Category Archives: Commentary

System Status


1 – a condition of harmonious, orderly interaction

2 – a group of interacting, interrelated, or interdependent elements forming a complex whole

3 – a set of principles or procedures according to which something is done; an organized scheme or method



1 – a social or professional position, condition, or standing to which varying degrees of responsibility, privilege, and esteem are attached

2 – a state of affairs or a change in social standing

Beep, beep, beep. “Medic-20 copy Code-3. Respond Code-3 to 123 Main Street for the three year old unconscious.” The dispatcher’s voice comes across the radio interrupting me as I am filling out my status report. I glance at the computer to see where the address is in comparison to where Medic-20 is posting. Medic-20 is about a mile from the call location and I’m another mile further than they are from the call. I put the SUV in drive and start heading that direction. There is a certain advantage to having the entire system status on my computer in the supervisor’s rig.

There’s a sixth sense to interpreting the description that the dispatcher gives to a call and actually knowing what is going on before arriving on scene. The wording in this call and the location put the little hairs on the back of my neck on end and I feel it’s something that I should get involved in today. For one thing, a three year old doesn’t know how to fake going unresponsive. We see it every day with adults who just plain decide to shut down and let EMS pick up the pieces. But a three year old isn’t quite that devious. Besides that, the address is an indoor swimming pool and water park and there is nothing good about a kid who’s unconscious near water.

I’m catching too many red lights as I head in the direction of the call so I remedy the situation. “Dispatch, S-4, can you attach me to Medic-20’s call and show me en-route?” The dispatcher comes back at me in a monotone response, “S-4 copy, showing you en-route.” The computer on my console starts making tones and a green line is routing me to the location where I’ve already started driving. Now that I have clearance to run hot to the call I can turn on the lights and siren and make better time. I take my little SUV through the red lights without a partner to help clear intersections. It’s still a bit unnerving to drive Code-3 without someone to help navigate, but it’s necessary. The traffic backs up in front of me and I switch tones in the siren to activate the rumbler; a low harmonic pulse that literally rattles the inside of the vehicles in front of me until they pull to the right. Unbelievably traffic clears, allowing me to make good time to the call. As I’m pulling into the parking lot I see my crew walking through the doors at the main entrance with a gurney and the fire engine is already sitting in front of their rig. I park my little SUV behind all of the big boy toys and casually stroll into the building without any equipment and not wearing my gloves.

It’s a strange experience to enter the scene of an emergency without equipment or protection, but the fact is that I’m not here to work on a patient or bring tools to the scene. There are two Paramedics ahead of me and the entire complement of advanced life support equipment has been carried in by others. My job is to support the team and ensure that patient care is seamless in regards to agencies and environment.

I walk solo through the water park and just keep the others in sight as I follow in silence. Screaming kids and teens are playing in the water and on the slides, lifeguards are watching from elevated chairs, chlorinated water splashes my boots. Finally I catch up to the crew in the lifeguard office where the child is sitting in a chair.

I know the paramedic from my service who is Medic-20 today. She was a new Level-1 Paramedic that was assigned to mentor under one of my old partners last year. My old partner was assigned to mentor under me a number of years ago so it seems the cycle continues. My teachings have passed to my partner who passed them to this wide eyed young Paramedic standing in front of me who is now on her own and making her own calls. She takes the report from the fire medic as I listen over her shoulder.

“So, apparently the little girl was pulled out of the water without a pulse and not breathing. They did CPR on her and then someone brought her here when she started breathing and they called us. She’s doesn’t speak English, her parent’s aren’t here, and all we have is a neighbor who is basically no help at all. Right now she’s just lethargic but she’s alert, at least, as much as I can tell she’s alert, but she’s really not talking much at all.”

I’ve been looking at the little girl while listening to the report. It seems to fit her presentation. With all of the strangers poking her and taking vitals right now I would expect her to be a little more agitated. Yet she’s looking like she just woke up from a nap. I slip an ungloved finger up to her eye and touch her dark skin while pulling her lower eyelid down a bit; bright white. Okay, good enough for me, she had a hypoxic event and she’s recovering. The mucus membranes of the eye shouldn’t be that white yet if they are the person is either very dehydrated or recently had a hypoxic event; that seems to fit the story. As the EMT from Medic-20 and the firefighters are transferring the patient to the gurney I catch the eye of the Paramedic. She looks over with big round eyes and a bit of a question.

