Man Down

My partner and I were dispatched to an address in the central part of town on an ‘Unknown Medical.’  We were to go to the alley and find the male patient in need of some unknown kind of help – we would know it was him because he was the “unconscious” guy on the cardboard mat in the corner of the parking lot.  Nice.  But one of my rules is that they give me an address and I go there to see if I can help someone.  It was a simple job.  I woke the guy up, asked if he was okay (he was), made sure he was sober enough to take care of himself (he was stone-cold sober), and told him to have a nice nap. 

At the beginning of my career I used to roust those patients and make them find a more hidden place to sleep: “Beat it; you can’t sleep here.”  My thought process was that if someone saw him and called 911 once, it could happen again.  Thus, he needed to find a more hidden place to make his camp so I didn’t have to go back.  But I no longer do that.

I have a role in making sure that the “down party” doesn’t need medical attention and that they are generally sober enough to not need to go to Detox, not die in a little fountain of rock-star-style aspirated vomit, and/or not stagger into traffic.  I’m fully down with the concept that the need for medical aid can include ingestions of ethanol that have resulted in altered mentation.  That’s okay.  But it isn’t my place to make them move camp for my convenience.  I am a medical provider, not a police officer.  I can’t enforce camping or trespassing laws.  This guy had found a shady spot after “flying his sign” on the corner and was napping in the shade.  He was sober.  Good enough.  I hope the rest of his siesta was good.

Turn Signal Idiots

This week I ran a call with one of the four medics that I am comfortable allowing to attend on a shift, so I happened to be driving.  It was a very long, very busy, very hot day.  All of these things conspired to make it so that I didn’t have time to eat – and a hot and hungry medic is an irritable, overly critical medic.  At least on any ambulance on which I’m working, that is.  So I wasn’t in the best of moods.  On the eighth call of the shift, we took a patient to the hospital – about 4 miles away from their house.  On the way to the hospital, with my partner in the back providing for the patient, I was behind a crappy old Honda minivan.  This idiot was driving along a main road for miles in the number one lane with their right turn signal on. 

At first, I thought that they were attempting to change lanes.  But as the miles passed, I realized that the driver was just a moron.  This was the kind of driver that had real problems staying in their lane, washing their vehicle, and other minimal issues of vehicle ownership.  What a jerk.  Driving along with their yellow turn signal light flashing like a imbecile.  As is my habit, I used this opportunity to check my own turn signal – yep, off like it should be, because I’m not an idiot. 

In any case, my partner and I dropped the patient off at the hospital and were assigned another post.  So we headed out.  On the way to the new post, there was another oblivious dimwit driving along with their turn signal on.  What is the matter with these people?  What causes a person to be so oblivious as to not recognize that their turn signal is blinking away unnecessarily?!?

Since it is a pretty well engrained habit, I checked my own turn signal again.  Still off.  Wait.  My turn signal was indeed off, but my arrowstick has been on for the 20 minutes that have elapsed since we were on scene of the last call.

Damn.

I guess all of us can be idiots at one time or another.

The Universal Language of Pain

EMS in the big city means that we occasionally need to communicate with patients that don’t speak English.  The best result is if your agency pays for a telephone translation service.  I can call dispatch, they connect me to the language line, and the phone gets passed around while my questions are answered.  But this takes significant time and our job can be time-dependent.  So it is not a perfect answer if you’re in a hurry.  Plus, there are just some patients who don't get to press my phone to their face.

Although I understand that they work for many people, I am not convinced that medical Spanish classes are the answer, for two reasons.  First, there are patients who speak neither English nor Spanish.  Second, the concept in the classes strikes me like memorizing a play.  You learn “What is wrong?” and “My chest hurts.”  If the answer to your “what’s wrong” question is anything but “My chest hurts” (and it usually is), then you’re S.O.L.  Think of the answers you get in English to the what’s wrong question.  Answers start in the past tense, with extra words like “well...,” and involve a whole story. 

