“And I Would Have Stayed Up With You All Night”

Just got back from my 6, er, 9.5 hour EMS (emergency medical service) shift (my medical school has a unique program that sends first year medical students to ride with paramedics to pick up emergency calls). I’m not going to go into much detail tonight (because my shift started at 6pm, and now it’s 4 AM), but I just wanted to mention: I have lots of respect and love for EMTs and parademics now. Briefly, some lessons I’ve learned tonight:

1. When there’s an ambulance truck behind you, GET OUT OF THE WAY! Even if they don’t have their siren on, the truck may be transporting a patient; they might just be taking it slow(er) so as not to cause too much pain to the patient. Nonetheless, that person needs to get to the hospital ASAP. One patient tonight had an post-surgery infection, and boy, did we get an earful each time the truck went over a bump.

2. Don’t be the boy that cried 9-1-1. Twice tonight we received false calls: one from a caller who then disconnected his/her phone line (i.e. prank call, but may have been associated with a mental illness), and another from someone pressing the wrong button on the house alarm. Sometimes there’s not a lot going on, but sometimes there is: EMS is a limited resource, and it’s not cool to waste it. Then again, if you’re sick or in serious pain, use it (because it’s better to be safe than sorry).

3. One thing that never really seemed concrete to me before tonight was the notion that EMS really prepares patients for hospital care. Although doctors and nurses have a much more complicated job regarding diagnosis and treatment, EMS does the initial stabilization of the patient’s condition during the first crucial hour of an acute crisis. Furthermore, while doctors and nurses might subconsciously expect patients to be served up on a silver platter (i.e. presented in a particular, uniform fashion), EMS deals with a very wide variety of situations. What I saw tonight was pretty mild: light blood, projectile vomit (i.e. fountain), diarrhea, nudity, stab wound.

4. With only a few exceptions, I think that paramedics and EMTs are the health care providers that bear witness to the most pain. They’re the first to see trauma, and they’re also the ones who see people in pain before they are sedated or calmed down within the hospital environment. Of the several calls we received, three of the four in which we brought patients back to the hospital were patients in excruciating pain. They weren’t just screaming for attention: you could tell that they were in really, really bad pain. By contrast, and I could be wrong, but I’m under the impression that most doctors and nurses don’t have to deal with as much pain because the patients they see have already been administered analgesics (pain killers), will rapidly be administered pain killers, or they only see individual patients for a few minutes at a time. Some might work with patients in a lot of pain all the time. But they have the ability to leave the room. However, for me and the two paramedics, we had to work with the screaming, pained patients for half an hour or more at a time (moving the patients from their houses to the ambulance truck, riding to the hospital, and then escorting them from the truck through the check-in process and eventually to a hospital bed).

5. People need health insurance. Otherwise, a lot of hospital Emergency Departments simply won’t take the patient seriously. The paramedics and I waited one hour and forty-five minutes with one uninsured patient on the stretcher, just inside the entrance of the ED, while the staff was “trying to find a bed.” This also meant that my team and I missed all of the trauma calls during our shift because of having to wait at this ED next to the stretcher. Another patient came in with another EMS crew half an hour after we arrived, and they immediately received a bed. Our guy was in serious pain, but he was a trooper and tried his best not to cry out. He eventually got a bed, but to me, it seemed clear that the nurses and the doctors weren’t going to go out of their way to take care of this particular patient. Of course, it was late at night, and they were probably all tired. But they definitely shuffled a lot faster for the other incoming patients. It doesn’t surprise me, especially since there is so much more incentive for taking care of paying patients.

6. Like many aspects of this early stage in my medical training, this was a very humbling experience. Even though I’m very happy and confident because of my good bedside manner, decent history-taking, growing ability to do a (decent) Tier One physical exam, and my early proficiency with IV cannuli and laryngoscopes, there are vast realms of medicine in which I have little knowledge or experience. One of these is Emergency Medicine: one Fast Track shift and one long EMS shift later, I still don’t quite get it. By that, I mean I don’t think my personality and approach fit it well. Maybe I just need more experience in this field to get my finger on the pulse, but I think I probably work better with the unknown in a more stable setting (outpatient?) or with more extensive background information and greater complexity in the challenge at hand (intensive care?). It gives me more respect for ED docs like shadowfax and Panda Bear who probably do enjoy the fresh unknown of incoming emergent patients. Either way, as I was standing there next to the patient my team brought into the ED for more than an hour, I really wished that I had enough expertise and knowledge to help him right then and there (since no one else was bothering to).

“… had I known how to save a life.”

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