I quietly lean into her ear. “You have to treat it like a near drowning with return of spontaneous circulation. Your only question is do you want to drive close or far away and how fast to drive.” With kids you don’t take chances. Presumably the life guards have their CPR cards and should know what to look for in terms of breathing and pulse. If the kid truly had neither and now she does she needs a full work up and some chest x-rays looking for water in the lungs and ensuring that the CPR didn’t displace any ribs. The driving close or far away only refers to which hospital to go to. The kids’ specialty hospital is 45 minutes away in rush hour traffic. The local hospital is just seven minutes away.

She looks undecided for just a few seconds and then comes to a decision. “I want to drive close and I’ll start off Code-2 and upgrade if I need to.” It’s half a statement and half a question as she looks to me for approval in her decision.

“Sounds good to me. I’ll run interference with the neighbor so you can get out of here.” I would have said any decision sounds good right now. The patient is doing fine and she, as a new medic, just needs the exercise in making a decision and sticking to it. But in this case she made the same decision that I would have made – I guess my old partner taught her well.

As the Medic-20 crew starts to push the gurney with the patient towards the front of the building I step in front of the neighbor and start asking her questions. She’s a heavy set woman in her late forties who walks with a walker and moves slowly like she’s in constant pain. As I question her she’s distracted as she looks over my shoulder at the patient disappearing in the crowd as they head towards the rig. I know the Medic-20 crew just wants to transport as soon as possible. All medics are the same when it comes to kids in this situation. If the kid is fine they just want to get them to the hospital and out of their charge before something changes for the worse. Had I let the neighbor follow she would have delayed them another ten minutes on scene with her slow moving and a long production of climbing into the truck. Not to mention the liability of helping her climb out of the truck on the other end and the overall delay in getting the kid to a doctor is unacceptable in this situation.

Having intercepted the neighbor long enough to give Medic-20 a clean getaway I walk over to the head lifeguard and ask to talk to the lifeguard who pulled the girl out of the water. I want to get a better understanding of how things happened. She’s a very emotional fifteen year old girl. She can barely catch her breath from the sobs and stuttered gasps for air as she attempts a retelling to me. After three or four minutes and a few stops for tears I finally have a story that makes sense and I feel I can leave.

Pulling out of the parking lot I glance down at my computer on the console. Medic-20 is about half way to the hospital and they are still driving Code-2. So the kid is probably doing fine. I punch the Medic-20 identifier into my cell phone and get the driver.

“Hey, so I finally got a good story and some contact info for the family. The little girl was on a water slide between two bigger kids. They went down the slide and the two big kids came up but the girl didn’t. She was under water for approximately twenty seconds when a nurse pulled her out, found her to be pulseless and apneic, and started doing CPR on her at poolside. After 30 seconds of CPR she started breathing again and was taken to the lifeguard room. All I have is a first name for the kid and the parent’s first name and phone number – the neighbor really didn’t know much. I called the father who speaks enough English to understand what’s going on and he said he’s on the way to the hospital.” She thanks me and hangs up. No doubt she is now relaying the information over her shoulder to the medic in the back of the rig so she can tell a better story to the doctor when she does a hand off.

I take a slow drive to the hospital and once I arrive I see Medic-20’s rear doors open and the patient compartment trashed with all sorts of bins and wrappers strewn around with a disheveled monitor propped in the corner with all of its wires hanging out. I spend ten minutes wiping down the interior and putting everything back into place. I then walk over to my little SUV and pop the cooler open to pull out two ice cold gatorades and prop them in the front cab so the crew will find them once they get out of the hospital.

I drive off before they can get out of the ED so they don’t think I’m interfering in their day too much. It’s a fine line to be involved in the call and supportive of my crews yet still allow them to function as the independent Paramedics and EMTs that we value in this service. I try to tread lightly and reward often. If I do my job right they may even forget that I was on the call yet they will remember that everything ran smoothly. I find a quiet corner of the parking lot in some shade and go back to updating my status report.



