The Big Dark Picture

Saturday, March 05 2005

I think most people who are not associated with emergency medicine get the impression that it’s Exciting. A good many of the folk working EMS do so for an adrenaline rush, I’m told. Alas, for DTs, this is not the case. Are we sure? Let’s look:

Here is DTs, riding in his first bambulance ride-along. Note the periodic muscular twitches! Observe the dilated pupils! Marvel at the slow, stuttering speech! Yes folks, this is a trained professional in the making!

But it ain’t excitement, per se. It’s more Fear of F*ing Up. Which he does, by the way – someday he may tell the tale.

Next slide, please.

Here is DTs, driving the bambulance after EVOC [emergency vehicle operators course]. Behold his teenager-like driving skills as he wrestles with driving and all the extra buttons and switches!

And here, running his first call… and here, running his first code… and here: Is this his first dead person? How tentative he is to presume death! And here… but need we see the rest? We do not. Suffice it to say that, every time it looked like Excitement was rearing its head, it was instead Excitement’s uninspired cousin, Nervousness. And Nervousness went that-a-way, slowly sanded off by repetition and confidence.

One of the aspects of Excitement which laymen suspect exists in EMS comes, I’m convinced, from TV shows which give the viewer The Big Picture. We don’t get that on the bambulance. At least not while it’s happening, anyway.

In TV-Land, the happy amigos are driving down the highway, fooling perhaps with the radio, when sudden catastrophe! The car swerves, the highway divider beckons, a montage of shots – mostly with the passengers crossing their arms over their faces as they scream in wide-eyed fear. Crash! Flip! Smoke and smouldering ruin! A Saintly Driverby peels the cell phone from his yap – “Call you back” – and dials 911.

Long-shot of the wreckage, and cresting the hill are Our Heroes, lights flashing. Reaction shots as their steely gaze encompasses the hideous carnage. Medium shot as they approach the thing; close-up over the shoulder of the muscular, mustachioed patient as he focuses on his rescuers’ approach. Zoom on the trapped leg with a “My leg! My Leg! And I am (gasp) a ballerina!”

Blah blah blah.

In Reality-Land, we come on the accident. It’s a mess. We pull over and are mostly concerned with not getting hit ourselves as we exit the ambulance. Motorists who slow to see what happened to them there in the wreck have seen enough. Satisfied, they whizz past us.

Careful going down the bank – the grass is slippery, you don’t want to slide into a sepuku situation on the protruding steel. Pay attention to your footing.

Five seconds per patient to decide who’s worse off – we see here Bad, Worse, and Dead. Being BLS, DTs and crew can give no drugs, fluids… we’ll take Bad, who was ejected. Here’s the medic to take Worse, and besides, Worse needs to be cut out of the car.

Put Bad on a backboard, collar and cot. Your entire crew is doing this and you trust each to do their role as you concentrate on your part. Look up, everyone’s done at the same time. Let’s go.

Roll him to the ambulance and load. It’s too cold to stay out, we can always unload. Quick check – severe trauma will not go to the closest hospital but instead need to fly to the trauma center. This guy’s injured, yeah – after all, there was enough force to make one occupant Dead – but Airway is good, breathing on his own, no real bleeding and no major bone breaks. We can take him, so Go!

We do not see the extrication of Worse, or all the other stuff you see on TV. The Overall. The Wow. That which makes it all so exciting.

That’s your typical load-and-go situation; you gotta talk to the fire guys when you get back from the hospital to even find out what kind of car it was.

Not exciting, but somehow satisfying.


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