Read part one of Dan’s article here.
As we head out of PRO Central, we get our first call of the night: a transfer from Provena to Carle for a kid with a liver laceration. We’re told that it’s a “stat” transfer, meaning it needs to happen immediately. So, off we go to Provena.
“This is a good one to start off with,” says Dave, “Nice and simple.”
I settled into my seat for the evening, a cooler between the front seats and the bay, where I could see the street over Dave and Leann’s shoulders. “No lights and sirens?” I ask.
“Not for this one. We’ll go code to a call if METCAD tones it out as a Bravo level call or above.”
“Uh huh,” I said, trying to find a comfortable spot on the cooler. “Hey, can you repeat that in English?”
“Sorry. METCAD are the folks who answer and dispatch the calls to 9-1-1. They determine how urgent the call is based on what they’re told over the phone and then let us know if we should go code – lights and sirens – or no code. Once we arrive on scene and assess the patient, we determine the type of care needed, either BLS – Basic – or ALS – Advanced Life Service.”
“Advanced Life Support,” pipes in Leann. She’s an EMT-Basic and a dispatcher, taking classes in pre-med, and up on what everything stands for.
“Yeah, ok,” says Dave. “Whatever. Anyway, BLS calls might include giving oxygen, measuring blood sugar and vital signs, immobilizing someone who fell, stopping bleeding, doing CPR, you know, relatively basic things like that. ALS calls add in the IVs, meds, heart monitor, defibrillation, intubation, etc.”
Leann continues, “The tricky thing about getting the calls from METCAD is that often what we find when we get on scene is way different than what METCAD is told over the phone. So you never really know what you’re going to get till you get there. Like Matt’s story.”
Matt the shift lead had told a story earlier about a call out in the county a few years ago, when they were dispatched for an accident with minor injuries. Instead of finding someone with a few scrapes and bruises, the volunteer firefighters who arrived on scene first found a woman that they quickly determined to be dead, since she’d been thrown from her car into a muddy field, was unresponsive, and had a gaping hole in her abdomen with a bloody, dirty mess of bodily mush lying next to her. They covered her up with their fire coats and called for the coroner. When Matt and his partner arrived in the ambulance, he went to get a look at her himself, just to make sure. From under the coats, a pair of bright green eyes looked up at him and said “I’m OK!” They scooped everything up and headed for the hospital, later learning that she survived (with little long-term damage) largely because it wasn’t organs lying in the mud, but fat tissue. An icky, funny story, typical of paramedics.
So, starting off the evening with a simple transfer sounds good to me, even if it’s a stat transfer. We hurry to Provena, and I learn my first lesson: stat doesn’t always mean stat. There are still some tests to run in the ER, and the release forms are not ready. Miscommunication like this happens, but it’s better to be called before you are needed than after. So, while we wait, we talk to the patient.
He’s a ten-year-old kid who tried to jump a curb on his bike and ended up landing on the handlebar, end-up. He’s got a small, round indent and a bruise on his stomach the size of a handlebar end. He reminds me of, well, me, when I was ten. And my son when he was ten. And every boy in the history of the world when he was ten. It’s a wonder that entire wings of hospitals are not continuously occupied by ten-year-old boys.
Unfortunately, he is unluckier than most in this instance, and has a liver laceration. Dad is there with son, trying to stay light about it for his son’s benefit, even though the worry seeps through. The boy needs to be transferred to Carle, where they have more specialized care for his injuries.
Tests are run, papers are signed, camaraderie with the ER staff is had, and we head to the ambulance. But when we get there and open the back door, the unit is dark, because I forgot to turn on the lights. I scramble up to find the switch.
“We might have to fire you already,” says Dave, “and it’s only 8:00.” Dave seems a little too delighted that I forgot 50% of my jobs, but what can I say. Those gloves are hard to get on. I was excited and distracted. I promise the boss man it won’t happen again. But I’m pretty sure I just blew my chance to do anything cool now.
On the way to Carle, Leann sits in back and keeps dad and boy calm. Another call comes in for a nearby car accident that requires two ambulances. They go to other units, because we are still in transit and unavailable.
When we pull up to Carle, the boy’s mom is there. She is pacing, taking deep breaths. Dave and Leann pull the boy out on the cot and she rushes up to touch him, her brows deeply furrowed, her eyes just able to hold back tears. Whatever else happens to this kid, he’s got a family who loves him.
After leaving Carle, while we wait for the units on the car accident to clear up, we go hang out on the “corner”: parking lot D-9, on the corner of Green and Lincoln, which positions us in a prime spot near the middle of town and on campus, ready for the next call.
