but that doesn't undo the spill, not really.

Not only that, but normal human coping mechanisms are not options for these folks.  Laws, codes of conduct, oaths of service... These things bind such personnel.  The darkness they encounter, they cannot talk about.  They can't go fishing with a buddy and talk about it, even if someone wanted to hear it, even if someone could stand to hear it.

So what do they do?

They drink, a lot.

They tell cynical, tasteless jokes.  A lot.

Sometimes they stretch the boundaries of their oaths, and they talk to one another.  Sometimes they violate their codes, and they just go ahead and talk to their wives or their friends.  Sometimes they find a counselor who is qualified, willing, and distanced enough to sit back and listen and is bound by an oath of her own.

That's probably the healthiest option, but it's not always as easy as it sounds to find such a person, let alone to feel the kind of trust necessary to expose them to the private darkness the cop is carrying around.

Most often, cops wear the darkness like a sheath over the badge.  It's a sign of toughness.  It's a sign of pride.  It's a sign of shared, gasping futility.  It's a way of saying, "I take this crap into my head so that you never have to, and nothing you can ever do will thank me enough for that."

We've been talking recently in my anthropology class about cognition and perception, about meaning and expression.  The world that you know is shaped by meanings that you have internalized.  Those meanings develop (in part) as the world passes through your perception (seeing it) and then your conception (organizing it, making sense of it).  It's one thing to know that the darkness is out there.  It changes your whole world when you come face to face with the darkness.  It breaks your world when you have no way to organize and make sense of it.

.Nevets.

Blogsclusive: "Life Support"

"Life Support"

by C. N. Nevets

                Di-di-di-di-di-di-dit.  “Attention, Medic Unit.  Attention, Medic Unit.  Medic Unit, respond to 1179 North Sunnydale Drive.    For a seizure a patient.”

                Even at 1am the November sky seems thick and woolen, like a heavy grave blanket over top our small town.  The air is chilly, but it’s not  crisp; it’s dull and ashen.  The fall leaves lay on the ground, wet and matted, clay-rich much dulling the smell of their decay.

                The house looks like Midwestern suburbia.  Clean, pretty, cookie-cutter.  Two stories, four bedrooms, three baths.  Attached garage.  Shutters.  The yard is mowed.  The hedges trimmed to perfect, flat-sided cubes. 

                Outside, a mother.  A woman.  Mid-forties in jeans and a sweat-shirt, hair pulled pack.  Her face is marked with concern.  She flags me down.

                “—I don’t really know the boy, but he’s staying here tonight.  I guess he has a history of seizures but it’s been a long time since he had one.  I don’t know what’s going on.”

                A boy with a history seizures.  I think 7 or 8 years old.  I think his parents should have left his meds.  I think his parents should have left a note and some instructions with what to do.  I think his parents should have left him with someone who knew him.  I think Wednesday night during the school year is a strange night for a sleep-over.

                The enter the house into a living room.  There are no lights on.  There is a couch, and an arm chair.  There is a lawn chair.  There are some empty boxes.  There are also four adults, sitting in the dark, fully-clothed, saying nothing and doing nothing.  Off to the right is a hallway, even darker.  Off the left, a hallway, with a hint of yellow light.  Through to the other side is an open doorway into a kitchen with a nightlight illuminating three children.  Two girls and a boy, the oldest fourteen and the youngest seven.  None of them are seizing.

                The middle girl raises her arm and points down the hallway to the left.

                It’s a short hallway.  There’s a bathroom at the end.  There’s a bedroom door on the left with light slipping out from under the door.  I open it and step in.

                The room reeks. Cigarette smoke.  Marijuana.  Alcohol.  Sweat.  Urine.  There are three high school boys, two of them in shorts and muscle shirts.  One of them has pupils the size of saucers.  The other has pupils the size of pinpricks.  The third is on the floor, face-down, stretched out, wearing jeans, socks, two shirts, and a jacket.  A cop is in the corner, tall and stern with his arms crossed.  When he sees me, he kneels down and rolls the kid on the floor to his back. 

                “—This is the one.”

                The kid’s eyes are unfocused. 

