KN, p. 180 “What happens in the ambulance?”
We’ve been seeing quite a few ambulances in the neighborhood lately. It’s human nature to wonder who is sick or hurt and to see more than one a week at certain houses is more than a little worrying. We are lucky enough to live within four miles of the hospital, so response time is pretty quick – 7-8 minutes from the time the call is made to get help. But, we have two Senior citizens living close by and sadly, the sirens have been blaring every few days. A couple of times, the crisis was managed at the house and other times, our old friends made the trips to the hospital.
What does a paramedic actually do? Suppose the patient is not at home, surrounded by friends and family?
The paramedics are responsible for pre-hospital care. They do all they can to keep the patient alive until the person can be seen by a doctor. They cannot act on their own, however. After hearing the patient’s Vital Sign numbers, the Emergency Room doctor at a health care facility (usually the closest hospital) gives orders to the paramedic via phone or other device about the procedure to follow. This is no easy task, because the EMTs/paramedics must communicate not just the numbers, but also the state of the patient’s appearance and what may have caused the problem to begin with. A medical history isn’t always available (as at an accident scene), and the reason for a sudden loss of breath sounds or heart beating may not be apparent.
A paramedic’s first job is to keep the patient alive, and that may mean getting the heart started again, getting breathing going again, and/or stopping blood loss.
There are protocols to follow.
One person is in charge of the case at the time. He/she delegates the jobs for the rest of the team to carry out.
It is a two person job to clear the airways, monitor the patient’s vitals and administer whatever drugs are necessary to get breathing started.
If the heart has stopped, there is a mathematical procedure to follow: 32 chest compressions followed by two breaths, with the team switching positions every five minutes. Ever try to do this? It’s not easy to keep the compressions going for five full minutes. They must continue the process until the heart beats on its own or until the ambulance reaches the hospital. They keep “working on the code.” If they can get started on the chest compressions within three minutes, then there is a greater likelihood that oxygen will get restored to the brain.
But, that’s not all that is happening on the ride to the hospital. Blood sugar and other levels are checked while in transport. These days, an ambulance is a mobile intensive care unit. It’s the paramedics’ lab. Tablets are proving to be invaluable, because they can deliver more information to the doctor – including cardiac readings – and then the doctor can make more informed decisions about the transit care.
Ever take a ride in an ambulance when you weren’t a patient? I got to do that once and I was surprised to find out that the siren wasn’t nearly as loud when we were sitting inside. I also discovered how much bouncing goes on in the back of the ambulance. Roads are not as smooth as you might think and some neighborhoods have speed bumps installed that slow down the ride considerably. But, one of the guys revealed that they train while the ambulance is moving – including inserting lines for fluids! They anticipate the normal bumps and rocking that occurs and develop a rhythm for doing their jobs. A bit like getting used to working at sea.
Because there may be a shortage of doctors available to give medical orders (they may be busy with another patient from an accident, or another heart attack victim) some regions of the country now have paramedics that are so highly trained that they can work under a doctor’s license without contacting a hospital. This requires special certification – not every paramedic is allowed to do this.
The average pay for paramedics is a little over $40,000 a year. What kind of training is needed? The first step is Emergency Medical Technician (EMT) training – about 150 hours (9 weeks). After passing certification tests and working in the field for at least six months, then the candidates become eligible to attend Paramedics school – an additional 1200-1800 hours of training (perhaps two years). Then, you can work in a fire station, in a hospital, or anywhere that employs a paramedic – even at a resort. Of course, you have to be able to lift sick and injured people, have a stomach for working with broken bones, nauseous patients, and bloody accident scenes. Think you can do that? It’s a rewarding career if you can.
A related article shows what an EMT might do at the scene of an explosion, before the patient ever gets into the ambulance. The event was a simulation, but the pictures may be too intense for some people. Click here to read “How many bodies at the scene?”
*Photos by Patti Phillips