Aboard Ambulance One

By Pat Remick
I recently made three trips by ambulance in a five-hour period but never was examined by medical personnel.

That's because I was riding the Portsmouth, NH, Fire Department's Ambulance One for research on my novel-in-progress, which has a paramedic as one of the main character's love interests. Any member of the public can request permission to do an ambulance ride-a-long and I wanted a busy shift in the busiest area of the city.

My first challenge was deciding what to wear on the recent Friday night. I knew it should be something that could withstand blood or other bodily fluids, be comfortable, and not make it too obvious that I wasn't a legitimate member of the ambulance crew. I opted for a City of Portsmouth polo shirt, dark pants and sneakers. Just to make sure no one drove into me at accident scenes, they handed me a Portsmouth Fire Department reflective vest that I sort of forgot to return, if you know what I mean.

I was told to report at the beginning of the 5:30 p.m. shift to be assigned to the firefighters staffing Ambulance One out of the Central Fire Station. All firefighters in Portsmouth are trained as intermediate Emergency Medical Technicians (EMTs) but the most trained also have attained paramedic status after up to two years of additional study, which allows them to dispense up to 40 medications and do cardiac monitoring in the field. This is important in stabilizing the patient by doing much of the activities that would be done if a patient were to go directly to the ER -- and reduces the great need to drive at breakneck speed to the hospital, possibly causing an accident.

However, our first run was to the grocery store so the junior man on duty (only five years with the Department) could do the shopping for dinner, which he also had to prepare and then clean up afterward. As his more tenured partner noted, "Seniority sucks unless you have it." The five men on duty wolfed down their American chop suey, heads-down, after confiding they employ this eating method because 40 percent of the time they get called out and don't get to finish a meal. However, they noted this style of eating has become a habit that is not appreciated by significant others at meals outside of the station.

Station One, also known as the Central Fire Station, has two firefighters assigned to the ambulance and two to the fire truck that also would respond to any medical emergencies. One of the four on the shift must be a paramedic. Portsmouth has the same arrangement at its Station 2. The fire truck responds with the ambulance in case there is a need for more than two EMTs on a call. The crew quickly determines whether the fire engine guys are needed and if not, they return immediately to the station. In a city of 21,000, you'd think two ambulances would be sufficient but last Friday night, there were three ambulance calls within the same time period. Apparently this happens often (19 to 25% of the time)-- and depending on the geographic area of the call, an ambulance from a nearby town is asked to respond.

Over the course of my five-hour shift, we had three runs: a minor traffic accident (no transport after evaluation and after the victim signed paperwork), a woman said to have heat prostration but it might have been vertigo judging by repeated nausea each time she moved, and a seizure suffered by a nursing home resident rehabilitating from a stroke. Each time, the EMTs calmly evaluated the potential patients and methodically went through their mental checklists. En route to the calls, I sat in the paramedic seat in the wagon, facing backward, but in the front seat on the way to the hospital. Both were exciting.

When I asked what type of personality is preferred for the job, one of the EMTs said, "Good people skills -- and you need the ability to be able to defuse aggravated patients; you have to be a good organizer so you can prioritize and you have to have a strong stomach." Lacking in all three areas, I decided this would not be a good career change but it gave me a new appreciation for those who have. Later, the EMT elaborated on how important it can be to be able to calm patients, noting: "It's not much of a stretch for someone who's suicidal to become homicidal." Scary stuff.

During our down-time, I separately asked each of them about their worst calls. Both said they were incidents involving young children. Death is a little easier to deal with, they explained, if the victim is elderly or has engaged in behaviors that could be responsible for their demise. But children dying is another matter.

They also said they often receive calls from people seeking transport to the hospital when their issues might not seem sufficient to warrant an ambulance ride that will cost them, the insurance company or the government $400 each. But, they note, "not everything is what it seems." And if the patient complains of difficulty breathing, the EMTs cannot take the risk of not doing a hospital transport. "We picked up one woman 52 times in three months," he said. "But one of those times, she was very ill."

However, it's these types of non-emergency calls that may cause an EMT to say he's driving the "pinky wagon" -- meaning the patient being transported has a complaint as minor as an injury to his pinky finger. I learned that other common terms for an ambulance are the rig, truck and wagon.

The Portsmouth EMTs work two day shifts of 7:30 a.m. to 5:30 p.m., followed by two night shifts of 5:30 p.m. to 7:30 a.m., and then get four days off. This type of schedule makes it easier to commute from long distances or take second jobs. During the night shifts, they are required to remain awake until 10 p.m. but can then try to sleep. They say about 10% of the time, they go through the night without a call. Other times, they're called out repeatedly.

I've heard that some folks describe the night shifts as "dozing for dollars," but imagine what it must be like to go to bed knowing you likely will be forced out of a sound sleep in the middle of the night and have to get dressed, run out the door, and hop on an ambulance in 90 seconds or less. In addition, you have to be alert enough to deal with the unknown, knowing that failure to do so could result in death -- the patient's and possibly your own.

I'm not sure there are enough dollars in the world for me to take on a job like that, but I certainly have a new appreciation for the men and women who do