"I See Drunk People..."

"Hey Buddy." I shake his shoulder, firmly. "HEY BUDDY!" He's slumped in the stall, pants down, on the shitter. A small gash seeps on his forehead, probably from hitting his head on the toilet paper holder. A laptop case lies at his feet. Outside, behind me, several police officers and my crew chat in the train station restroom. My right hand seeks a radial pulse... ah, there it is. Not dead. My left hand cracks the ampule of ammonia inhalant, soaking the wrapper with pink foulness. I hold the sachet under my patient's nose for a long moment. He gently bats at it, the vapors plumb the depths of his addled mind. We call them Silver Bullets, the only tool for the job of rousing the poisoned, intoxicated, unresponsive zombie. At last, the odor finds purchase on his brain and pries the stupor out of the way, like a heavy door.

"Cut that shit out, man!" He swats again, this time his hand is pushing the ammonia away. I pull it away for a second and then firmly press it under his nostrils.

"Wake up. What's your name? Talk to me."

"Whatdaya want?" His eyes are open, unfocused, he grabs my hand. I withdraw, replaced by a police officer. A rambling conversation ensues. "Oh, a few beers," he allows. Humorless chuckles from the crowd. The station is closed. He is drunk, broke, homeless. A plan is formulated. I'm gloved up, closest, least senior; it falls to me to hoist his drawers, get him moving to a bench outside the men's toilet. This is, in fact, more difficult in practice than theory might predict.

He can barely stand, his pants are still fastened, belted, and catch on his skinny hips. He sways, I lift and steer him past urinals, sinks, out the door. His bare ass is covered by his coat, but I keep him at arm's length anyway. If he collapses I'll keep his head from hitting the tiles, but I will not get poop on me.

He's on a bench now, and I wonder if the cleaning lady who found him will scrub the oak after he's gone. The police are asking him questions again, while I collect vital signs. Does he have a medical emergency? Where does he want to go?

He wants a place to sleep, and the fire department is not needed. I pack up my kit, snapping the case closed, clack, clack. We stride out the doors, into the autumn night, to our idling fire engine.

Several times a day, miscellaneous fire department vehicles are dispatched to man down calls, usually called in by a well-intentioned driver with a cell phone. These alarms are routed to Fire instead of Police, despite an historical record demonstrating "man down" equals "public intoxication." Aid cars, engines, ladder trucks roll up on the address, searching for the patient, taking clues from the information relayed by the (frequently confused) passerby. Frequently, no patient can be found, or a blast from the air horn rouses them from their nap, and they move on, to seek a more private retreat. But, more often, we find ourselves standing above a drunk, shaking him by the shoulder, reaching for the trusty Silver Bullet.

In addition to blood pressure, pulse, and respiration rate, we assess our patient's level of consciousness, as a matter of course. If he answers questions appropriately, he's alert. As his LOC decreases, a response may require shouting or painful stimuli. Genuine unresponsiveness, an emergency in itself, makes the situation, instantly, more serious. Our assessment becomes more critical, and, in certain circumstances, perhaps a tad cynical.

It's not unheard of, to be called for a Police incident in which the subject suddenly goes limp, feigning injury or illness. In EMT school, we were taught to grind our knuckles vigorously into the sternum to elicit a response from the verbally unresponsive. It's old school, and requires no special skill. The sternal rub might reveal the BS in the BLS (Basic Life Support), but it looks bad when executed properly. "Why would that nice firefighter hurt that poor man like that?" an on-looker might ask. Try doing it to yourself, and see how much effort it takes to provoke a grimace. A better technique is to place your fingers behind the jaw, at the neck, and dig a finger into the hollow on both sides. This is innocuous, appearing to the casual observer as a tender, caring touch. Alternatively, a limp arm can be lifted over the patient's face, dropped, and observed. The arm of a patient faking coma will not hit his face, but falls adjacent to his head.

We go on these calls on the off chance that a real medical emergency has occurred. Last night we were dispatched to see a woman at a bus stop. "Unconscious, breathing, pants around knees." We arrived to find her draped sideways over the bus stop structure, bare butt in the air. Handing off an ammonia sachet, I sprinted to fetch a blanket from the rig, while Randy, our driver and former paramedic, checked her carotid pulse. I returned to find my captain and Randy lowering her onto the sidewalk. I covered her nakedness with the blanket and Randy set up the bag valve mask to assist respirations. He asked for an oral airway, a curved beam of plastic, "H"-shaped in cross-section, that keeps the back of the throat from collapsing, and closing off the air supply. She didn't gag on the device as it was twisted into position. That's a bad sign.

An empty bottle of vodka lay on the grass where her head had rested, and pills were found in her purse. Her clothes and shoes looked reasonably expensive, not the usual man down attire. Medics arrived, an IV was started, Narcan administered. One of the medics expressed doubt that the Narcan, a anti-narcotic, would have, with this patient, its magic effect. Sometimes, it sucks to be right. After they tubed the patient, I drove the medic rig to the ER, the engine following. We don't know what happened, we don't know her outcome. Seldom do we.

But, this I know: There will be man down calls. I make sure the kit is always stocked with barf bags and Silver Bullets.