                “What happened?”

                The kid says he doesn’t know.

                “He fell.” 

                “How?”

                “He was just sitting on the couch and fell and started shaking.  His head was in that shelf.  We held him and had him bite on a wallet.”

                “He was just sitting?”

                “Yeah.”

                “Are you hurt?”

                The kid says no, but he presses a hand to his abdomen.

                “Is your stomach hurt?”

                The kid says yes. 

                I examine his abdomen.  No signs of injury.  He’s not sensitive to touch.

                “Did you hit your head?”

                The kid says no.

                “Can you stand up?”

                The kid says yes and he tries and it’s like watching a fish try to stand up and its tail except that he’s even less successful.

                On the floor there’s a pile of cigarette butts.  There are half a dozen gas station fountain drinks, spiked with something amber that the kids probably call whiskey.  One of them has cigarette butts floating in it.  Another has cigarillo stubs.   

                “—What were you guys doing right before this happened?”

                “Just sitting.”

                “Drinking anything?”

                “No.”

                “Smoking at all?”

                “No.”

                “Take any drugs?”

                “No.”

                “Smoke a little weed?”

                “No.”

                The cop rolls his eyes.

                One of the kids hands me an orange pill bottle only slightly smaller than a pop can.

                “—These are his meds.”

                Justin Gris.  Seizure meds.  Dr. Colle, a pediatrician.

                “—Justin, you wanna go to the hospital and get checked out?”

                The kid asks why.

                “You had a seizure.”

                The kid says he didn’t.

                “Then what happened?”

                The kid says he had a seizure.

                His friends both try to convince him to go.  The mom-type woman  walks back to the living room.  The cop tells the kid he wants to go the hospital.  The kid finally agrees.

                “—Can you stand up?”

                The kid tries.  He can’t make it. The cop, me, my helper – we assist him to his feet and keep him steady.  We help him to the cot, which the ambulance driver is holding steady.  It’s like we’re helping the Little Mermaid take her first steps. We’re doing the walking.  He’s just along for the ride.  His spine sags.  His legs wobble.   

                “—You sure didn’t have anything to drink?”

                The kid says he’s sure.

                “No drugs either?”

                The kid says no.

                We get him on the got, secure him, load him onto the ambulance.  His vitals are normal.  His pupils are jacked open and when I shine a penlight in them, they tighten just a bit, slowly, and then they saucer out again.

                “ – Are you sure you didn’t do any drugs, Justin?”

                The kid says he smoked one blunt.

                “Are you sure you only smoked one?”

                He says yeah.

                “Because earlier you told me you were sure you didn’t smoke any.”

                He says yeah.

                “Was that blunt dipped in any alcohol?”

                He says no.

                “Laced with any other drugs?”

                He says no.

                We start to the hospital, no lights, no siren, but quickly.  His vitals are stable.   He stinks of BO, smoke, and his own urine.

                “—How old are you?”

                Eighteen.

                “You go to school, Justin?”

                No.

                “You work?”

                No.

                “What do you do?”

                I don’t know.

                “Those your friends back there?”

                I guess.

                “We’re going to get you to the hospital, Justin.  The doctors will check you out.  Make sure you’re okay.”

                Outside, there are no stars in the densely shrouded November sky.  The heater does what it can to fend off the chill in the air.  The ambulance speeds along the road, cruising over a thick blanket of wet, moldering leaves.

(c) Copyright 2001, C. N. Nevets

The 3 AM Call: An EMT's-Eye View

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Some volunteer EMT's don't mind being woken by a page in the middle of the night.  Some can't stand it.  No one goes to bed and thinks, "I sure I hope get woken up."  But it happens.  A lot.

You go to bed and some nights you think, "Uh, I really hope I can just sleep through this night."  Some nights you think, "Well, I'd love to get a run tonight, and I feel pretty good, so it'd be alright to get toned out tonight."  Until you've been doing it a while and start to get jaded, you feel a little guilty about it even being a question.  After all, if you're needed, you're needed.  You volunteered.  It seems petty to even think about complaining.