Reflection 2/2

I’m a little disoriented as I sit in the front seat of an ambulance that is foreign to me and the unfamiliar dispatcher sends me to posts in my mostly urban county which are obscured by code numbers that I don’t understand. The computer on the console draws lines on a map telling us where to go as we fumble with the switches trying to find the siren.

“Medic-40, delta level response for a seventeen-delta-three, fall-not alert, switch to fire control three.”

“Uhh, Medic-40 copy.” What the hell is a seventeen-delta-three and how do I switch to fire control three?

Having finally found the siren and switched to the proper response frequency we are following the line on the computer in hopes of finding the call location. Rolling through traffic I see the familiar landmarks and denizens of the hood hanging on their normal corners. It’s somehow comforting to feel a connection with the hood on a day that seems so different in every other aspect.

Pulling up to the corner I see my neighbor, Darren, the lieutenant on the fire crew that beat us to the scene by only thirty seconds. Sitting on the stairs in front of him is Chauntel, a frequent flyer that I recognize from just last week, and her husband standing next to her holding a huge purse.

“Hey Darren, what’s going on?” The rest of the firefighters on Darren’s crew have bailed on taking care of the patient and are poking around my ambulance to admire the equipment and new ambulance smell.

“You know Chauntel right? Looks like she took too many of her Vicodin and wasn’t able to keep her feet under her while walking down the stairs. She’s not altered or anything, just feeling a little dizzy and complaining of knee pain.”

“Cool, I got it.” I kneel down to look at Chauntel as Darren joins his crew in opening cabinets on my rig. “Hi Chauntel, am I taking you to the hospital today or are you okay to go home?”

“I best go to the hospital, you know, jus to get checked out. I don’t think my Vicodins are work’n too well cuz I still got the pain in my knee.”

I help Chauntel onto the gurney and raise it up with the push of a button. Power gurneys; finally a career-extending piece of equipment.

As my partner drives us to the hospital I continue with my assessment of Chauntel.

“How bad is the pain in your knee?”

“It’s a ten outta ten! An’ it feels sharp!” Awesome, she knows our pain scale without having to be prompted.

“Do you want some Morphine for the pain Chauntel?”

“Na, I can’t have Morphine, I allergic to it! You got any Dilaudid?” Classic!

“Chauntel, you know I don’t carry Dilaudid. And when did you become allergic to Morphine? You weren’t allergic to it last week.”

“Well, I is now!” I’m not one to judge her pain level, or her, but the drug seeking mentality is fairly transparent to us at this point. I guess some things never change.

“How do you like the new uniforms Chauntel? Did you notice the shirt’s a different color?” Just making small talk as there’s not really that much to treat on this call.

“Oh, is those new? Now you mention it you got some pretty eyes. Is you married?” Seriously, that’s what you notice. Bloody hell with the eyes again!

“Yeah Chauntel, I’m married, and so are you. As a matter of fact your husband is sitting in the front seat.”

In a conspiratorial, quiet voice. “Well, he ain’t really my husband, I jus’ call him that. You mind if I take a nap on the way? I feeling kinda tired.”

“Go ahead Chauntel, we’ll be there in about ten minutes.” I switch to the captain’s chair to try to figure out how to use the new computer.

Now you put water into a cup, it becomes the cup. You put water into a bottle, it becomes the bottle. You put water into a teapot, and it becomes the teapot. Now water can flow or it can crash! Be water, my friend.

Bruce Lee, TAO of Jeet Kune Do



Reflection 1/2


1  :  an image, representation, counterpart

2  :  the act of reflecting or the state of being reflected

3  :  mental concentration; careful consideration – a thought or opinion resulting from such consideration

“The pessimist resembles a man who observes with fear and sadness that his wall calendar, from which he daily tears a sheet, grows thinner with each passing day. On the other hand, the person who attacks the problems of life actively is like a man who removes each successive leaf from his calendar and files it neatly and carefully away with its predecessors, after first having jotted down a few diary notes on the back. He can reflect with pride and joy on all the richness set down in these notes, on all the life he has already lived to the fullest. What will it matter to him if he notices that he is growing old? Has he any reason to envy the young people whom he sees, or wax nostalgic over his own lost youth? What reasons has he to envy a young person? For the possibilities that a young person has, the future which is in store for him? 

