Scrum 2/2

The call came in as “chest pain with shortness of breath.” It’s a typical EMS bread-and-butter call that we get a few times a day. Nothing out of the ordinary in this one or in the notes in the MDT. Having just left my sleeping 5150 patient in the county hospital I’m giving John a break on the driving as I know where this call is and I’m tired of giving turn-by turn directions to someone who’s not familiar with the county. It’s a pretty basic Code-3 run through the urban downtown until I run into the riot and have to re-route up a one way street to get away from the bottle throwing mob.

Finally I make the turn to my street and see the fire engine parked on the side. There’s another skirmish line of SWAT protecting this street from rioters and one of the officers heads in my direction immediately. “Turn off your goddamned lights! You’re going to incite these assholes!”

I flick the lights off and slide out of the rig to find my patient. He’s sitting in front of a homeless shelter and I recognize him as a frequent flier from many previous calls. The fire lieutenant makes a bee-line for me as I’m walking up.

“What the hell! I gave you routing directions to come up from the south. Don’t you know there’s a riot over there? You come in here with lights and siren and you’re going to work them up even more. What the hell is wrong with you?”

“Yeah, I noticed the riot. My dispatcher didn’t give me anything. Just ‘chest pain’ and this address.” I’m not going to get into an argument with this guy in the midst of a riot. I’m going to grab my patient and get the hell out of here and let my supervisor sort it out later. I have the luxury of being able to ignore the rants of a fire lieutenant because I don’t fall into his chain of command. Yet it’s that same separation that seems to have led to the breakdown in communication that led me to unintentionally endanger everyone on scene. I walk past him to check out the patient.

John’s eyes are the size of saucers as he’s pushing the gurney up to the patient and we load him into the rig. “Code-2 to county, let’s just get out of here!”

As John is getting egress directions from a SWAT officer I’m doing an initial work up on Charles, my new patient. I cut the hospital band off of his wrist – he was in another hospital this morning – and go down the typical chest pain protocols. John’s pretty worked up and I’m getting bounced around the back of the rig quite a bit but I don’t care at this point.

Charles gets the normal chest pain meds: aspirin, nitroglycerin, etc. In less than ten minutes we are rolling him into the county hospital triage room. I ask John to get a follow-up set of vitals as I pull my cell phone to contact my supervisor.

“Hey Rich, it’s KC on Medic-40.”

“Yeah, what’s going on?”

“Did you know there’s a riot down town because dispatch sure as hell doesn’t! They just sent me Code-3 to a chest pain call in the middle of it. I ran into a skirmish line of SWAT and maybe 400 protesters while running hot. I pissed off PD and fire because I came in with lights and siren. Dispatch never gave me routing or a heads up on the riot. The fire LT was pissed because he gave routing to his dispatch but it never made it to us. I walked into this thing blind and put everyone at risk for escalation!”

“OK, hold on a minute.”

I hear Rich come up on my radio addressing dispatch. “You need to put out an all-page. No one is to run Code-3 in downtown. We have SWAT activity and protesters near Medic-40’s last call location. Get on the phone with PD and find out what the perimeter is and make sure our units have intel to get around this.”

Addressing me on the cell phone again. “Okay, I’ll be up there in a few minutes. Are you guys okay?”

“Yeah, we’re fine.”


Back at my deployment center after an exhausting day I clock out and head to my car. I put my gear bag in the trunk and pull out a trash bag with all of my uniforms in it and head back inside. Handing my bag of uniforms to the deployment coordinator I pull my ID badge and pager and hand them in as this is my last shift. With the top down and cool wind in my hair I accelerate on the freeway onramp to get up to speed and head for home on my last day with the company. But not my last day in the county…

Photo credit: AP Photo/Noah Berger



Scrum 1/2


1 – rugby – the method of beginning play in which the forwards of each team crouch side by side with locked arms; play starts when the ball is thrown in between them and the two sides compete for possession

2 – a confused crowd of people pressed close together and trying to get something or speak to someone

3 – a brief and disorderly struggle or fight

The limitation of riots, moral questions aside, is that they cannot win and their participants know it. Hence, rioting is not revolutionary but reactionary because it invites defeat. It involves an emotional catharsis, but it must be followed by a sense of futility.

