Our shift has barely started and we aren’t quite ready to go on the road, but dispatch calls to see if we can take a rectal bleed call just down the street. We look at each other, nod, and take the call.
We get a lot of calls for rectal bleeds, few of them are anything significant – but when people truly have an active gastrointestinal bleed, it can be very bad. Very life threatening. Who knows what we’ll find. On the way to the call I dig out my safety goggles and glove up.
“If you are having a life-threatening emergency, it will be good to have this team.”
In the old days, prior to the implementation of the 9-1-1 system, the ambulances in Portland ran without the support of the local fire departments.* It was a system that worked well, was efficient, and simple. Today when you call 9-1-1 for a medical emergency, you should be prepared for the small party that will invade your house. There will be at least four firefighters on the engine or truck, maybe a two firemedics on the rescue, and two paramedics on the ambulance.
If you are having a life-threatening emergency, it will be good to have this team. Less than 5% of EMS calls require this level of response, however, the system hasn’t figured out how to predict when and how to send the right resources. You call, and we send the whole kit and caboodle! This issue* alone probably generates the most questions from the public.
For the sake of efficiency, and because the ambulances are operated by a for-profit corporation, there are just enough units on the road to transport people to the hospital – about 80% of those who dial 9-1-1 for assistance. Rarely does the ambulance arrive on scene first.
However, because this particular call was right around the corner from us, we arrived on scene first. It was very refreshing to have first contact with a patient for a change. Usually I have to wait 5-10 minutes (or more) before I have any direct patient contact. Our first responders from the local fire agency usually provide the initial evaluation and care. But on this evening, I was able to calmly assess the situation in a less chaotic environment. Did I mention, it was refreshing!
I put my fingers on her wrist. This simple act gave me a lot of information. As I felt her pulse, I got an idea of what her blood pressure might be, how fast/slow her pulse rate was, whether she was cool/warm, moist/dry, weak, or strong. The whole time, I’m establishing eye contact and a rapport with her. She was very alert and communicative, and not that sick. I called on the radio and slowed the rescue to Code-1 (without lights and sirens) – something I wish they’d do for us more often.
“It doesn’t happen often – but it sure is nice when it does.”
Her belly hurt and she was bleeding a small amount, but she was not one of those rectal bleeds. The rescue called and said they were delayed by a train – so we just canceled them. We started an IV, put her in the ambulance, gave her some fluids, and took her to the hospital. The whole time I was able to establish and maintain a caring, compassionate conversation with her. The call went smoothly, it was quiet, and I believe that the best thing I did for her was to care – and show her I cared. (Oh sure, the 400cc of fluid lowered her pulse rate considerably too!)
About an hour later we saw another lady with belly pain. Her’s was more intense, but she had no shock symptoms. Unfortunately, I didn’t really know that until shortly before transport. Well, I knew, because the firemedics told me so, but I had no direct knowledge. I hadn’t been able to talk to her, touch her, or look her in the eyes. I wasn’t sure anyone had – as everyone was focused on the procedures. Eventually the first responders returned to their fire station, and I was better able to assess this belle’s condition.
Her vitals were fine, but she was in serious pain. After several doses of narcotics and caring conversation, she was feeling much better. It’s always rewarding to make a difference (we even solved a couple of social/emotional needs along the way).
A couple of hours later we transported another lady with more issues than you care to read about. Unfortunately, she was on the bottom rung of our society’s arbitrary social strata. And she was very broken. Some would call these people “system abusers.” I disagree – I believe they are using the system exactly the way we have designed it. Without intense medical care, and deep psychiatric treatment, she will die. Unfortunately the players in the system had already written her off.
Once again, I had the opportunity to care – to offer compassionate understanding. As we waited for a bed at the ICU of the receiving hospital, she timidly looked at me and said, “thank you.”
It doesn’t happen often – but it sure is nice when it does.
* I in no way intend to denigrate or dismiss my fellow emergency responders. My comments have more to do with the system WE have created – and the overkill it involves. We are stuck in an outmoded model and it is time to change. I have the utmost respect for all the men and women I respond with. However, we need to find a better way to be more efficient, offer more compassion and caring, and reduce the chaos onscene.