‘Nightwatch’ Episode Shows the Raw Emotions of EMS

Emergency responders and members of the public that have been following the new A&E Network series NIGHTWATCH are getting a close-up look into some of the many New Orleans EMS units, police patrol vehicles and fire rigs that respond to 1,000 calls a day. They get to see the working relationship between their EMS, police and fire responders.

They also get a glimpse into the heart and soul of EMS responders, seeing and hearing their often comical conversations while responding to calls, learning about the working relationship among the partners and crew members.

But, most importantly, viewers are witnessing the human side of the responders who are frequently subjected to stress and challenges that the public rarely sees.

Episode 4, entitled “The Darkest Shift on the Scariest Night”, aired on Thursday, Feb 12, and presented a focused look at EMS in New Orleans on one of the biggest and most active days and nights of the year, Halloween.

If you’ve never been to New Orleans on Halloween it may be difficult for you to envision thousands of happy, crazy, fun seeking and often heavily intoxicated people parading through the streets in and around Bourbon Street — in some of the most bizarre outfits you will ever see. I’ve been on Bourbon Street on Halloween and can tell you that it is unlike any other party or experience that you will ever have. As you walk through the streets and pass the countless bars and music venues, you will often see an engine company from a local fire station positioned with dozens of people around it, chatting with the firefighters and having their photos taken with them.

If you walk down side streets adjacent to the main streets where large crowds are gathered almost elbow to elbow, you’ll often find a variety of the New Orleans EMS ambulances, Sprint Car SUVs, bicycle EMTs and paramedics, NOEMS Gators, and ASAP all-wheel drive Mini Ambulances discretely positioned and available for response.

The vehicles will be locked and the EMS provider positioned at street corners and other locations to observe the crowd, interact with them, and enjoy the festivities while being immediately available to respond to individuals in distress in their immediate coverage zone or exit the massive crowd environment in an instant to be able to respond to calls in their overall response district.

Episode 4 was particularly interesting for me because it started out with the crews reflecting on their requirement to work on a major holiday. If you work in a system such as New Orleans that has massive events such as Mardi Gras or the annual Halloween parade, you know that you will probably have to work the event rather than have a day off to enjoy it. This takes a particularly strong mindset, particularly because emergency responders love to have a good time and enjoy the attractions and environment of their city.

Working on Halloween or Mardi Gras in New Orleans means that the responders know they are going to be barraged with responses and encounter patients that: don’t know where they’re at, often don’t care where they’re at, and who frequently either fight with them, verbally abuse them or try to refuse their care and/or transport to a medical facility.

Episode 4 was an important episode for emergency responders and the public to watch. In the opening segment, the partners are shown conversing about the requirement to work on such a busy holiday shift and also reflecting on the crazies they will encounter throughout the shift.

Holly Monteleone and her partner, Nick Manning, are shown discussing how they always seem to have to work on major holidays, a fact that they accept because of the need for them, and most other NOEMS personnel, to staff the multiple extra units and respond to the tremendously large call volume spikes that can be expected on those holidays and the days leading up to them. 

We got a chance to meet Keeley Williams and Rebecca “Becca” Howell, two Sprint car paramedics who respond to assist other crews or handle jobs solo in a decked out SUV.

When you first see Keeley, she is shown smiling, laughing and dancing along with revelers on Bourbon Street. And then later, you see Keeley, in another section of New Orleans, shake her head as she supports firefighters at the scene of a structure fire and watches a grown man dressed as a banana walk. (You can’t make this stuff up. It is vintage New Orleans!)

We later see Holly and Nick decorating the cab of their ambulance to join in the Halloween mood and experience while being ready to respond. In systems that I have supervise, I would not allow crews to decorate their ambulances on holidays such as Christmas when the family of patients could be riding in the vehicle and get a false impression of the sincerity of the crews if they saw festive decorations in the patient compartment or cab of the ambulances. It was also problematic because many people do not celebrate Christmas.