Photo by Brad and Sabrina

But sleep.  Sleep is good.  And when you have a job, and you're tired, and you have to go to work the next day, too -- sleep is very, very good.

When it happens --

When the pager goes off --

When you're rattled abruptly out of your sleep cycle by the sharp, piercing, rapid-fire beeps, you don't know  what's going on.  You look at your alarm clock first.  The numbers don't register, but you get the sense it's still late.  Early.  Whichever.  Not the time to wake up.

Suddenly your mind half-tunes in the words, already in progress, "Attention Medic Unit, Attention Medic Unit.  Respond  to 303 E Raymond Street, Apartment B."  She speaks in a droning monotone, unnatural pauses forcing her words into rhythm that feels even more awkward as you rise from the dead of sleep.  "For a patient with breathing difficulties."

You remember then what the noise is, why it's waking you, what you're supposed to do.  You remember you're an EMT.  It's your job to help that person.

"This is a Lifeline call."

You rise swiftly.

"Be advised that an officer is en route."

Perhaps you sleep naked and need to pull on your clothes.  Perhaps you sleep fully dressed, head to toe.  If you're like me, you sleep in the shirt, pants, and socks, but not the rest.  You move out to the living room, stopping yourself from turning on the lights because your wife is still asleep.

You slip your feet into your shoes.

You think about tying them, but then you remember that takes too much time.

You pull a hat on.

Grab your watch.

Pat your pockets to make sure you're wearing the pants with your medical tools in them.

Suddenly, you feel slow, and you hurry up and finish.  On the way to the station, your mind starting to clear as soon as you back the car out onto the road, you start thinking about how to prepare.  Maybe you remind yourself of some of the acronyms and mnemonics.  Maybe you think about the last breathing difficulty patient you had.  Maybe you remember the last time you went to 303 E Raymond Street, Apartment B.

By the time the second tones go off, two minutes after the first, you're afraid you're running late, even though it's only been two clock minutes since the first tones went off.  It's not two minutes.  It's when the minute hand is two minutes further along than it was.  From 3:26:58 to 3:28:00 is two minutes.

But in the dark of 3:30am, even as you shake your dreams off and focus on the real world, you still worry about it.

A minute later, you're in the ambulance and on the way.

After the run, after the patient has been transported.  After the patient has been delivered to the hospital with an open airway, and as good a vital set as possible.  After care of the patient has been handed over to the emergency room nursing staff,  and the paperwork has been filled out, and the truck has been cleaned up, and  your driver has finished off his cigarette, you hop in and ride home, unwinding, along the way.  The longer the ride home, the better off you are, the looser the grip of adrenaline on your wakefulness.  That's when you can go home, crash, and go to sleep.

But you don't always get a full run.  You don't always get to see a patient through.  You don't always get that long wind-down.  Sometimes.  Many times.  For stretches, most times.  You get a signal 9, a disregard.  Woken up and possibly amped, you hear her voice again.  Her droning monotone.  The awkward rhythm.

"Attention Medic Unit, Attention Medic Unit.  Per County.   You can.  Disregard."

"Medic Unit clear."

And then it's back home.  A short ride.  You never got to use the adrenaline that was required to wake you up from the depths of your sleep.  You never get a chance to wind down and let the adrenaline ease off.  As quick as you made it to the station, you're back.  And then you're home.  Wide awake.  It's 3:40 in the morning.  You know you're tired.  You know you want to sleep.

You know it's going to be a while.

And you think, "Well, at this point, we might as well get another run."

.Nevets.

The Humans are Dead

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In case you've not noticed before, I've added some news feeds to the blog, about topics related to themes in this blog.  (There's a tab up top!)  As I was glancing through this afternoon, I came across this article from the York Daily Record about the county looking for a more accurate way to track EMS (ambulance) response times.

Photo by Coolcaesar

This, I think is one of those things that I think most people assume is far more technical and precise than it is.  If I were to ask ten people on the street how EMS responses were recorded and reported, both in real time and for statistical purposes, I'm not sure what they would say.  I doubt many would say, "It's based on what you say on the radio."