Waiting is what EMTs do a lot of the time. So we sit and we wait. Every time the dispatch radio beeps I tense up, but there are distinctive tones for PRO that they recognize and I don’t, among the police calls and other chatter. “Waiting is definitely the weirdest thing about working on the ambulance,” says Dave. “The knowledge that at any given moment – while you’re checking your unit, watching TV, going to the bathroom, waiting for the food you just paid for, talking to the doctor about the patient you just brought in, whatever – you could suddenly have a call that sends you across the county and into the worst moment in someone’s life.”
So, we wait. And we talk. I get an education in the structure, funding, politics, and competence of the various fire and EMS units in Champaign County. It’s not as much fun as saving lives, but it’s interesting nonetheless.
Champaign County is served by two ambulance services: PRO and Arrow. Emergency medical services in most cities around the country are funded and run by the municipal fire departments (be they volunteer or paid staff), but here in Champaign County, PRO and Arrow are privately owned by the two major health care providers, Provena (PRO) and Carle (Arrow). METCAD, the 9-1-1 dispatch service, is run by the county City of Champaign, but covers the entire county. Each ambulance service holds contracts with the individual volunteer fire departments in the county, based mainly it seems on politics and/or tradition. As it is, Arrow generally covers most points south and west of Champaign-Urbana, PRO most points north and east. They then divide Champaign-Urbana east and west at Neil St., and swap city coverage once a month.
The upshot is that when you call 9-1-1, METCAD determines where you are and dispatches the ambulance service contracted for your location. However, if one service has all its units currently in use, the other service is called in to help. Also, for most medical calls, METCAD will send the local fire department to your location as well, since many are EMTs themselves and can assist with medical care in advance of or in conjunction with the arrival of the ambulance. Some area departments (Urbana, Homer, St. Joseph) are certified to give EMT-Intermediate level care, so they can give IVs and some medications prior to PRO or Arrow’s arrival.
PRO’s work schedule is split into two shifts of 12-hours apiece: day and night. This is unlike Arrow and both city (C-U) fire departments, who work primarily 24-hour shifts. PRO was formed back in 1987 with the notion that working 12-hour shifts is better both for patients and the EMTs, keeping them awake and fresh at all times. The majority of career fire and EMS departments in the country work 24-hour shifts (with the hope that they will get some sleep at night while on shift), but PRO has maintained 12-hour shifts despite many other services moving to 24s.
There’s some rivalry between PRO and Arrow. Certainly this shows up at the contractual level, when one service or the other attempts to win more of the county EMS pie. But at the rank and file level, Dave says there’s mostly friendly cooperation. They are all in the business of saving lives, and you can only be so competitive about that. However, rivalry does spill out sometimes, even among first responders. One of the PRO day shifters had come in today with a story about a firefighter in a nearby town usually served by Arrow who refused to help carry a cot into a house on a call that day, because he wanted PRO to “earn their living.” But that kind of professional discourtesy is the exception to the rule – the vast majority of firefighters and police work hand-in-hand with paramedics.
That each ambulance service is owned by a medical provider affects where patients are taken by default. They’ll each take you to whichever hospital you prefer, but if you don’t specify, PRO takes you to Provena and Arrow takes you to Carle. However, since Carle has the only level one trauma center in the region, serious accidents are always taken to Carle.
Still waiting, Dave and Leann show me how to hook up a heart monitor with four electrodes, and then a more precise, complicated one called a 12-lead. Another device measures the percentage of oxygen in your blood. They put it on me, find that my pulse is fine, with 98% oxygen flow, and tell me that I don’t have to go to the emergency room right now. I hold my breath to see if I can get my oxygen level down. I get it down to 94% before I almost pass out and do have to go to the emergency room. Dave offers to show me the Inter-Osseous Device, which is basically a drill they use to put a large needle into the bone marrow of your tibia when they aren’t able to get a regular IV. I suggest that we can save that for another time.
This waiting is hard. And it’s a complicated kind of waiting.
“How do you handle just waiting for tragedy to strike someone?” I ask.
Dave has a ready answer, because you can’t be an EMT without having thought this one through. “Well, anyone who has a job, particularly someone who likes their job, wants to do their job,” he says as takes off my pulse monitor. “People are going to get sick and injured. I don’t want any one particular person to be sick or injured, but when it happens, I want to be the person that helps them.”
EMTs are in the same position as firefighters and police officers, who don’t root for fire or crime, but want to be there when it happens. And, like any job, they don’t want to do the same, simple tasks all day, but take on interesting cases that put their skills and talents to use.
