There is your life before the truck, and there is your life after the truck. An apprenticeship with paramedics shows what it really means to have a bad day. PLUS: Learning how to be a DIY chef and a plumber
It was a Friday night, dark and cold, the wind whipping through the empty fields. We were at a ball on a rural road. Someone had strayed too far in the snow on the shoulder and disappeared into a ditch. There were two occupants, but somehow were good, not a scratch on them. On the way back to the ambulance - here in Ottawa, calls ambulances trucks - who stop to look inside his car, which was still on the roof. There were two weights that had settled there and hit the ceiling. We were ducking ears in our coats and we talked about the possibility that people were not the brain when the radio squawked.
Serving a region with a population of just over one million, the Ottawa Paramedic Service responded to more than 103,000 calls last year. The calls come to the radio cluster. In my first five minutes in the van, there were calls to a woman who has a seizure in a grocery store, an eight week old, choking, a homeless man found unconscious in an alley, a man with difficulty, a possible heart attack in a chicken restaurant breathing. If you just sit inside the truck listening to the radio, you'd think the world was falling apart. It's crazy. But even amidst all the shouting and chaos, there are calls that stand out. A code of 4 is a deadly emergency lights and sirens. A code of 4 VSA - vital signs absent - it lights and sirens and a little more. This call was a VSA, a woman lying in the dark to our west. Darryl and I jumped in the truck and resisted.
Darryl Wilton was my mentor and partner. He is thirty-six, tall with a shaved head. If you could make a special ambulance when you have 911, you want to ask about him. It was in the truck for twelve years, and saw many things. As part of my training, I showed photographs published or not, the media of some recent to ensure they had the stomach for work calls. He did not have to deal with me, too. ("The effect of over-the-barrel fall," he called bilious effusion that conscripts suffer.) There was the wreck of the motorcycle in which husband and wife have been launched through an intersection as test dummies. He was the poor man who had been shot in a printing press in his right arm. That's when I was introduced to the term "degloving." The boy had lost skin flap of his fingers on his shoulder. His arm looked like an illustration in a textbook of anatomy, a collection of red and white lightning muscle bone and ligaments the happiness trap.
I realized that there would in my life before I spent time in the truck and my life after. We ran through the night, and tried to prepare. Darryl prepared, too, but in a different way. He changed his mind in its methodical report. It was almost as if he was trying to patients in advance to see them. "Time is tissue," he said. With each passing before treatment, more body parts that should be white or blue pink and white or blue minute is death. As we listened changes in the radio, he asked me what I thought about what would happen, and he gently guided likely reality. Code which came just after the snowstorms were often four heart attacks - someone comes out with a shovel and your heart can not handle the stress VSA morning were often impractical, because it was likely that the victim had died at night, hours before he was discovered .. Then the code becomes a code of 4 5. "It's not brain dead, we can work," Darryl said. "And obviously death, what we can not."
We knew that this woman was old and set in his garage. It was a little after 19:00, which gave us some opportunities. It had snowed hard enough, then maybe she had a shovel in his hands. (Paramedic calls follow the seasons: summer sees an increase in injuries, winter brings an increase in medical calls.) Or maybe fell on a patch of ice and hit his head. Darryl fear that had fallen during the afternoon and was not found until someone came home from work. Both came to the area between us and took blue nitrile gloves.
Fence posts blurred. Turn off lights and sirens clear minds and traffic, how boxers use music input. I became the number marked on snowflakes caught in our lights. They froze in front of us as crystals suspended in the darkness, a thousand small red and white tiles. There was something very, very nice in the snow, and stared at me, and my slow breathing, and when the voice on the radio again said that we were probably headed to a code of 5, I was a loan.
She was lying on the cement on his back, folded incredibly small. His knee was blown and she threw a shoe. His face was waxy white, whiter than even her hair. His eyes were closed and his mouth was open. It also froze nearly half.
She was found by her son, who was sitting in his kitchen. Another ambulance driver, Jennifer, sat with him; when the victim is a body, attention is directed to the survivors. He explained what was coming, trying to soften the coming shock. She said the coroner had to happen and how under the tarp was his mother would be taken by the directors of the organization of the city. When police arrived, Darryl suggested calling the family doctor instead of the coroner to fill out the death certificate, as the house was in good condition, so that the money could be a problem. (If the judge, the body is taken to the morgue, and go to the hill morgue money. If the family doctor comes, the body can be taken directly to the funeral, a cheaper and more avenue compassion for understand pain.) Darryl has always looked beyond purely medical issues like this. But police shrugged and put the body in the system anyway. We took off the gloves and walked through the snow to the truck and started driving into town the happiness trap.