Here's how it works in our area, and it's somewhat similar in most places.  This process holds true for both volunteer and professional EMS units, though the professional units are usually stationed at their ambulances and so don't require a second alert tone.

1. Dispatch receives an alarm (e.g., a 911 call or a Life Alert).
2. Dispatch sends alert tones to an EMS unit.
3. After two minutes, Dispatch sends second alert tones to EMS unit.
4. EMS crew assembles, and reports on the radio that they are responding.
5. Ambulance drives to scene.
6. When ambulance arrives at scene, driver reports on the radio that the unit is on scene.
7. When the ambulance is ready to leave the scene, the driver reports that, as well as the current mileage on the odometer.
8. Ambulance drives to hospital.
9. When the ambulance arrives at hospital, driver reports on the radio that the unit is arriving at destination, and reports the ending mileage.

Seems simple and reasonable when you see it spelled out like that, and it typically works pretty well.  For better or worse, though, it depends on humans.    Someone must report and someone must hear.  Someone must speak clearly and someone must understand correctly.  No one can forget a step, or the entire record is essentially meaningless.

For instance, in our area, we are permitted to take a patient to an out-of-county hospital if they request, but we are required to report on the radio our time leaving the county and our time back in the county. (Among other reasons, so that dispatch doesn't try to divert us to another call, but also so that our response can be accurately timed and recorded.)  It's an easy thing to overlook while on a run.

Even if the calls are made as they should be and understood as they should be, the information has to be recorded and input.  

Things get even murkier when it comes to recording which district the response is in.  It's important for a number of reasons to know how often our EMS unit covers a call in another territory.  This information comes entirely from two sources: a note made by the dispatcher, based on their understanding of the geography; and a note made by the EMT who fills out the reports, based on their understanding of the territories.

Some areas have begun using GPS, RFID, and other technologies to track the real time movements of emergency personnel, but these tools are expensive -- not to mention invasive.  In our area, GPS systems are used to record the speed of ambulances, but not to actively monitor locations or to track response times or route efficiency.

NASA Android,
photo by Geoff Stearns

This is an interesting topic specifically, but I think it also plays into a broader conversation about relying on humans in this increased technical era.    We have come to expect mathematical precision in everything, and every year that passes increases the needle-point fineness of the precision we expect.    When we don't have the precision, we fear we are wasting money.  We fear we are jeopardizing public safety.  People will cry about government waste and the safety of the children.

And, then, when technological solutions reduce the number of employees required to conduct business, we lament lost jobs.  When humans are replaced by machines, we weep over the dehumanization of our civilization.  When we track people's movements and record their performance to the millisecond and millimeter, we object to the invasion of privacy and grumble about micromanagement.

And, yet, we want precision.  We want accuracy.  We want what we call scientific certainty.

But we want it with a human face.

'Tis a pickle, my friends.  'Tis a pickle.

.Nevets.

EMS 301: What an EMT Actually Does

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No matter what color an ambulance is, it's something of a black box to folks who don't work in EMS.  I thought perhaps one of the most helpful things I could do as an EMT would be to simply lay out for you what an EMT does.  While there are variations on the way an individual EMT processes these tasks, based on the situation and personal experience, these basic steps are the way every site visit should begin, per national standards.  Understanding this recipe will help you understand what an EMT does.

photo by Coolcaesar

Before treating the patient, the EMT must...


1) Ensure that the scene is safe.  An EMS crew is of no use to a patient if the scene puts the patient or the crew in danger.

2) Confirm the number of patients.  Many times a dispatch is vague, e.g., "for a medical problem."  There's nothing worse than driving away from a scene with a family left behind wondering, "Well that's great for gramma, but what about Sally?"

3) Determine the basic nature of the illness or mechanism of injury.  In other words, what's wrong with the patient or patients and what's the short version of what happened?

4) Based on the patient and the mechanism of injury, Decide if precautions should be taken to immobilize and protect the cervical spine.  Because damage to the vertebrae in the neck can be life-threatening, the EMT needs to take care to protect that part of the body before any further treatment is undertaken.