“Oh, by the way,” says Dave, stepping out of the unit, “this parking lot is the scene of a video that went viral a few years back. After a snowstorm one night, an EMT was doing donuts with the ambulance here and was filmed by some students in the dorm over there. It wasn’t PRO, thankfully, but I have to say, it was a pretty impressive piece of driving. He was circling a car the entire time.”
So, add “doing donuts” to the list of things EMTs can do, especially while bored, right before they are fired.
We finally get a call. I don’t know whether I should perk up or be sad. I put on my gloves.
It’s a “Car vs. Ped” at 5th & Armory, on campus. A pedestrian was hit by a car. We arrive, but the intersection is empty of both cars and injured pedestrians. A police car arrives at the same time, and the officer gives us the universal “I don’t know either” shrug. Leann calls dispatch to see what the deal is.
A new location is given – different intersection, same street – and we head over as quickly as we can through the maze of campus one-ways (though those one-ways become much less of an obstacle when you have lights and sirens on your vehicle). When we arrive, a bevy of police cars and fire trucks are already there.
There’s a man in the street, yelling at everyone. The car owner is off to the side, a young college-aged guy.
Dave steps down next to the guy in the road. “OK sir, where does it hurt?”
“My leg! My leg! Ow, Ow, it hurts! It hurts! Get the guy who did this! Arrest him!”
Dave starts to gently prod the guys leg, but the guy doesn’t seem to notice, because he’s very busy waving his fingers at people. There’s something off about his protestations, something overly dramatic and unconvincing. I notice a large amount of eye-rolling coming from everyone around. The driver is heatedly telling an officer that the guy walked into the road and then suddenly dropped to the ground, ten feet from his car. The story seems to be corroborated by the many witnesses lurking around the scene.
Dave and Leann are at their accident-scene best, quickly and calmly attempting to determine what we are dealing with. Leann works with the firefighters to move the man onto a backboard and check him for obvious injuries.
“Sir, have you been drinking tonight?” asks Dave.
He calms down a little, and admits, “Uh, yes.”
“Are you on any medication?”
“No, I stopped taking it. My leg! It really hurts! Arrest somebody!”
Based on answers from the guy and information from the police, we find that we have a middle-aged homeless man with a history of mental illness who has not been taking his meds. Despite not having a scratch or even some dirt on him from getting run over by a car, he insists that he’s terribly injured and wants to go to the hospital. Another ambulance arrives on scene to offer assistance, and Matt the shift lead wheels the cot out of our unit (the lit and air conditioned unit, I might add) and helps move the man off the roadway.
It doesn’t matter how likely it is that someone is faking an injury. EMTs still do a full assessment, and in the end, if the patient wants to go, they legally have no choice but to take him. So Dave cuts the guy’s pants away from his leg and pokes and prods it again. Nothing seems to be wrong with it, but the guy is both angry and occasionally writhing around. He might also be falling-down drunk, but it’s hard to tell because he’s not upright at any point during our interaction.
Nonetheless, he keeps yelling and complaining, so he gets a free trip to Provena. As we pull into the ER bay, Dave kneels down next to the man, holds his hand, and gently tries to reassure him that we’re all here to help him, that the police will do their best to find the person who hit him, and that the nurses inside will help him get back on his medications if he wants them, as long as he remains calm and quiet while we’re inside the hospital. The man seems genuinely moved, nodding his head and looking sad and worried. Within moments of entering the ER, though, he’s shouting profanities left and right at the top of his lungs. Dave smiles at the assembled nurses and security guards and shrugs his shoulders.
After a quick clean up, we head back to the corner yet again.
“So who pays for this when it’s a homeless guy?” I ask.
“Typically they’ll be ‘self pay’, which means they don’t have insurance, and the odds are very high we won’t get paid anything. So, the hospital writes it off as charity care. If he’s on Medicaid or Medicare, then the state pays for it. Maybe. Hopefully. Or not.” says Leann. “But when they do pay, the state only pays a small percentage, so the hospital doesn’t get much.
“Do you get many calls that involve mentally ill people?”
“Oh sure,” says Leann. “But our job isn’t to fix mental illness or problems like that. It’s to treat those patients with respect, just like anyone else, and make sure they don’t hurt themselves or others. Including us.”
The link between mental illness, homelessness, and addiction is well documented, but it’s poignant to see a trifecta play out during EMS duty. Back in the 1980s, many large scale mental illness institutions were closed, and homelessness skyrocketed. It wasn’t just budget cuts, but the idea that mental illness was a local problem, not a federal one, and should be funded by state and local institutions. Tonight I discover that as even the smaller local mental health and addiction treatment facilities continue to close, much of the care for these patients falls instead to firefighters, EMTs, and emergency rooms.
Next up: Six-Minute Chinese, in between car and motorcycle crashes.