Columns, Patient Care

Staying Composed Among the Chaos of ‘Meeting the Mexican Ambulance’

Issue 4 and Volume 40.

The San Ysidro, Calif., border crossing near San Diego is the busiest land border crossing in the world. So many EMS calls are generated that two additional ambulances are stationed within a quarter mile of a main dedicated ambulance, Medic 720.

Patients crossing the Mexican border into the U.S. by ambulance can be very challenging calls. When dispatch tells us to “meet the Mexican ambulance,” no other information is provided. We’re flying blind. Over the years, I’ve tried to replicate this type of call in simulations for my students, only to receive eye rolls and comments like, “Are you serious?”

The call starts at the secondary border crossing. Normally the crew from the Mexican ambulance doesn’t speak English, so hopefully someone on your crew is bilingual; it’s much smoother that way. If not, you often have a patient turned over to you with minimal information.

They’re likely coming from a Mexican hospital, so any paperwork detailing the mechanism of injury, nature of illness, treatments or medications is written in Spanish. Often they have IV meds with indecipherable labels, and patients aren’t on pumps. Unfortunately, sterility isn’t as high a priority as in the States so the ET tube, IV tubing, splints and other items likely aren’t up to snuff either.

If the patient was involved in a traumatic event, it may have been hours ago or a week ago. They can easily have a Glasgow Coma Scale (GCS) of 3 and you don’t know if they’re chemically sedated or head injured. The whole call can feel like a whirlwind if you let it.

Recently, I assigned a very capable student to a friend on a ride along. What call did he get? He met the Mexican ambulance. Once he arrived, he was presented with a 7-year-old who had been run over by a truck five days earlier—a horrible call for any responder. The child was intubated and on a ventilator that couldn’t be turned over to the crew, on IV med drips containing unknown contents, and had a GCS of 3 and multiple traumatic injuriesa pretty rough call for an intern. He managed the call well by using translators and relying on his training over the past year.

What makes these calls different from those you typically see in the States? One thing is the injury may have happened days earlier so the inflammatory response we aren’t usually privy to is likely in full swing. Infection is another issue. One crew recently encountered a 3-year-old girl with a fever of 104 degrees F. She had three infected past IV sites and a current IV so obviously infected that her arm was horribly swollen.

There are also many clinics in Mexico claiming to cure cancer, only to have the patient wind up worse off. A 95-year-old man was recently brought from a cancer clinic with skin cancer that had progressed to gangrene. It had eaten away so much tissue on the left side of his face that you could see directly into his oral cavity, cheekbone and nasal cavity. The most disturbing part of the call was that, without all of that tissue in place, his left eye actually fell out during the EMS transfer.

Complicated births are another border mainstay. In one incident, 30-week gestation twins required the U.S. consulate, Mexican consulate, and undersecretary of the Department of Homeland Security to facilitate the patients being allowed into the country. In some instances, patients that aren’t granted entry are forced to return to Mexico. For people whose primary focus is patient care, it’s heartbreaking to see a person in need of care being driven back across the border.

Border calls can also present paramedics and student alike with cases you would normally only see in a Hollywood thriller, with patients found in gas tanks and trunks being smuggled into the county. Recently, a 16-year-old walked through the pedestrian crossing with a bottle of liquid meth. To prove it wasn’t, he drank it before anyone could stop him and was dead before a medic could run to his aid.

Why is training important when responding to border calls? Because a pager that reads, “Meet the Mexican ambulance,” might actually be for an MCI involving multiple Chinese tourists involved in a bus rollover that you have to assess rapidly with little assistance from your neighboring colleagues in EMS—San Diego’s equivalent of a tornado.