Sunday, 28 September 2008

Richmond: Ride along

It was Sunday and after scoffing down muffins & toast for breakfast we headed over to the ambulance depot on Hermitage Road. It was a hot summers day and we were due to go out on the 'Rigs' for our observation shifts. This is known as a 'Ride along' in the states. Each of us would be assigned a different crew so we could observe how they operate. We assembled in the control room and chatted to the dispatch staff while we waited. Slowly different crews came in and took a person with them. Now it was my turn. I was assigned to a Paramedic supervisor and an EMT-B and we were soon on our way out on to the streets in vehicle 76. We headed out to one of the many response posts within the city. I can't remember the name of the spot but it was on a hill overlooking the city providing good views of downtown Richmond. We could see the high rise buildings and VMC which is the level 1 trauma centre. I was chatting to the guys about the sort of work they deal with, which to be honest is the same as here with the exception of shootings. Richmond has one of the highest number of shootings through out the USA. We have an increasing amount of shootings here in the UK but it is usually in the big cities. We tend to deal with more stabbings than shootings. After exchanging stories the EMT-B, a nice guy from Tennessee, said 'EMS is EMS where ever you go'. 'Too true, and the treatment principals are the same no matter what the cause of the trauma'. I replied. I also learned that the EMT-B was in fact an EMT-i (intermediate) in his home state and had moved to Richmond. The EMT-i has more skills than an EMT-B (Basic) and can, depending where you are, intubate, IVs and certain drugs & fluids. They are the next one down from Paramedic. They don't have EMT-i in RAA which I thought must have been frustrating, being capable of undertaking certain skills but now not being able to use them.
After about 15 minutes a call came in for a chest pain and we were soon en-route. What surprised me was the relatively slow speed they were doing even on the highway. This has something to do with the 'black box' which is on every RAA ambulance. It monitors an individuals driving and will record any excessive speed, erratic changes or aggressive driving. It's one of the ways in which RAA are using technology to help reduce accidents involving ambulances and according to their management, it seems to be working.
We arrive on scene and pull up next to two Richmond PD cruisers. There are two police officers waiting for us and they give us a brief run down of the call. At this point I'm getting some starnge looks as I'm wearing my greens. A worried mother has call 911 because her 20 something year old son has done some crack cocaine and is now having chest pain. In side the house there is another police officer. He was standing with his thumbs tucked in his belt, side arm clearly showing. He looked like a stockier and older version of Eddie Murphy but a lot meaner. The Paramedic started to question the guy who continually refused any help but did allow a set of basic observations to be taken. His pressure was up and he was sweating. Even after the Paramedic warned him that cocaine in excess could cause a heart attack he still refused hospital. He signed a refusal to say he would accept responsibilty if some thing happened later on. His mom wasn't happy but that was his right.
Out side the cops finally spoke to me, 'Eddie' said 'What are you, some kinda state trooper or something?' 'Nope, I'm from the UK, I'm a Paramedic'. 'Get the Fuck outta here! I thought you were Canadian or some shit like that, what you doin over here?' So I told him and after a few minutes having a laugh and a joke with him and the other cops we left. At the time I wished I had a photo with these guys but didn't think it was appropriate given the neighbourhood we were in and the fact that we were technically still on a job.
One thing I found to be different was that the medics over here take the trolley in to virtually every job, probably because nearly all their patients go to hospital. Also when someone refuses, that's it. Over here we would probably have done an 12 lead ECG to try & rule out an MI or Ischaemia and even use it to try and sway the patient to go in. They obviously do things a little different. He's refused and in front of the Police as well, good enough.

Next, off to another response post to await the next call.

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