One simple trick that I learned is to memorize the word for “pain” in multiple languages.  The worst case is that you can point to various body parts and ask, “Pain?”  Between that and some pantomime (noisily pretend to vomit, point to them, and raise your eyebrows in the universal expression of questioning) you can usually get at least some idea of what the issue seems to be.  Sometimes it works, and it is better than nothing.  So here are the words for pain in commonly spoken languages, straight from the all-knowing sages at Google, with my attempt at writing the pronunciation in parentheses.  You can go online to hear audio files of the words being spoken, as well.

• Spanish: dolor (duh-lor)
• Arabic: alam (uh-luh-muh)  Big chunks of the Middle East and North Africa can speak some variation of Arabic.
• Chinese/Mandarin: tòng ma (sounds like tung, spoken “downward” and the ma is how a question is indicated)  A lot of Chinese immigrants speak Cantonese rather than Mandarin, though, so watch out for that.
• French: douleur (dew-ler)  Besides the obvious, many African countries speak French.
• German: Schmerzen (schmer-tsen)
• Hindi: Darda (Dard, with the ‘r’ barely spoken)  Hindi is the language of most of India.
• Italian: dolore (dew-lourey)  Italian is less useful, but I’ve actually found that some Somali people can speak it.
• Japanese: itami (ee-tam-ee said really fast)
• Klingon: ‘oy’ Apparently the apostrophes mean something.  Just checking that you are paying attention.
• Portuguese: dor (sounds like dure with a silent ‘e’ – the first syllable in ‘duration’) Portuguese is spoken in Brazil, as well as in Portugal.
• Russian: bol’ (bull -  I’ve also had good results with bull-yeet)
• Thai: Khwām cēbpwd (kwam seb-wood)
• Vietnamese: dau (tau)

If you know words for pain in other languages that are commonly spoken in your jurisdiction, include them in the comments.

Two Rules of EMS

I have two rules for EMS:

Rule #1: Don’t kill anyone

Rule #2: Look cool

Actually, that is the original version of my EMS rules.  Rule #1 has morphed from “Don’t kill anyone” to “Don’t make anyone worse off” to leaving people better off – make their issue a little bit better than it was when you met them.  But that isn’t as catchy and memorable a thing to say for the two rules.

We spend a lot of time in classes learning to save lives.  It’s unfortunate that nobody expressly explains that our job isn’t often to save a life.  Our job is to start the process of fixing the problem that people called us for.  Everyone has a different threshold at which a problem is unmanageable to them.  For some, it is being pulseless due to a gunshot wound.  For others it is loneliness.  But our job usually exists somewhere in between those two.  Your problem threshold isn’t germane to the discussion.  We understand that it is probably higher than your patients’.

If I count lives saved as the only way that my time was not wasted and the only metric of a successful call, then I will burn out quickly. 

We.  Do.  Not.  Usually.  Save.  Anyone. 

Sorry to break that to you.  I will grant that there are rare calls in which we can save a life – a chunk of steak in an airway comes to mind.  But those only happen a few times in a long career.  Even a cardiac arrest with field ROSC hasn’t been saved by EMS – we only started a very long process that is continued by dozens of people in the hospital.  All we did is to leave them better off than they were when we found them.  Thus, to me, it was a success.  This is also true for the pulseless GSW victim who was pronounced upon arrival.  That patient may have died, but I left them better off than when I found them (for the most part, hopefully).   It may not have even possible to save their lives.  So if the hospital pronounces that patient, does that make everything I did a useless string of failure?

It is a successful call when I can give analgesia to someone in pain, comfort someone who is scared, offer good advice to someone who doesn’t know what to do, or even just set up the hospital for future success by starting an IV and taking vital signs.  All those are successful calls.  We have a lot of them.  Just focus on leaving people better off than when you found them when you are not on a life-or-death call – no matter what their problem is.  Your self-image will more closely align with reality, you will have more job satisfaction, you will be happier, and you will be able to focus on what your job really entails.

As for Rule #2, I don’t think that I have to say that you cannot succeed at Rule #2 if you have failed at Rule #1.  Maybe I will expand more on the concept of looking cool later.