No, thank you,’ he will think. ‘Instead of possibilities, I have realities in my past, not only the reality of work done and of love loved, but of sufferings bravely suffered. These sufferings are even the things of which I am most proud, although these are things which cannot inspire envy.’ ” 

Viktor E. Frankl – Man’s Search for Meaning

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…

It’s an emotional day, to say the least, and I have time to reflect upon the years as I navigate through the darkness to the normalcy that I call home.  Ultimately, I have an optimistic view of the future and that optimism has its origins in the accomplishments of the past. There’s a lot to be proud of in the work that my tribe of EMTs and Paramedics have done in this county. Through incredible adversity we have advanced street medicine to a finely honed machine. Though the machine sometimes throws a cog we always find a way around it to accomplish the tasks at hand. We have had outstanding leaders at the helm as well as the occasional drunken captain, but in the field we have always pulled together to bring the best possible care to our patients.

My mostly urban county has taken a toll on us yet it has given us so much more than is easy to recount in a single telling. The high call volume gives us a variety of experiences early in our careers. Those that survive the first few years have the mark of a battle hardened soldier on their foreheads. We may bear a few more worry lines and some new gray hairs, but we can also boast of relationships, forged in the trenches, that will last a lifetime. Some of those comrades will ship out tomorrow to take our flavor of street medicine to other counties. I wonder how they will be received when they finally reach their destination. Will they look back with fondness to the mostly urban county of our origin? Will they see themselves as finally having escaped the chaos? Maybe they will be ostracized in their new system and find that coming home is the only tolerable option – it’s happened already and we haven’t even started the transition.

The freeway takes me into the outskirts of the county and closer to home – I’m just one car in a constant stream of headlights and tail lights blurring into streaks reflected in the glass buildings in the empty office parks. As the economy fell the new buildings became empty and now stand as hollow glass blocks, devoid of occupancy; a sea of monuments showing us the economic reality that we all tried to deny until it was too late. In a real estate parody of the Occupy movement they stand idle, refusing to leave, yet their message is lost in obscurity.



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.


Guest Post

I recently wrote a guest post for Kelly over at ‘A day in the life of an ambulance driver”. It’s a review of a lecture given at EMS World Expo entitled: Is it Time We Armed Our EMTs?

Go have a read if you want to see something outside of my normal pulpy style of writing.

Traffic 2/2

As I push the gurney through the sally port towards the ambulance with our police escorts, I’m able to have a few moments to myself to ponder the situation. I’ve transported many prisoners in the past and often pick up violent offenders off the streets fresh from a well deserved police “attitude adjustment” requiring a trip to the ED. But somehow this is different. This isn’t a random act of violence or even a simple premeditated crime. This man is potentially the perpetrator of organized subjugation of innocent children. The level of pure evil that spawns this behavior is unfathomable to me and I’m having a bit of a hard time with the whole situation.

I load the gurney into the ambulance and tell Kevin that I’m just going to fire off a quick 12-lead and we can start transporting. It won’t affect my transport decision as the police requested a hospital that is also a cardiac receiving center, but I need to know if this warrants alerting the cath-team if my new patient actually is having a STEMI (S-T Elevation Myocardial Infarction – heart attack). Given his skin signs and level of distress, though, I highly doubt he is.

With the 12-lead complete – normal as expected – the police cruiser pulls in behind us for an escort to the ED as we start transporting. The rote task of taking vitals and applying the monitor to a patient that I can’t talk to gives me a few more minutes to contemplate my emotional state. On the one hand I may have evil incarnate strapped to my gurney, sitting only inches from me, and that brings a flood of emotions to the surface that I’m entirely uncomfortable experiencing. On the other hand, this is a patient and I’m a Paramedic – end of story! My job is to treat the problem in front of me and be an advocate for a patient who can’t even convey his needs due to a language barrier. Conflicting emotions and logical arguments fly through my head at synaptic speed – like strobes on an ambulance – and quickly resolve in the blink of an eye.