5) Given the patient, the scene, and all the other factors, Evaluate the need for additional help.  Will the crew need a lift assist for a heavy patient?  Does the patient need to be extracted by the fire department?  Should the police be called toe secure the scene?  As a basic life support unit, do you need to call for advanced life support?

6) Be protected by appropriate BSI ("body/substance isolation") measures.  The crew should always be gloved, and may need to wear gowns, masks, or safety glasses depending on the scene and patient.

Once  this "scene size-up" has been completed, the initial assessment of the patient may begin along these lines:


1) General Impression.  The EMT needs to have a basic idea of the patient and the situation as the foundation for the rest of the assessment.  For instance, "A male, middle-aged patient complaining of chest pain."  Nothing more complicated than that.

2) Obvious Life Threats.  Is a patient has an obviously life-threatening injury or condition, the EMT doesn't need to and shouldn't fret about the rest of the detail until that life threat has been dealt with.


3) Level of Consciousness.  Is the patient alert?  Is the patient responsive?  Often times, this is taken care of  right away by simply saying something like, "Hi, I'm Nevets, and I'm with the ambulance.  What can I help you with tonight?"  If the patience responds appropriately, you know they are responsive to verbal stimuli, and you can move on.  If there are problems with the LOC, then steps should be taken to correct these problems.

The next steps are the ABC's:

4) Airway.  Does the patient have a patent, or open airway?  Is there a working pathway for air to move from outside the body into the lungs and back out?  The EMT needs to be concerned about obstructions, wounds, and other things that compromise this.  The good news is that, since the movement of air is required to speak, if the patient answered the question in Step 1, you know there is an open airway.  In some cases, airway maintenance is so complicated that the EMT never moves beyond this until the patient is at the hospital.  There's a common saying: We never deliver a patient without an airway.


5) Breathing.  Okay, so there's an airway.  That's great!  But how's their breathing?  The EMT will get a respiration rate (how quickly the patient is breathing), check for unusual breath sounds, ensure that both sides of the chest are rising and falling about the same, and evaluate the quality of the breaths.

6) Circulation.  Only at this point should the EMT worry about things like blood pressure, pulse, bleeding and other signs of circulatory distress.  To many people it's surprising that we wait this long, but the truth is if a patient as an altered level of consciousness or is not breathing, it doesn't matter how well their heart is working: they may die with a perfectly good heart.  Without oxygen, the heart can do no good.  If the brain is damaged, it may not matter if the heart gets it blood.

At this point, the EMT makes a Decision for rapid transport ("priority") or for further assessment on-scene.  Look for another post soon about the further assessment process -- but in the meantime I was this was either helpful or interesting.  If you have any questions, please let me know!

p.s., If you haven't already, please do go back and read EMS 101 and EMS 201.

.Nevets.

EMS 201 for Crime Writers

All---

It seems like time for the second installment of information about EMS (Emergency Medical Services) in the USA, intended to help writers understand things from my own experience working on the local ambulance and being part of the country, state, and national networks that encompass our little unit.

If you missed the first part, you can click on the lick in the bar at the top of the page.  I could easily link to it here, but I'm trying to reinforce the use of the bar.  This may be a lingering mood from working with clients all day; I'm not sure.

At any rate, what I wanted to cover today, in brief, is the typical sequence of emergency response.  I've noticed that this is one area where people typically have no clue other than what they see on TV and piece together from their own experience and their sense of logic.

So here you go in quick form:

1. Person calls 911 or activates LifeLine (who then alert 911).

2. 911 dispatches as necessary police, fire, and ambulance.  Each service often has another dispatcher internal to it that is the contact point for 911.

3. Units arrive on scene (if dispatched) in the same order: police, then fire, then ambulance.

4. If the ambulance that was dispatched offers Basic Life Support only, that crew will make the determination and call their own dispatch to ask for Advanced Life Support or a helicopter transport.