Without lights, the snow was just snow again. We speculate about what had happened to the woman, the construction of a diagnosis in the opposite direction. Now, none of the options was good. "It's hard to know which came first, the fracture or fall," Darryl said. We both hoped aloud that she had gone quickly but we both knew it probably was not. The truck stopped. We need the radio to wake life. In Ottawa, they maintain close monitoring of call volumes per hour and try to have enough trucks on the way to meet. That request provided save money - depending on organizational effectiveness - but also keeps busy paramedics is always better to have bad calls blur as fence posts ..
Fortunately, a man of twenty-four, forced us not to eat for two days before going to the gym, then sits on a steam bath for forty minutes. He was found unconscious in the locker room, he took lights and sirens Code 4. Darryl, and stopped to talk to the dead woman and began to talk about volume depletion, low blood pressure, and how our first step would be to give a thorough physical exam to make sure he did not hurt himself sustainable, followed by a great success of saline IV.
The boy woke announcing that all he needed was a cheeseburger.
In a way, the human body is a seemingly simple machine: The air must enter and exit, and blood has to go round and round. Anything that disrupts the two processes is wrong and must be corrected quickly. I was told again and again to remember the ABCs: airway, breathing, circulation. This is the essence of emergency medicine. The problem is that there are hundreds of reasons why ABC stop working .
Courage. It is a pump. A heart attack prevents pumping, which means that the blood can not carry oxygen to the brain, which means that the brain die, and the brain can not be repaired or restored to life. It's pretty simple math. However, there are several types of cardiac arrest, and each must be treated differently. Some make the heart Flatline, as we have all seen on television. We also saw doctors Shock TV flatlining a patient with pallets, but the way it works. In fact, the blades are used when someone's heart is beating too fast or fibrillation should be surprised at a normal pace. CPR will not restart a heart, either. CPR saves lives - really, no kidding - because the pumping someone's chest will generate enough blood flow (although only about 16 percent of the volume of normal ejection of the heart) to keep the brain alive until a help arrives. But only the seriously toxic drugs such as epinephrine, atropine, and dopamine coax a blown heart starts beating again correctly.
The drugs were in the blue bag. It is portable pharmacy hand in the emergency room, and came with us every call. There glucagon and glucose for diabetics, morphine and fentanyl for pain, naloxone drug overdose, and a couple dozen other drugs. Three other pieces of equipment were carried out on every call, no exceptions: A red bag containing an oxygen tank, intubation equipment, and a heart monitor. The truck was equipped with bags of trauma dressings (orange), a bag containing resuscitation equipment for babies (light green), and a bag of the spine with the limitations and necklaces (dark green). The appearance of these bags on a stage meant something very bad had happened.
Before my first visit, I was working my way through the bags with a paramedic named Suzanne Christmas. It was impossible to cover everything that could happen in a given shift - broken bones, bruises, childbirth, heart failure, brain injury, gunshot wounds, stabbings, toxic shock - or when tragedy could take place: a room, a bar or a car upside down in a ditch. It is a job that requires a kind of free spirit, and like most of the paramedics came across Suzanne was bright eyes and quick smile. "Seeing what we see, we know how lucky we are to be alive," he said.
It was one of the great lessons of the van. I expected to find a lot of burnouts dragging through the night shift, broken men and women immersed in the blue bag so they could sleep. But paramedics are a surprisingly sunny group. They understand that everything is so random anyway, a cosmic confluence of vectors. One night, four children were in a car and ran through the streets sleet until the driver lost control. The car spun like a roulette wheel before finally being stopped by a lamppost. A child unlucky enough to have chosen the siege that ended in the same lamp, suffered massive head injuries. The other three were. They knew the feeling out of the body after death trap, the feeling that every day between now and the last will be a gift that could easily have gone unopened. Paramedics know it feels better than anyone, because they walk in free nightmares and again. They know what a real true evil day, and know that day will come for them too, but today is not that day, and that knowledge alone was enough reason to smile Suzanne .
With the help of Suzanne, I intubated mannequin me repeatedly until I stopped to break teeth, I calculated doses of the drug based on the weight and delivery time for the patient, brought me a piece of currency in the throat of a mannequin with a pair of tweezers McGill, and learned to read the ECG and mark the difference between ventricular fibrillation and torsades de pointes. . (Ottawa Paramedics are among the first in the world to be trained to diagnose 12-lead ECG A type of heart attack, STEMI, creates a pattern ambulance wave called "grave," a diagnosis of STEMI patient is delivered directly to the heart surgeon, bypassing the emergency room, to undergo angioplasty.) Unlike services in many cities in the United States, the Ottawa Paramedic Service requires each recruit had completed two years of university education in the sciences health and two to four years and paramedics, and spend at least 480 hours in the truck. These are not the mercenaries junkie Bringing Out the Dead the happiness trap.
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