Martin Luther King, Jr.

The high intensity LED strobes on the rig are lighting up the dark concrete canyons of empty streets in my urban workplace as I get closer to the call location. Sirens and the occasional air horn reverberate from the buildings as I creep through intersections and accelerate down the open streets. I pass City Hall and point out the tent city that was resurrected after a somewhat violent clash between the city police and members of the Occupy movement.

My EMT partner is helping to cover shifts in this county and is far from his normal surroundings of rural EMS calls. John is a part time EMT in one of the rural counties that surrounds my mostly urban county. He picked up this shift to get some overtime,  and being new in the EMS community, he wanted to come here to get some “action.” He’s about to get more than he bargained for as we get closer to the call location.

I round the corner just two blocks from my destination when I’m met with a SWAT skirmish line slowly backing towards my flashing rig. Thirty officers in full riot gear – extra padding in the uniform, full helmets with gas masks on, and plastic shields – are holding off a mob of four hundred angry people in dark clothing. The occasional bottle is lobbed from the crowd and breaks on the asphalt near their feet. The officer in charge whirls around to face me and a single motion from his baton-wielding arm is enough to convince me that I need to find another route to my destination. No arguments from me – this is the last place I want to be right now!

I pick up the mic as I point the rig up a one-way downtown street with headlights coming at me in all lanes. “Medic-40, we’re re-routing, we got blocked by protesters at Main street.” Driving the wrong way, up a one-way street, I’m giving an update to dispatch while pulling my ballistic vest from my bag and trying not to have an accident while I dodge oncoming traffic. I don’t remember this lesson being in my Emergency Vehicle Operation Course!

“You green-eyed mutha’ fucka’! I’m gon’ whoop yo ass like on Jerry Springer!” She’s screaming insults at me and balling up her fist as I escort her to the rig.

“Okay, you can whoop my ass later, let me check you out first.” Placating the psychotic patient has become something of an acquired skill in this county.

She called 911 saying that she needed an ambulance and then hung up. My dispatcher was unable to get her on repeated call backs so they sent us and a fire crew to see what’s going on. Seeing all of that in the call notes of the MDT I requested a PD back-up before we even got on scene. It’s just safer to have the guys with guns on scene when you don’t know what you’re getting into.

“Don’t you take me to no county hospital! I know my rights. You have to take me to EPS!” I’m taking a blood pressure as she yells at me. Just as I thought – way too hypertensive – she’ll need medical clearance before going to EPS (emergency psych services). She’s not going to like this because I’m now obligated to take her to the county hospital.

“Okay, here’s the thing. I need to put these restraints on you because you’re threatening me.” She struggles a little but lets me put the substantial leather wrist restraints on her – thereby greatly decreasing the chance that she can follow through with her threats to whoop my ass.

The city PD officers must be a little busy because they’re taking an eternity to get here. The fire crew simply escorted the screaming woman to the back of my rig and told me she wants to go to EPS. Before I even had her situated on the gurney the fire engine was driving away. Thanks a lot, guys!

“Why aren’t you taking your Seroquel?”

“I don’t like the way it make me feel! It make me all sleepy! Fuck you! Take me to EPS you green-eyed mutha’ fucka’!” Classic; the crazy person doesn’t like feeling normal so they stop taking their anti-psychotic medication. I’m about to make you feel VERY sleepy!

I’m drawing up a sedative in a syringe as the officers finally arrive and walk up to the back of my rig to face my not-so-pleasant patient. “I hear you want a green sheet, what’s going on?”

My patient seals the deal with her next outburst. “Fuck you! I’ll put you on a green sheet you bald-ass mutha’ fucka’. Let me up! I gon’ whoop his ass too!”

“Good enough for me. I’ll be back in a minute.” The officer walks back to his car to write up a 5150 form – a 72-hour hold for psychiatric evaluation – as his partner stands by in case we need any help.

As my patient is distracted by slinging insults at the officer I inject a sedative into her arm. With a green sheet in hand I have a pleasant drive to the county hospital and get a chance to do my paperwork while my patient snores like a chainsaw on the gurney.