When I first started in EMS I was almost always the first on scene because our local fire department only responded to jaws of life calls and the PD usually only responded to reports of violence assaults. I loved getting their first. The scene was pristine. Sure I had a dispatch subject, but from early on I knew that was rarely a reliable indicator of what I would find. The “Annie! Annie! Are you okay?” they taught us in EMT school in assessing a mannequin actually came in handy. I rarely arrived to find someone doing CPR. I was the one who shook the patient, applied my hand to their neck to feel for a pulse and listened for breathing. Soon enough I could determine if someone was dead by first sight on walking in the door. I remember finding a man at a card table, still as can be, and still holding his hand of five card stud, staring at two kings he would never play. I laid him on the floor and started compressions.
Over the years as fire departments started first responding, or in some towns, even providing their own ALS, more often than not, my first action on the scene was not “Annie! Annie! Are you okay?” but asking a first responder, “What do you have?” and they’d fill me in as I surveyed the scene. There are benefits to being the second responder. Instead of looking for the house number, we look for the big red fire engine parked out in front. I rarely have to carry my oxygen tank in, and extrications are so much easier with ample crew members to help carry your gear out and sometimes even help with carrying the patient. Instead of getting out my notepad, in many cases, I am handed a carbon copy of the demographics and med list to slip in my pocket, Name, dob, allergies. A great help.
For the last two years however, I have been by myself in a rapid response fly car intercept vehicle. I carry a fire radio so I hear when they are toned out. This is often two or three minutes before the ambulance is dispatched. Since I am already in my vehicle, either driving or parked at a post, I flick my lights on and hit the sirens while the fire guys and gals are still sliding down their fire poles.
I am often again, first on scene. “Annie! Annie! Are you okay?” Often, it is for opioid overdoses. I do so many I carry an oral airway in my pocket. I pop that in, Grab my ambu-bag out of my shoulder pack and start ventilating. Fire arrives next, takes over bagging, while I get an IV and apply a small titrated amount of naloxone, 0.1mg q 1 minute. Admittedly, if the patient is blue and in full respiratory arrest, and looks like they have poor IV access, I may jump right to 1.2 mg IM. I have done CPR by myself quite a number of times while waiting for reinforcements to arrive. But even more times, I have found cold dead bodies and then spoken into my radio, “Cancel the ambulance. It’s a presumption.” I sit with the body until the Police come to take over the scene. I leave them an index card with my name, date of birth, license number, vehicle number, time of death, and name and dob of the decedent. It is all for their report.
Last week, I arrived first at a tall apartment building whose elevator was out of order. Since I was first, I had to carry my medic bag, the heart monitor, suction, oxygen tank and isolation bag. A woman led me up the stairwell. It was unseasonably hot that afternoon after having started the day out cold and wet. I was still too warmly dressed and my gear was heavy. I couldn’t keep up with her bounds. My left knee started to throb and I cursed myself for slacking off the step-ups as part of gym routine. I felt my full sixty-three almost sixty-four years. Fortunately, the woman who was leading me didn’t crack any jokes about my age. She didn’t say, “Paramedic! Paramedic! Are you okay?”
“I thought you said it was on the third floor,” I said as an excuse for my pause in the stairwell.
“No, man, it’s the fifth floor,” she said. “Just two more.”
“Right,” I said, and got back to it.
This week, I started doing step-ups in the gym again with twenty pound dumbbells in each hand. Not a whole lot of step-ups, but enough to grow on for the next sessions.
My daughter starts high school next year. I need to keep working until she is through college.
Besides, I still like this job too much to retire yet.