Blood in the Gutter: Handling the Awful Call
EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don’t have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we’ll pay you $50. We don’t know everything, but we do know a lot of smart people. If we need to, we’ll contact just the right experts and share their advice with you. Send ideas c/o emseditor@aol.com.
There’s unusual urgency in the radio traffic tonight, as your local police, fire and ambulance dispatchers direct their various resources to a nice residential neighborhood near you. The dual wailing of your sirens is punctuated by the robotic beeping of the switching circuitry for your flashers. You’re rolling toward the scene of a “multiple assault, weapon believed to be a hatchet.” PD is on scene and has cleared you to come in.
You and Mert grimace at one another briefly as you approach, and note a four-inch stream of blood extending 20 feet from an open garage door, down the sloped concrete driveway and actively flowing at least another 10 feet down a curbside gutter. A very young cop approaches the driver’s door, opens it and cautions you both to please not step in the blood.
“We have two vics,” he says, and his voice seems thin and reedy. “Somebody really hacked these people up. One is a female, she’s in the bedroom, DOA. The other is yours; he’s a 14-year-old kid, over there.” He motions toward the far side of the two-car garage, on the other side of a late-model Ford sedan. The kid’s as white as a sheet. He’s supine on the floor in a pool of blood, the obvious source of the stream you saw on your way in. There’s no room to work. You ask PD if they want you to move the patient or the car, and they choose the car. Nobody can find the keys, so you drag the kid as far as you need to.
He’s apneic and pulseless, and the pupils are blown. But the ECG reveals a wide-beat tachycardia with a rate of 150. You locate at least six deep lacerations, mostly on the back side of his torso, head and extremities, that vary between four and eight inches in length. You tube him, insert two big IVs and transport to a nearby trauma center, where he is pronounced. The weapon turns out to be a machete, and Dad’s the suspect. He’s still at large.
This is a pretty brutal mechanism. How do you keep your cool on calls like these?
A technique that EMSers have used for many years (even experienced ones) is to remind yourself that this is not your emergency. It’s somebody else’s emergency, and you’ve been asked to help as much as you can. Try saying these words to yourself as you’re getting your equipment out of the rig, and on your way into the scene: “This is not my emergency.” It’s a way of keeping things in perspective and a good grip on your emotions.
How do you protect yourself from becoming cynical as a result of these kinds of calls?
Actually, this example is fairly mild compared to the kinds of things you will encounter in a 20- or 30-year career. Even so, most people are a lot like you. They work hard, love their spouses, raise good kids, pay their taxes and would never intentionally hurt anyone. But some people don’t think that way. They’re nothing like you. They can do things that are a ton worse than this and honestly never feel any remorse. The important thing to remember is they’re exceptional, and so are the emergencies they cause. If you work somewhere that exposes you to things like human butchery, alcoholism or chronic apathy all the time, get yourself out of there once in a while and expose yourself to some normal people. EMS is about life, and life is about balance. Nobody can run those kinds of calls all the time and remain a good caregiver.
What if I work in a system where the newest employees are stuck in the worst possible areas for years until they can develop enough seniority to get out of there?
Leave—even if you have to move to another town or a different state. Those kinds of systems destroy good caregivers. Your life and your gifts are too valuable to waste on a system that has no respect for you. EMTs are not expendable, and great EMTs are world-class treasures.
The senior paramedics in my system act as though being tough is what makes you a good EMSer. Are they wrong?
Yup. Think about the one person you love more than anyone else in the world. What kind of crew do you want taking care of them when they have their big one? Do you want a bunch of undisciplined, disrespectful bad-asses? Or do you want professional caregivers who are kind, who know their medicine and who realize that your loved one owns their certificates?
The choices are yours.
