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Thursday, March 7, 2013

Field Medicine: Humbling Introduction

Following my return from studying in Canada, I really pounded the pavement in our State’s largest city; still, employment eluded me. I was too young or too educated for any job in their classified ads. The most shocking was that I was just too honest to work in a finance company! Personal computers had not been born yet, and a Macintosh was the kind of apple one ate for a snack. Phoning companies, checking classified ads, and walking from door to door, asking for a job was our only road to employment in those days.

One morning Dad spotted an ad in our local, weekly newspaper. “How about checking into this one?” He pushed the folded back newspaper over to my side of the kitchen table.

“Dad, it’s a volunteer job. I’m not sure they even pay anything. Besides, what do I know about working for an ambulance service? Nothing, that’s what,”

“Hey, you graduated in Pre-Med; you should know something about health problems, shouldn’t you?”

“Well, sure I do, Dad; but this is a totally different kind of work here. We’re not talking about what goes on in a hospital. This is the blood and guts stage out on the highway. I don’t know anything about that kind of medical work. I really don’t, Dad.”

“Nonsense. You’re a First Aid instructor, according to the American Red Cross, aren’t you? You’ll be fine. Just give them a call; what can it hurt? They can only tell you ‘No.’ Maybe they’ll train you.”

Dad remembered that one of my courses at university had required I earn the certification as a First Aid instructor; something I’d forgotten as soon as the certificate was in my hand. Maybe he was right; it couldn’t hurt to phone. Even a volunteer job was better than no job at all.

The phone call ended up being the interview, followed by a face-to-face meeting where I filled out a one-page application form. Since I had been born and raised in the community, little was not already known about me. In this case, it was a good thing and no references were needed to secure the volunteer position as an ambulance attendant. I got the job.

With absolutely no ambition or desire to actually drive a speeding vehicle with siren and lights flashing, I really resisted the suggestion that I obtain a chauffeur’s driver’s license…just in case. I did not baulk at the requirement that I complete a course for Emergency Medical Technicians, with a focus on Ambulance (EMT-A.) I knew that this was something I needed to feel more competent to help roadside patients, which were known as victims. I had so much to learn! I would be on-call while I took the EMT-A course, not after its completion.

The first time I answered the phone and heard, “MVA. Be there in five minutes,” my racing heart nearly caused me to stumble as I quickly dressed on my way to the pick-up door. I’d better learn to sleep in more clothing. A Motor Vehicle Accident (MVA) could mean a minor event or seriously injured folks. Oh my, would I know what to do? Could I do what I would be asked in the stress of the moment? I really didn’t know; it wasn’t a hospital setting, with all sorts of support staff and gear all over the place. It was the side of a dirt road out in the middle of nowhere.

My mind flashed through all sorts of possible scenarios as I watched my partner pull equipment out of bins and hook up the oxygen. The Jump Box was tossed to me just as the speeding ambulance began to slow. “Take that and follow me. I’ll tell you what to do when I see what we’ve got. The dispatcher had no information at all; I don’t even know how many victims we have here. Follow me and be quick about it. Don’t talk unless I ask you something. Don’t ask questions; just do what I tell you. We’ll go over the case once the victims are in the hospital. Until then, don’t ask questions. Clarification is the one reason for you to speak; got that?” My training partner was running alongside me, talking a mile a minute while scanning both sides of the road and the dirt highway on which we ran. For my part, I hung on to the large, plastic tackle box that had been made to hold everything one might need to care for a roadside victim. Clinging to it while jumping out of the ambulance gave it the functional name. On this first-ever ambulance call, it also served to give me the sense that I had a part in the action. I had not a clue what to do, but I hung on to the Jump Box with all my might as I ran.

Dropping to our knees alongside the first victim we spotted, my trainer barked an order, “Take the BP. Shout it to me as soon as you get it. Vic’s got shallow breathing but I don’t see any blood. I’ll be across the road. HP says that one’s bleeding.” My training partner was gone as soon as I looked up from opening the cuff. The Jump Box went with her.

I carefully positioned the stethoscope and began to pump up the blood pressure cuff. As the cuff slowly deflated I struggled to hear the familiar beating of the heart through the stethoscope. Finally, I heard it. Mentally, I took note and rejected what I’d read on the gauge. It couldn’t be 70 for the systolic (top) number! I must have made a mistake. I deflated the cuff completely and began again; this time being more careful to press on the diaphragm of the stethoscope to be sure I heard that first beat of the heart. It was long in coming and this time it read 65. I let the cuff deflate until I could no longer hear the beat and the gauge read 45. No, that couldn’t be right; I’m doing something wrong. Unless I was working post-op recovery room, the BP was always closer to 120/80 on patients this guy’s age. I just must be doing something wrong out here on the cold, wet grassy slope next to the country highway, where the victim’s body had landed.

“Sojourner, what’s that BP? I’m not hearing you!” The shout came from directly across the road.

“I can’t really get it right. I’ve tried three times but—“

“What is it? Just tell me what you’ve got. Stop taking it and tell me what you’ve got.”

“60/40 was the last time.”

Again the shout, “Pulse?”

Oh no, I’d been too busy trying to take the BP; I hadn’t done the rest of the vital signs. Fortunately the Highway Patrol (HP) officer asked my partner a question so I had a chance to finish before she shouted a second time.

“Pulse: a fairly strong78! Respirations a shallow 6!” I returned at full volume, though my words seemed to be swallowed up by the night.

“Okay, leave him with the blankets and get over here!”  

I helped load the bandaged, stabilized second victim onto the backboard, and then hoisted him onto the ambulance stretcher. “Get in there and hook him up to the oxygen. It’s ready to go; just hook him up.”

While I attended to the victim inside the ambulance, Bill and my partner loaded the first victim onto the second backboard and carried him to the ambulance. Soon we were all flying across the gravel, headed for the interstate highway that would take our victims to the hospital.

As promised, over the de-briefing cup of coffee in the hospital cafeteria, my training partner explained the details to me. “Sojourner, did you get a whiff of your vic’s breath when you were taking his BP?”

“Uh, to tell you the truth, I can’t be sure. It didn’t make an impression, if I did.”

“The first rule is to immediately notice everything that your five senses will give you. From the moment we knelt beside him, I smelled the alcohol. I didn’t smell blood, nor did I see it. Sometimes, you can’t see it, but you can usually smell it. You’ll learn the smell soon enough. As soon as I smelled the alcohol, I knew his BP would be low. The readings you got were normal for someone under the influence of alcohol. I reckon you’ll not forget that, right?”

Boy, was that ever true! I never forgot it, or the incident that caused me to learn the lesson. My first victim recovered without incident; probably his drunken state sent him into a state of oblivion for the entire episode. His friend had injuries from which he, too, recovered.

I did get the chauffeur’s drivers license and did, on occasion, need to drive the ambulance. I never got a thrill out of it. I only sat in that position when there was no other option. Guess thrill-seeking rides are just not a part of my makeup.

I learned many important lessons throughout my training as an EMT-A…only some of which came from the textbooks and manuals! Sometimes, the books don’t think to mention some of the situations I found myself experiencing. I can truthfully admit, without God’s consolation and uplifting hand, I might not have made it.

*All names have been changed

****Field Medicine: Not in Any Book…Next Post




Field Medicine: Not in Any Book

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