March 19, 2018

From car accidents to overdoses, emergency medical technicians (EMTs) need to be prepared for anything and everything. It’s a profession that requires both mental and physical stamina, and willingness to respond courageously to the unknown. In order to better understand the real-life challenges and stresses that an EMTs endure, we interviewed full-time paramedic and author Peter Canning. A 20-year veteran, Canning has chronicled his passion for the job in two autobiographies and two novels. Here’s his snapshot of a recent day in the life of an EMT.

What follows is an extended version of Mr. Canning’s Day in the Life… account:

5:30 AM:

I punch in and checkout my equipment, my house bag which contains my medications, IV and airway supplies, my heart monitor, and then the equipment on the ambulance shelves, while my partner checks the ambulance to see that the siren and emergency lights are working and that we have plenty oxygen to make it through the shift. He also checks the oil and engine fluids.

Then, we sign on with our dispatcher and already there is a 911 call for us. No time for coffee. A 68-year-old woman has been vomiting all night. I feel her forehead she is burning up. Her tongue is also dry and cratered. I give her Zofran for her nausea and IV fluid for her dehydration. We transport her to the hospital.

6:23 AM:

I am writing my PCR (Patient Care Report) on my laptop computer in the hospital EMS room when my pager goes off “Can you clear for a Priority One?” We head out lights and sirens for the report of a person unresponsive in a car. Before we can get there, we are cancelled. It turns out the person was merely sleeping. Dispatch has another call for us. A motor vehicle crash by the highway entrance ramp. Both drivers are out of the car inspecting the damage, which is minor. One driver has arm pain, but refuses to go by ambulance to the hospital. We have him sign a refusal of care, and then clear the scene.

7:04 AM:

Report of another person not responsive. A woman stands by the front door and we can see she is crying as she flags us down. The man is on the second floor in the bathroom. He collapsed on the toilet. His skin is cool and diaphoretic. We apply an oxygen mask. While my partner tries to get a blood pressure, I put him on the cardiac monitor. His heart rate is critically slow and the 12-lead ECG shows he is having a massive heart attack. I apply pads to his chest, and start pacing him. The monitor gives small regular electrical jolts to his heart to increase his heart rate. This is successful and he opens his eyes now, and tells us he is having crushing chest pain. The fire department has arrived and they help us secure him to a scoop stretcher, and then carry him down the narrow staircase and out to our stretcher. I call the hospital with a STEMI Alert and transmit them a copy of the man’s 12-lead ecg. On the way to the hospital, I put in two IV lines and give the man some aspirin. The cardiology team meets us at the ED entrance and we take the man right up to the cardiac catheterization lab bypassing the ED. We move the man onto the cardiac table. The cardiologist invites us to stay and watch the procedure, but already our pagers read “Status Zero.”

8:11 AM:

We are sent to a central location. Just as we pull into the coffee shop, they call our number. Medical Alarm. We arrive at a small one-story house in the Blue Hills section. We enter the house and find the woman on the floor by the living room couch. She says she is not hurt, and does not want to go to the hospital. Her aide did not come this morning. She tried to get up with her walker and make herself some breakfast but she slipped getting off the bed and she is unable to get herself up from the floor. My partner and I get her back in bed and after a full assessment can find no injuries. We call the aide agency and they assure they will be sending someone out in a few hours. The woman says she is hungry, so I make her some toast, eggs and get her some tea. She thanks us and we clear.

9:04 AM:

We finally get a break. I stop at a Jamaican restaurant on Albany Avenue and get an order of ackee and saltfish with boiled green banana, dumpling and yam.

9:38 AM:  

Behind the apartment door we find a 79-year-old man with swollen legs, who has gained 20 pounds in the last two weeks. His lungs are filled with fluid, and he is only able to speak a few words at a time. His pulse saturation is 87. I put a nitro tab under his tongue and apply a CPAP mask, which provides constant positive pressure oxygen, helping him breathe better. His saturation comes up to 96% and I can see the relief in his eyes.

