Tuesday, March 08, 2011

Closer To Home

I was commenting recently (within the past hour, in fact) about how I don’t write much these days about what happens at work. The fact is that I don’t always remember to, and I have to really work to remember what happened on any given tour. But let me tell you a little about my schedule and I think you will understand why this is the way it is, at least for the time being.

First, my work schedule consists of a 24 hour tour on one of the two ALS-level city trucks in Newton on Wednesdays. That would be tomorrow, in fact. And while Newton is a moderately busy city, it simply doesn’t compare to the tours I worked in Manchester, nor does it compare to the level of insanity that my friend Michael Morse contends with. He is a Captain with the Fire Department in Providence, RI, and he commands a Rescue company. By “Rescue”, I mean an EMS unit that I suspect has other duties at a fire scene. Usually, that means in conjunction with a ladder (or truck, depending on how your department classifies its apparatus) they go into fully involved buildings to search for those people unfortunate enough to be trapped inside. It is dicey work, and that simply is putting it mildly. I say that because, truthfully, you never know what’s going to happen when you’re looking for people in a building that has fire inside and out, it’s hot, there is no visibility, and the question of whether or not stairways, floors, or anything that bears weight is going to hold while you’re on it.

As for the EMS aspect of his job, read some of his posts. Providence is a tough, scary place. One wouldn’t necessarily think so, but it is. It easily outdoes places around where I am. Manchester, in its own right, is tough enough as well as busy enough, but I really think Providence has it beat hands-down. Newton is nothing like Providence. In fact, I compare Newton to some of the other places we have contracts, like Revere, Chelsea, or Somerville, and I can’t help thinking that we have it easier than most. Yes, it is busy. But the majority of people we transport really are sick. Considering the demographic, it’s people who have health insurance that live relatively healthy lifestyles. And when they call us, most of the time it is not for trivial things. It’s because something is really wrong.

At the same time, I look at Waltham, the city that borders Newton to the north. It is much closer (figuratively) to Providence or Manchester or Somerville, Revere, or Chelsea than Newton is. For one thing, the population is considerably more ethnically diverse. There are fewer people that speak English as a first language – hell, there are fewer people that speak English. The EMS crews that work in Waltham have lots more in the way of trauma: stabbings, shootings, fights, that sort of thing. They have a larger incidence of problems with drugs. And they have a larger share of Route 128 to deal with. We have some of that, and we also have a decent sized slice of the Massachusetts Turnpike that we have to concern ourselves with, but it seems that our “index of stupidity”, for lack of a better term, is not all that high.

I also think of the people that I work with who have schedules that put them in the places I mention. Their call volume is ridiculously high. It is not uncommon for some of these crews to do 18-20 calls over a 24 hour tour. I think the most I’ve done over 24 hours in Newton is 14-15 calls, or something like that. There are days where I do as few as 5-6 calls, and I don’t complain about those. It seems, though, that those calls are dispatched usually after 10:00 PM more often than not. But that is part of the job, and I never complain about that (at least not seriously – we all grumble when we got woken out of a sound sleep to respond to an elderly person at an assisted living facility who needs a lift assist).

On my Saturday tour, I work 16 hours in the role of the duty supervisor for Boston division units and personnel. That includes the crews who work in Boston and the crews who work in Newton. It is not a terribly difficult job; I answer requests for assistance from my crews, usually in the way of providing supplies they need to stock their vehicles appropriately. I also deal with personnel-related stuff, mostly intra-crew squabbling, problems with the facilities, scheduling issues… And I act as an intercept unit for BLS-level crews who get sent to situations where a Paramedic is needed. I also will go sometimes (depending on the nature of the call) with Paramedic-level ambulances where they may need a chauffeur or a third set of hands.

An example of this happened Saturday night. One of the Newton crews was dispatched for an unconscious child. It was a full response: ALS-level ambulance, engine company, police. I also responded in the event that it was something bad, like a cardiac arrest. As it turned out, it was a two year-old female who had spiked a fever and had been seizing for approximately 30 minutes prior to us being called. As I understood it, the seizing wasn’t totally continuous, but it was going on solidly enough that this child needed to be medicated. Plus, there was a language barrier: one of the few times where there was an issue with language, the parents of this child spoke limited English. Their primary language was Japanese.

As I said, she was two years of age, weight of approximately 12-14 kilograms, a heart rate of 220-240, and she was rather warm. Definitely a sick kid. The firefighters got her on high-concentration oxygen, and  the medics on the truck were able to get her settled with rectal Diazepam (Valium) and asked me if I would drive for them. Of course, I did. My vehicle got beached, and the captain on the engine company brought it back to the firehouse for me while I took the crew, the patient, and her mother to the hospital.

Once we got there and they transferred care to the hospital staff, I was trapped with them for a little while. That actually turned out to be longer than I had expected as they got another call from the hospital to one of the three country clubs in Newton for a person choking. We headed there – I jumped in the back instead of driving. As it was, I quickly became a third wheel, in a manner of speaking. When we arrived, the engine company who responded informed us that the patient was okay; the object (a peanut) was dislodged, and she – a 76 year-old female who looked and acted about 20 years younger – was breathing and talking without difficulty. So we went in to see her, and she was indeed fine. In fact, she was quite feisty. She wanted no part of a hospital visit, and she made that clear to us.

One of the medics later on teased me about her flirting with a man better than 25 years her junior, and it took me a few minutes to realize he was talking about me…


TOTWTYTR said...

The way I understand it, in Providence a "rescue" is an ambulance. What we would call a rescue, they call "special hazards".

Maybe Michael will chime in and correct or confirm my recollection.

Walt Trachim said...

Actually, the rescue/ambulance concept is not unheard of. I know of a couple of communities up my way (Bedford, NH and Concord, NH come to mind) where the duty ambulance crew - provided they are firefighters - are part of the RIT team along with their respective ladder company.

I have heard the term "Special Hazards", but I didn't know what it meant. All I could think of was the NYPD ESU.

Susie Hemingway said...

What I understand from this post Walt, is that you all work far too hard! I know how well you are all trained but you must use so much mental energy every day. It must be draining sometimes to switch from crisis to crisis and when you mentioned the hours - Phew !! Still as I have said before, what would we do without you guys (and gals) I have so much to thank the paramedics here for, as H was saved more than once in the back of an Ambulance, to be able to return home again for a while with us. Good work Walt and stay safe out there!

brendan said...

TOTW has it right. In some of Providence's mutual-aid areas, Rescues do in fact occasionally have firefighting responsibilities as well- for example, the first-due Rescue goes in, while the second-due takes care of fireground EMS responsibilities.

In Providence, the first-due Rescue Officer becomes the EMS Sector Officer, and the second-due handles any transports that are necessary. If that happens, the second-due is replaced with another Rescue, and so on.

"Special Hazards" is the heavy rescue. I couldn't even begin to tell who whose idea that was; I just know that the "Rescue Squad" was the designation of FD-based ambulances going back for decades in RI.