There can be a little variation in this sequence, but honestly not very much.  Here's why:

• The police can get anywhere faster.  Their cars are faster than our trucks, they have a little more legal freedom, and they are already mobilized and not needed to load up from a station.  The police are are responsible for securing the scene.   If the scene needs the police, even if the other services somehow get there first, they will almost always wait for the police to arrive and make sure the scene is safe.  Our number one priority is not the patient's health; it's the safety of our crew.  If our crew isn't safe, the patient isn't safe either.
• The fire crew is also the rescue squad in most situations.  That means they are the ones who are responsible for extricating patients from cars and stuff like that.  There is no point in an ambulance getting there first.  They also are often able to respond more quickly, because there are more fire units than there are ambulance units, and so they have a better distribution.
• The ambulance is where the EMTs or paramedics work.  While many fire crews have EMTs on them, and even some police departments, most jurisdictions defer care decisions to the EMTs who are on ambulances.  It is those folks who make the determination if more advanced services are needed or a helicopter might be appropriate.

So that's the order -- police, then fire, then ambulance, then helicopter (if appropriate).  There are few exceptions to this sequence in most jurisdictions, though obviously not every service is required at every scene.

Finally, a clarification about helicopters.  Helicopters are rarely faster than ambulances.  When they are, it is usually because there is intervening terrain or traffic that makes travel by road difficult.  Otherwise, it is so much quicker to mobilize an ambulance than an aircraft, that there is often not a whole lot of patient time gained in the end.   When that's the case the main reasons to go with a helicopter are (a) to minimize transport time itself, or (b) to expedite delivery of the patient to a specialty center.  Sometimes the total patient care time is not what's critical; what's critical is minimizing the time that the patient is being moved, and sometimes a helicopter can provide that.  Most ambulances cannot  bypass their own hospital system as easy as helicopter, so in a case when the EMT determines a trauma, burn, or other specialty care center is necessary, they may ask for a helicopter to ensure a beeline (almost literally) to that center.

Well, that's it for tonight.  Hope it's helpful, and if you have any other questions, just let me know!

.Nevets.

The soundtrack for writing this post was provided by Cracker.

EMS 101 for Crime Writers

All---

I don't have a ton of time today, but I thought that for crime writers and authors in the US this would be helpful.  Also perhaps helpful for my readers outside the US, and certainly will help any readers of my blog understand what the heck I'm talking about:

In the United States, Emergency Medical Services (or EMS) refers primarily to pre-hospital medicine and patient transport.  It's essentially the ambulance (and helicopter) folks.  While there are many variations from state to state, this is basic break-down of the EMS world in Indiana.  Each level builds on the previous.


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First Responder - Provides first aid and CPR, arrives prior to ambulance
EMT-Basic - Provides basic life-support, including airway management and patient transport
EMT-Advanced - More advanced, including IV's and simple EKG's
EMT-Intermediate - More advanced, including endotracheal tubing
Paramedic - Provides advanced life-support.

In addition, many EMS units (especially volunteer units) employ drivers who are not medics and also medical assistants.  Many fire departments require their members to be EMT's or at least first responders, because fire departments are typically in charge of extrication of patients from vehicles.

EMT, of course, stands for Emergency Medical Technician.  Ambulance units like ours are typically BLS, meaning that we provide Basic Life Support.  Our primary medic is an EMT.  ALS, or advanced life support units, include a paramedic, and typically must run from a hospital.

I know on TV they always call the ambulance a, "bus."  I'm sure people really do that, but around here call it a truck or an ambulance.

When you're paged, you're "toned out," because each unit has its own unique set of tones so that its members know when to respond.  (Or, in this digital age, its pagers' know which which calls to react to.)

When we go out to respond to a call, we call it a run.

And, lastly, while we are encouraged to use plain English at all times on the radio, most old-timers still mix in a lot of ten codes and numeric signals.  Many of these are local and peculiar to the service and system.  (Which is one of the main reasons Homeland Security would prefer we use plain English.)  Around here, Signal 1 means you're on scene, Signal 9 means you can disregard the call, and Signal 14 means a possible death.  Code 1 means a transport at normal speed with no lights or sirens.  Code 2 means to go quickly, but no lights and sirens.  Code 3 means to go all out.  A 10/11/12 is a possibly lethal cardiac event.  A 10-50 is a car accident.  Just to give you a sample...

Okay, hope there's some worthwhile information in here!

.Nevets.