In our fire stations, there's some small stigma attached to people who willingly commit to attending ten months of medic school in Seattle. At first, I was reluctant to share my goals, but our paramedics are also firefighters, performing truck operations (search and rescue, ventilation...) at working fires, and thus retain some firefighter street cred. I'm told it's a brutal ten months, but Harborview paramedics are considered some of the best in the business, with many thousands of patient contacts during their fellowship.
Every June, Harborview and UW host the WAMI (WA, AK, MT, ID) Trauma Conference. EMS providers, doctors, nurses, paramedics, and clinical eggheads converge on Seattle for two days of symposia and edu-muh-cation. There's pastries in the lobby, with vendors hawking gadgets, tools, and services. I've attended two of these conferences and come home with pockets bulging with swag and fancy ballpoint pens. The grub's pretty good, too.
Last year, at the very tail end of the two days, after hours of listening and learning, I was privy to a fascinating presentation by a panel of wilderness rescuers, paramedics, doctors, and surgeons. A friend of theirs, a seasoned
climber, a doctor at Harborview hospital, was scaling a mountain in the wilds of Alaska. The members of the panel took turns sharing the story of their roles in the dramatic rescue and rehabilitation of this man, after he lost his footing and fell on the ice, breaking his neck. He spoke, himself, of losing all sensation in his limbs on that mountain, lying on that snow, for eleven terrifying minutes, as the shattered bones of his cervical vertebrae and the swelling pinched his spinal cord. He told us of imagining a motionless life if he survived. In a perfect storm of situation, training, and friendship, his buddies got him off the mountain and into immediate medical care. He teetered on the brink of permanent paralysis for those eleven minutes, but, in the end, other friends at Harborview repaired his neck, and he recently ran a very respectable marathon.Absolutely lacking any seniority, I change assignments regularly, and I bounce around the City, working variously on fire engines, ladder trucks, and air cars. My situation is in flux, and I accept the possibility that I may arrive at my assigned post, only to be told to pack up my gear and move to another station. It's nice to have a home, though, and I am currently working on an aid car, with my new partner, SE. Yesterday, we were toned out to an aid call at a teriyaki restaurant, in a decaying strip mall. BLS, 30's male, fall, neck pain.
Every aid car shift with a new partner is a small adventure in negotiation and technique. The rider deals mostly with paperwork, and patient interviews, performing the de facto officer role. The driver drives, of course, maintains the rig, and carries the kits, usually. There's a lot of wiggle room in the two roles for overlap and cooperation. Some guys want a hard division of labor, others adapt their contribution to the situation at hand. Either way, you're often all alone, and your partner better have your back. Over time, you grow into the personality of your partner, and you develop a rhythm and flow.
SE and I are still learning how to work together. That sounds like we're constantly butting heads and arguing over minor points of honor and protocol, but, in reality, we both bend over backwards to help each other. It's much more like those two gophers in the Bugs Bunny / Roadrunner Hour cartoons of my childhood Saturday mornings:
GOPHER 1: "I'm so sorry. I was completely out of step."
GOPHER 2: "Oh, no, no, no. You must be mistaken. You were in perfect synchronization. It must have been me!"
GOPHER 1: "Ridiculous! Your sense of rhythm is superb! I am the guilty party in this case."
GOPHER 2: "I am sorry, but I cannot let you take the blame for some wrong I am responsible for. No. No. No."
(And on and on...)
We arrived on scene, to find a grubby man sitting against the restaurant's front wall. He has some blood on his shirt from a small scratch on his left elbow, grass-stained socks on his feet, moaning loudly, too loudly. His pants and shirt are dirty, hair unwashed. I take vitals, while SE tries to get a story from our patient. His pupils are unreactive, and he is sweating. His story is confused, but our competing contributions to patient care do not help. He fell, from an undetermined height, while he may or may not have been walking along a rockwork retaining wall, while he may or may not have been using the stairs. Two hundred feet away, there are stairs, but they are equally far from the nearest retaining wall. He denies any medications or allergies, but admits to using Dilaudid, a narcotic, for pain two months ago. Hmmmm.
He says he landed on his head, but there's no visible trauma to his scalp. His neck hurts. I consider mechanism of injury, a possible four foot tumble off the rock wall, and I am inclined to full spinal precautions. SE agrees, and fetches the backboard and our spinal kit. On the backboard, his neck immobilized in a C-collar, head taped to the board, he's yelling as we gently load him in the aid car. The hospital is just a few blocks away, but I drive slowly, snaking around potholes and manhole covers. I hear him, in the back, " -because it HURTS, man!", shouting, angry.
After, returning to station, SE and I agree that this guy is probably seeking pain medication, and wasn't really injured. We laugh with an affected cynicism at how we backboarded him and how he was probably strapped down for an hour or more. Yeah, we see it all the time.
Later that night, we took a nice Russian grandmother to the ED for a bleeding varicose vein. I made up the stretcher with fresh linens outside, in the summer midnight air, and waited for SE to finish delivering the short report to the nurse. I finished and sat down on the rear bumper just as he came out the sliding door.
"Hey, I checked on the dude we brought in earlier. The guy with
neck pain." He made little quote marks in the air with his fingers. "He had C1 and C2 fractures. They transferred him to Harborview. Good thing we backboarded him."In EMT school, the importance of C-spine protection was pounded into my head. Keeping the neck from moving minimizes further spinal insult and prevents a permanent paralysis like the doctor on the mountain suffered for those eleven awful minutes. The higher on the neck, the greater the paralysis. An injury below the C5/C6 vertebrae preserves your diaphragmatic function, allowing you to breathe on your own. An injury at C1/C2 would have certainly doomed our patient to a sessile life on a respirator, numb from the nose to the toes.
"Protocol, dude!"
"Dude!"
In the dark cab, we bump knuckled fists.
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