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Tales from a Busy 24-Hour EMS Shift

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When I work part time on the weekends, I end up taking shifts all over the city. For historical reasons, some of our trucks are 24-hour trucks while others are 12-hour trucks. Counterintuitively, some of the 24-hour trucks are busy for those 24 hours, and some of the 12-hour trucks are not.

Nowadays, I try to avoid the 24-hour trucks because I’m useless for the two days following a shift and not very helpful to my patients after 2 in the morning. I also don’t like getting up before dawn to drive to the city for a 7 a.m. shift, so luckily we’ve got some tactical 12-hour trucks that start around noon. Perfect; I get to sleep in a little and still get home in time for a decent night’s sleep. But sometimes, I don’t have a choice of shifts.

And that’s what happened this past week. I was assigned to a 24-hour truck starting at 7 a.m. It is one of the busiest rigs in the city. They do between 12 and 20-plus calls in a 24-hour period. Oh well, guess I could man up for one day, remembering when we were medics once—and young.

Sure enough, at 7:04 a.m., we were toned out for our first call. On leaving the hospital, we were toned to the next call. And that’s the way it went all day. This medic unit’s “box” has the perfect storm of numerous nursing homes nestled in neighborhoods whose socioeconomic condition tends to encourage the use of 9-1-1 as the number to call for every bump, bruise, cut, headache and hangover. Of course, those same socioeconomic conditions lead people to poor health, not to mention shoot, stab and beat each other up.
We got back to station a few times, just long enough to start loading our plates for a meal, begin watching a show or start working on a project, which was too bad because the station is awesome and the fire crew lots of fun—for the few minutes we saw them, that is.

So what kind of a nut-job works on a rig that often runs 24 hours straight? Sure, I can see a young medic sticking to it for a while for the experience and bragging rights, but the guy I worked with, let’s call him Roy, was at the station for more than three years. Surely he must be either a head case or a crispy burnout.

Surprisingly, he was neither. Roy seemed to actually enjoy the pace, and he said he loves the station and the guys he works with. (They rag on each other mercilessly—a sure sign of “bromance” in the fire service.) They even hang out together off duty. Unlike some stations where the medic crews are barely tolerated, here they are welcomed in all activities, share in all duties and are not treated as bastard step-children of any hair color. But surely, after years of this relentless pounding, Roy must be a pretty surly medic.

Late in the evening we were dispatched to an “extended care facility” for a “mental-emotional.” Terrific. It was Roy’s turn to tech the call, so I hung back and watched. The staff told us that the patient, Henry, had been admitted with brain cancer. Apparently, that day, he had become increasingly unmanageable (or decreasingly manageable, if you prefer). He was fully dressed and didn’t appear to have any physical deficits, but the staff had had to assign a round-the-clock sitter to follow Henry and keep him out of trouble. But it wasn’t working so well. Henry was going into residents’ rooms and yelling at them, and generally causing a ruckus. The staff seemed truly kind and caring, but they finally had to call the physician and he ordered transport to the hospital. Not quite sure what was supposed to happen there, but, hey, that’s above my pay grade.

Henry was sitting in a chair in an activity room with several of the staff. After getting the report, Roy walked in and asked Henry if he could sit down. They were all in a semi-circle—Henry, Roy and three staff members. I watched as Roy conducted a little encounter session, establishing rapport with Henry and the staff. But most of all he gave Henry respect and the appearance, at least, of having the power to make the ultimate decision as to what was to happen to him. And it worked very well, despite the fact that Henry and the staff couldn’t agree on the reality of Henry’s behavior. Roy took his time, was in no hurry. The result was a calm, pleasant walk to the stretcher and transport to the hospital. No drama, no yelling and no restraining. Despite the constant drumbeat of call after call, day after day, clearly Roy had lost neither his humanity nor his tact, and he treated this call as if it were the only call of the day.

So I say hats off to the maniacs who stick with the busy trucks year after year, and not only don’t lose their minds but retain their hearts as well.

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