10:52 AM:

We are called to the bus stop for a sick person. “It’s got to be Mary,” my partner says to me. He’s right. We pick Mary up nearly every day, usually at bus stops. She spends her days riding around the city. She is a woman in her 50s who has anxiety and obsessive compulsive disorder. We take her to the hospital and they have us put her in the waiting room. She’ll probably leave in an hour or two and call for another ambulance later in the day.

11:48 AM:

A large man in his 30s stands in the middle of traffic completely naked.  The police officer asks us for a blanket to wrap the man with, but the man wants no part of the blanket. He has a blank look in his eye and is muttering something incomprehensible. This is not an unusual scene for us. People who overdose on PCP feel very hot and have no compunction about undressing in public. Sometimes they are calm, other times they can be violent. He starts shouting at the officers and raises his fist like a boxer.   It takes four police officers to get him on our stretcher. I sedate him with midazolam, a sedative by giving him an injection in his thigh while the officer struggles to hold him down. By the time we get to the hospital he is sleeping peacefully.

12:57 PM:

Dispatch sends us on a transfer. A woman on the orthopedic floor is being discharged to rehab. We load her on our stretcher while carrying her balloons and bags and drive her to a local nursing home where we get her located in her room. I refill her flower vase with water.

2:08 PM:

Overdose on Park Street in the bathroom of a fast food restaurant. A customer complained that the bathroom door was still locked and no one answered his knock. The manager opened the door and there is a young man with a needle in their arm not breathing. I feel the patient’s neck. He has a pounding pulse. We get out our ambu-bag and start breathing for the patient. I take the opioid antagonist Naloxone (Narcan) out of my kit, and squirt it up his nose. Opioid like heroin can block receptors in the brain that enable a person to breath. The Narcan knocks the opioid off the receptor and restores breathing. We continue bagging. In two minutes, the patient starts breathing on his own. He wakes up with a start. “Easy,” I say. “You ODed. We gave you Narcan.” On the way to the hospital he tells me he was in an accident at work. He got hooked on prescription pain pills. Heroin is cheaper and works the same. I give him the state opioid hotline number that he can call if he wants help. I tell him if he is going to use, he needs to have someone with him, and to always have Narcan with him. Years ago I would have told him to just say no, but now we follow the principles of Harm Reduction. Recognizing people are going to use illegal drugs, we encourage them to use safely until they are ready for treatment. A dead person can’t recover.

3:05 PM:

I stop at El Mercado on Park Street and buy roast pork, yucca and tostones (fried green plantain) from one of the food stalls. On the way out I give my change to homeless woman named Rosa whose arm is in a cast. She fell and broke her arm last week and we brought her to the hospital.

3:46 PM:

We are sent to cover downtown, and when we get there, they send us back to the area we came from. We are there less than five minutes and they send us to another area. System status management is designed to spread ambulances out to minimize response times. When we finally reach the post I get out and stretch my legs. They call our number. Pedestrian struck. Three blocks from our location. An elderly woman has been hit in the crosswalk by a car that has fled the scene. She is alert, but seems confused. Her leg is clearly broken and she had an abrasion on her head.  She says it hurts when she breathes. We quickly apply a cervical collar to her neck and splint her leg, and then get her on the stretcher. On the way to the hospital, I take her blood pressure, check her more thoroughly for hidden injuries, splint her leg and give her medicine for her pain. My partner calls the hospital and requests the trauma room. The elderly often have internal injuries that we can’t see, and they are more likely to die from their injuries than younger people. After giving the report to the trauma team, an ER doctor tells me the STEMI patient we brought in earlier had a 100% blockage of his right coronary artery, and as soon as they cleared the blockage, his heart block resolved. He is alert and doing well. We also see the naked man we brought in. He is dressed in a hospital gown, snoring in his bed.

5:21 PM:

Dispatch calls our number. Is it going to be another call or are we done?  “You’re all set,” the dispatcher says, “Have a good night.” “You too,” I say. Back at the base, we restock the ambulance, turn in our computer and keys, and punch out. “Let’s do it again, tomorrow,” my partner says as we head to our cars. “I’ll be here,” I say.