But, in New Orleans on Halloween night, when almost everyone in the downtown area is dressed in bizarre clothing (or none at all), and some wear frightening masks or face paint, the temporary decorations displayed by Nick and Holly seem to fit the night. 

You see, the residents and visitors to New Orleans for Halloween and Mardis Gras, start partying about a week before the actual holiday, and then “over-party” on the actual day of the celebration, often waking up and not being aware of what happened to them.

Holly points out to Nick in the opening segment that “We give up our holidays to serve the people on the holidays.”  This illustrates the love and respect the crews have for the time-honored party traditions in the “Big Easy.”

In the next scene, Paramedic Dan Flynn and his partner, EMT Titus Tero, respond to an “unresponsive male” in a bathroom. It turns out to be a heroin overdose, with a needle found near the young, unconscious male’s limp body. The crew (NOEMS and their fire first responders) work rapidly to reverse the effects of the heroin, through the administration of IV Narcan.

The close working relationship between New Orleans EMS and the New Orleans Fire Dept. is again illustrated in this episode when, following the overdose call, Dan remarks that “The fire department was doing a great job of bagging [the patient on their arrival”.

Shortly after this call, Dan and Titus respond to what seems to be a regular event in New Orleans on the night watch, a shooting. What made this series so powerful is its focus on the rapid care and movement of these unfortunate shooting victims to centers of excellence in the city.

Dan and Titus find their young male victim standing up and a 500 cc pool of blood near him. He’s in shock and close to death but doesn’t realize it, but Dan and Titus do. So they move him rapidly to their ambulance even though he is resisting their efforts to treat him. They know what’s best for him and tell him so. Titus later makes a profound comment, saying that “there’s no calendar for when people [who are shot or severely traumatized] hit a boiling point.”

In their rapid sequence of care for this patient, they place him on the stretcher inside their ambulance while he is still exhibiting vital signs. He then lapses into an unconscious state and they bag him and bolus him with NSS after determining he is in PEA (pulseless electrical activity by the heart) at a rate of just 56.

Their efforts however don’t prevent him from rapidly lapsing into cardiac arrest, so they immediately (within 10 seconds) apply a Physio-Control LUCAS 2 mechanical CPR device and have it compress his dying heart. This enables them to continue airway management, hemorrhage control and fluid therapy without having to worry about performing constant compressions in a moving ambulance.

They are able to deploy the LUCAS 2 device so rapidly because of their routine use of it, the convenient storage location for it (next to the patient — on the curbside floor area for easy deployment), but also because the fire first responders are familiar with the device and can help position and snap it into place in just seconds.

In unsolicited testimony for the LUCAS 2 after the call, Titus says that the “LUCAS 2 is a Godsend to EMTs because it does consistent compressions on the chest.”

The cameras then follow Holly and Nick as they try to find a patient at a dispatched address location that turns out to be an empty lot between two well-marked houses. Laughing that it was a Halloween “ghost call”, Nick chides Holly that the ghost knows her address and could be at her house when she goes home after the shift.  Holly brushes it off, saying “that ghost don’t know my address” but is clearly “spooked” by the conversation and the thought of a ghost. [Pun intended]

In the next scene, “Becca”, a young, highly motivated, paramedic, responds in Sprint Car 6249 to a reported “jumper” on one of New Orleans’ tallest bridges.

When she arrives on scene, she finds police officers at the base of the 100′ tall bridge, standing over the lifeless body of a young male who parked his sports car on the bridge above and jumped to his death.

Becca follows the New Orleans EMS protocol for determination and declaration of death, which is itself a learning moment for emergency responders watching the episode.

Becca’s comments in this segment were both sincere and educational. In reflecting on the unfortunate death, she says, “It’s chilling to see the transition between life and death.” 

