The 2008 Excellence in EMS Award Honorable Mentions

Honorable Mentions — 2008 Excellence in EMS Award

Man in Black

By Chance Marchiafava
Paramedic, Acadian Ambulance, Louisiana

The man in black laughs at me as I compress the baby's chest. His mother found him face down in his crib, unresponsive. I try to ignore the small cold body that I hold in my arms as we get back in the unit.

The man in black laughs at me as I play my flashlight around the body lying in the field. He has been thrown out of the back window of a car, and lies, motionless and broken, in tall grass near the interstate. A beetle crawls across his nose, which I brush off.

The man in black laughs at me as I watch a nursing home CNA do lazy, ineffective compressions on the chest of a resident, her hands splayed across the middle of his chest. She does not lean over the body or press down much. The man's eyes stare vacantly at the ceiling.

The man in black sits in an easy chair across from the patient I am now assessing. His heart is beating 30 times a minute and he is so pale that he looks like a black and white photo of himself.

"You're too late. He's going to die." The man in black is leaning over my shoulder as I fasten the Velcro of the cuff around the man's arm.

I can't obtain a blood pressure.

"He's going to die," he says. Smiles. "He's going to die. You can't save him."

I quickly run a twelve lead. No STEMI. We load into the unit. Oxygen is applied. We get enroute to the hospital.

"You're going to miss the IV. He's gonna die. You can't save him."

I stick the IV in his arm. Pace or Drugs? Pace or Drugs?

The man in black sniffs at me with a grin on his face. "You're killing him. Every second you wait you're killing him. He's going to die."

I compromise by slapping the pads on the man and pulling up my atropine.

"A little medicine to help you, sir!" I cinch the line and push in the medicine. The man's heart rate rises to 35, 40,37... stays in between 35-40.

The man in black looks at me sourly. "It doesn't matter. He could be having the big one. He's going to die."

I try again for another pressure and get a systolic of 70. No bottom number.

"You should've gone with pacing!" The man in black is gleeful again. "You've killed him."

Shut up, I think to myself.

I push in another half milligram of atropine.

Slowly, the man's rate picks up. I look at him and see he's gotten some color back in his cheeks. Not today, buddy, I think to myself.

I leave the line wide open and patch the hospital. His rate is now in the 60's and I have a pressure of 100/50. We bring him into the cardiac room, and I walk out, sweaty, tired. But I won. I won it this time.

* * *

I slide the atropine boxes into the trash can and look at the man in black triumphantly.

He stares at me petulantly. "I win in the end!" He says. "I win! I always win in the end."

"Maybe so," I say, my voice strong and loud. "Maybe so. But not today."

On a day-to-day basis we fight battles that we will inevitably lose. My instructors told me that on a long enough time line, the survival rate for everyone drops to zero.

But life is not a timeline; it’s something that is lived. And we aim to keep helping people to live it.

So everyday, I put on my uniform, slip on my boots, and me and the team? We do our damnedest to beat Death at his own game.

That is our mission.

Christmas with the Coastguard

By Weyshawn Douglas Koons
Paramedic, San Juan Island EMS

I’m home and finishing dinner on Christmas Eve. The tones go off, “San Juan EMS, respond to Shipyard Cove Marina. Man down, bleeding from head, decreased LOC. Deputy in route.”

My flashing lights surround me as the mist envelops all. Thick fog hovers just off the deck as I pass the airstrip. Airlift probably won’t be getting in here tonight. Town is steeped in silence. Christmas lights radiate color through the fog. It drifts past my wipers. I hear Aid 31 arrive and am advised to continue code red.

Turning left I descend down the steep hill to Shipyard Cove. The ambulance is there with its lights flashing. I pull up, grabbing my radio, stethoscope, and gloves and walk down the thick planked dock. I can see my crew on board an older, ram shackled powerboat. They have their hands full. Our patient is in his late fifties and quite combative. The deputy is still two minutes out.

This man has fallen, his head hitting the edge of a cast iron woodstove. He has a gaping H-shaped laceration open from ear-to-ear. My EMTs are trying to control this combative patient as well as the bleeding. The space is small and the boat is rocking. Blood is everywhere.

Airlift has been activated but with the ceiling so low, they’ll be a no-go. After sedating our patient we are able to get him safely strapped to the backboard with his airway and bleeding controlled. We bundled him up to keep his core temperature from getting any cooler. Dispatch relays, “Airlift is grounded. Coastguard contacted.”

We are in route to the medical center. More bulk is added and a tighter pressure dressing applied as blood is seeping through. This injury has essentially scalped our patient. He needs to get out of here. I am worried about a depressed skull fracture. Things felt pretty mushy.

Arriving at the clinic we make our way inside where there is more room to work. I’m hoping our doc can stitch this enough to control the bleed while we wait to hear from the Coastguard. It generally takes about an hour to sort out the details with their trauma surgeon and get things rolling.

I am pretty disappointed. The Coastguard carries limited medical personnel which means I have to fly. The weather conditions are bad enough but the really tough part is that they never bring me back home. They’re willing to risk lives to transport a critically injured patient but not to return medical personnel. It looks like I’ll be spending Christmas Eve and at least part of Christmas Day at the Coastguard station. Their medical control finally gives his blessing for the flight. We have a twenty two minute ETA. Our doc is finishing up the sutures.

I call my husband. “Bad news, I have to fly with my patient. There’s a fog bank to the east so we’ll head to the Olympic Peninsula, Port Angeles.”

“Oh no, is it safe?” he asks, his voice full of worry.

“Safety’s not really the problem. You know the drill. They won’t bring me home. I’ll be stuck there.”

Silence. “Hey listen, you just be safe. We won’t exchange presents until you get home.”

I can see my Christmas morning quickly changing.

Out at the airport we load our patient into the helicopter. It’s awkward and I wish we had room to take one of my EMTs, but the weight limit is strict. My patient is packaged well, in good restraints with the bleeding finally controlled. My gear is well positioned but unsecured and dangerous if we have rough weather. I too am unsecured but at least have good patient access.

My head set is on and I am listening to the crew. I smile, realizing that the Captain tonight is a woman. I look out the window as we take off. It’s surreal, misty gray. My patient is hanging in there. Four minutes outside of PA the Captain breaks the silence and asks me if I have kids at home?

“Two, a boy and a girl. How about you?”

“Yeah, I also have two.” There is a short pause and I can hear the smile on her face. “Well,” she slowly drawls, “Merry Christmas. We’ll keep this bird hot. We’ve got an ambulance sitting on the pad. Transfer your patient quickly. We’re taking you home!”

“Captain, you do not know how much I appreciate this!”

Clearly though, she did know.

Excellence in EMS Award submissions were reviewed and scored by members of the following panel of judges: Steve Berry, Angela Clark Burba, Kelly Grayson, Bob Loftus, Mike McEvoy and a representative from the EMS1 Editorial Team.