Another one gone last night, another young life lost to guns. It started just as I was pulling into our area trauma center with a probable concussion. Came out over the radio.
DISPATCH: Priority 1 South Ave and Cortland Ave, 10-21 GOLF reported not breathing
It was a busy night at that hospital. They didn't have a bed for our patient right away, so we had to wait a good while. For that, I got to see the whole thing play out. Some of this will be graphic and possibly offensive. EMS humor isn't funny. Don't say I didn't warn you.
Names have been changed to protect the innocent and myself
The call came in right away. Our dispatch called up the hospital to let them know what might be coming. It didn't take long. Doctors, nurses, techs rushed to grab disposable gowns and stationed themselves in the trauma room. The clerical staff made calls to the on-call trauma surgeon, respiratory therapist. Others rushed off to gather equipment not already in place.
Patient registration registered "a letter" - a patient with an unknown identity. All the computerization of healthcare has made things a little funny and they didn't want any delays in getting documentation and orders in.
Then it was quiet for a while. Well, sort of. The charge nurse was on a bit of a tear at that moment, juggling a full waiting room with no available beds, and trying to get housekeeping to ready a room for our patient. A nasty gram left on the housekeeping supervisor's voice-mail gave me a lot more respect for her, followed up with a call to the ED supervisor letting them know the situation and that the housekeeping supervisor was out of contact.
Lots of unknown stuff was happening out there on the street, but no one knew the situation just then... until the phone rang.
DOCTOR: Just got an update, confirmed traumatic arrest.
and the phone rang again. Then one more time.
DOCTOR: That's the third call I've gotten confirming traumatic arrest.
See, its kind of funny how communications works. Our ambulances have a separate dispatch center from the county 911 system, and city police have their own dispatchers within county 911 separate from city fire. So PD calls in traumatic arrest, that dispatcher updates the hospital. Then FD calls in traumatic arrest, so THAT dispatcher updates the hospital. Then the paramedics confirm traumatic arrest, and our dispatch updates the hospital. Yay redundancy.
Anyway, that's about the time police started filtering into the hospital. Security too. Whenever there's a shooting or stabbing, the ED gets locked down. It's happened before that someone sneaks into a hospital to finish off a survivor, or start other types of trouble.
Finally the moment comes that everyone's been waiting for.
TELEMETRY RADIO: BEEP BEEEP BEEEEEEEP generic trauma center come on for generic ambulance
DOCTOR: generic trauma center, go ahead generic ambulance
PARAMEDIC ON RADIO: Responding to you with an ETA of 5 minutes with a 20s male with GSW to the chest. Patient is pulseless and apneic, asystole on the monitor. CPR is in progress. Patient is intubated with bilateral IV access established running normal saline wide open.
DOCTOR: Recieved generic ambulance. generic trauma center clear.
More waiting ensued. Two more ambulances had arrived during that time, though their patients were stable and ambulatory, so they went right to the waiting room. It started getting a little crowded just outside the ambulance entrance: two other ambulance crews, a doctor, a few cops, and a guy with a camera?
His flash starting going off as soon as the ambulance pulled in. What is this?
MY PARTNER: Who is that taking pictures? What the heck, is the press here already?
Anyway, the ambulance backed in and one of the 6 or so people crowding around opened the back doors to reveal what we'd all been waiting for. One guy in bunker pants. They co-opted one of the firefighters to help. One guy in a white shirt. That's one of our supervisors. One paramedic doing compressions, and another at the head doing ventilations.
It seems to take an awfully long time for anything to happen. The scene seems almost frozen, even though the motion is frantic. Fast is slow, slow is safe. There is no running in EMS. Ever so slowly the crowd around the back of the ambulance parts as one of them carefully, gradually walks the stretcher back. One person is in absolute control at this moment: the paramedic at the head. Whatever you do, don't dislodge the endotracheal tube!
What's that? More flashes from the camera.
MY PARTNER: Who is taking pictures?
COP NEARBY: It's okay, he's CID.
As the stretcher rolls by the guy with the camera turns and we finally see the badge hanging from his otherwise plain clothes. Gotta document everything. Probably would have been in the back of the ambulance too, if there was room. Wouldn't video be better though? Guess its not in the budget.
The paramedic doing compressions rides by standing on the foot of the stretcher, hanging on with one hand, bouncing up and down to do effective one hand chest compressions. Yeah, sometimes the TV shows get things right. I've seen much stranger improvisation when it comes to doing things on the move.
Everyone disappears into the trauma room. A few people rush in and out, doing various tasks, but mostly just making traffic jams in the hallway. One person to rush out is the paramedic at the head. She nearly slams into three different people on her way to a sink. As she passes, holding her hands up, I can see the big, slightly shiny smear on the front of her black uniform. Blood.
After washing up, she takes a few swipes at the stain with a paper towel. Obviously a futile gesture, but it made the point well enough. "Shit magnet" is a term of the trade. No one wants to work with a shit magnet. Especially one with blood stains on her uniform.
It isn't more than 5 minutes before all the people moving in and out of the trauma room are walking at a noticeably slower pace. No one needs to ask why. There are only two reasons not to walk with a quicker step: either everything is fine, or the patient is dead.
Someone asks anyway.
SOMEONE: They called it already?
It being time of death.
I've been on calls like this. It always starts in such a serene way. Well, the lights and sirens aren't so serene, but the mental preparation for what is about to happen is almost meditative. The crew doesn't talk to each other, besides the occasional "clear right" when going through an intersection. The mind scans the possibilities, the scenarios both real and imagined, trained for and experienced, preparing for absolutely everything....
...and all that is pointless, because none of that shit goes as planned. Still, all that adrenaline pumping gives one a laser-like focus on the job at hand. I don't care how much coffee I've had. On a normal call, the caffeine might be making my hands shake like I have Parkinson's disease or complex partial seizures but on a call like this everything slows down, everything becomes steady and sure. I don't think about it, I just do it. Everything is about finding a job to do, doing it, then moving on to the next one. Once there isn't a job left to do that isn't being done, someone needs to drive the fucking ambulance.
When all is said and done, there is nothing left to do but decompress. There, on the street across from the ER entrance, a line of ambulances and, in front of it, a circle of uniformed EMTs and paramedics and a cloud of smoke. No, its not a camp fire, but with all the laughing and chattering going on you might think it is. No one is going to sing Kumbaya though.
"Blood was squirting out with every chest compression"
"The firefighter said 'I need a towel' and someone got it for him. I thought he was going to wipe some of the vomit away from his face, but he put it under his head. 'That will help keep the ambulance clean'"
"Those IV's were working good though. By the end the blood squirting out looked awfully watery."
"When I got on scene, someone shouted we're intubating him now. I was mad someone was taking my tube so I went over and said 'Oh, hi Flash!' [the nickname of one of our supervisors]"
"I was ventilating and looked over at all the blood squirting onto the floor and thought 'maybe we should put something over that?'"
"Now my hand hurts [pantomiming squeezing the bag valve mask, holding the ET tube with the other hand]."
"Thankfully I have a spare pair of pants in my car"
Referring to the supervisor's vehicle, "500 is stuck on scene. It ran over a shell casing. Its evidence now."
Another day in paradise.