But, in what was one of the more touching and important moments of this episode (and series), the 44 Blue film crew captures Becca crying afterwards in her Sprint car as she reflects on the call, admitting that the unfortunate and untimely death of the young male was “a little unsettling”.

I don’t know about you, but my EMT and paramedic instructors (and the educational curriculums) did not prepare me for this transition which I experienced countless times, with the first few deaths I witnessed tremendously hard for me to reconcile in my mind.

This call pointed out to emergency personnel and the general public alike that EMTs and paramedics are first human and subject to extremely emotional calls that can (and do) often gnaw at them throughout their shift and, more significantly, throughout their careers. 

Some responders may be upset that Becca was shown crying, but I wasn’t. It made me recall some poignant moments during Barbara Walters’ famous interviews with General Norman “The Bear” Schwarzkopf shortly after the end of Gulf War in 1991 that I often use in EMS leadership lectures.1-2

The brilliant, tough, military strategist and leader, who had just orchestrated one of the most famous military campaigns in history, gave Walters a light hearted tour of his underground bunker and War Room.

Then, Barbara sat down with him for a one on one discussion of the war. Several of her questions evoked emotion in him that surprised me and I’m sure many others who were watching the interview.

The first was a question Walters asked Schwarzkopf about being scared. She said, “I know this is a strange question to ask a general, but, were you ever scared?” 

His response was, “Sure. I’ve been scared in every war I’ve ever been in.”1

While discussing Schwarzkopf’s father who was a Major General in the Army, Walters said to him. “You know, there are certain questions I ask you, like about your father, and the tears come to your eyes.”2

Schwarzkopf replies, “I didn’t know it showed.” 

She follows up by saying, “The old picture of generals; Generals don’t cry. Generals don’t get tears in their eyes.” 

Schwarzkopf replies, “Sure they do”.

Walters follows with, “They just don’t admit it?”

With a gentle look in his eye, Schwarzkopf then says, “Oh, I think they admitted it. Grant, after Shiloh, went back and cried. Sherman went back and cried. “¦ And these are the tough old guys. [General] Lee cried at the loss of human life — at the pressures that are brought to bear. Lincoln cried.”

But the most powerful leadership message came when Schwarzkopf told Walters, “Frankly, any man that doesn’t cry scares me a little bit. I don’t think I would like a man who was incapable of enough emotion to get tears in his eyes every now and then. That type of person scares me. That’s not a human being.”    

This interview, referenced and Web-linked at the end of this article, is a must watch for all EMS personnel, particularly EMS managers, so they realize what true leadership is and, more importantly that all responders, like tough, respected military leaders, are human and should never be afraid to show emotion after a difficult call.

Episode 4 concludes with another powerful message evolving from this new, high-powered show, when Dan and Titus reflect of the bizarre Halloween night shift where one New Orleans EMS crew was called upon to manage 17 intoxicated partiers. The statement, worth remembering, was, “If we’re not here to take care of them, they’re gonna be the next ones shot because they can’t take care of themselves.”

Watch NIGHTWATCH on Thursday nights and go on the Web to watch Episode 4; http://www.aetv.com/nightwatch/video/the-darkest-shift-on-the-scariest-night.

And come to the EMS TODAY Conference in Baltimore, Feb. 26-26 to meet the men and women of New Orleans EMS featured on the show. They will be appearing in Meet & Greet opportunities in the Physio-Control booth on Thursday night, Feb 26 and Saturday, Feb 28 and in the Braun Ambulance booth on Friday, Feb 27th along with one of the custom Braun ambulances featured in the series.

Footnotes:

  1. Barbara Walters interview with General Norman Schwarzkopf (Part 1) http://wn.com/interview_with_general_norman_schwarzkoph (5:49 – 5:59 minute segment)
  2. Barbara Walters interview with General Norman Schwarzkopf (Part 2) http://wn.com/interview_with_general_norman_schwarzkoph (2:05 – 4:28 minute segment)

 

 

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