I fall into the sequential tasks of treating my non-English speaking patient for chest pain; aspirin, oxygen, vitals, IV, nitroglycerine, vitals, nitro, etc… “Here, chew this up, don’t swallow,” I tell him as I make a chewing motion with my mouth and move my hand like a hungry sock puppet and hand him the aspirin. “Did you take any Viagra today?” Stupid question, he’s in jail, I’m a little off my game here. He shrugs in non-comprehension. I spray the nitro in his mouth. Whatever, if I crash his blood pressure out I’ll try to fix it and apologize to the docs at the ED.

The ambulance comes to a stop on the freeway as there is an accident in front of us. We heard it get dispatched as we responded to this call but I guess Kevin is a little off of his game as well since he didn’t use surface streets to bypass the congestion. I can see the police escort sitting just behind us – in the stopped traffic – through the back window of the rig.

Pulling the stethoscope from my ears after the latest check on vitals my patient turns to look me square in the eyes. In heavily accented broken English he speaks to me in a quiet voice. “I can see that you a very nice man. Is all a mistake. They not my bitches, they my sisters… I have much money. I give you. You let me go!”

  • Child trafficking is one of the fastest growing crimes in the world.
  • There are 2.5 million child sex slaves in the world today, some as young as 4 and 5.
  • More than 1,000,000 children worldwide will become victims of child trafficking this year.
  • Over 100,000 children in the U.S. are currently exploited through commercial sex, and 300,000 children in the U.S. are at risk every year for commercial sexual exploitation.
  • Investigators and researchers estimate the average predator in the U.S. can make more than $200,000 a year off one young girl.
  • The global market of child trafficking is over $12 billion a year.
  • The total market value of illicit human trafficking is estimated to be over $32 billion a year.
  • An estimated 14,500-17,500 foreign nationals are trafficked into the U.S. each year.
  • Approximately 80% of human trafficking victims are women and girls and up to 50% are minors.
  • 600,000-800,000 people are bought and sold across international borders each year; 50% are children, most are female.  The majority of these victims are forced into the sex trade.
  • There are open sex slavery cases in all 50 states.
  • U.S. citizen child victims are often runaway and homeless youth.
  • Runaways, orphans and the poor are targets for sexual predators.
  • Approximately 80% of trafficking involves sexual exploitation, and 19% involves labor exploitation.
  • There are more slaves today than ever before in human history.

Information from various sources ~ U.S. Dept. of Justice, U.S. Dept. of State, UNICEF, UN, UNODC

As long as the mind is enslaved, the body can never be free. Psychological freedom, a firm sense of self-esteem, is the most powerful weapon against the long night of physical slavery.

Martin Luther King, 1967

Traffic 1/2


1 : the passage of people or vehicles along routes of transportation; traffic congestion

2 : dealings, business, or intercourse

3 : social or verbal exchange; communication

4 : buying and selling; barter; trade, sometimes of a wrong or illegal kind

5 : to carry on trade or business, especially of an illicit kind; human trafficking

The lock on the heavy jail cell door releases and the door slides open with mechanical precision, making a loud clunk which reverberates off of the austere concrete walls of the sally port (a double-door safety system that they have in prisons. From the outside, you go through one door, and when it closes and locks, the second door opens to let you into the interior). Standing in front of me is the fire captain who’s taking information from the jail’s processing officer – he looks up long enough to point us down a hall. We continue walking down the hallway of holding cells and I see freshly processed prisoners, still wearing their street clothes, sitting on benches in their cells watching the procession of uniforms glide past their limited view through the bars. In the open cell at the end of the hall I finally see my patient – a man in handcuffs, leg shackles, and an orange jump-suit – sitting on the bench with firefighters taking vitals and four very large officers keeping an eye on things.

Finally, I see a friendly face – the fire medic stands up to give me a quick report. “Hey KC, so it’s your basic incarceritis. Forty-eight year old male, chest pain by three hours, vitals normal, no primary symptoms. That’s about all we have unless you speak Mandarin.”

“Sweet! No problem.” I step around the medic and address the prisoner. “Ni hao ma?” In perfect intonation I ask him how he’s doing in a typical Mandarin greeting. Fortunately I grew up in the Chinese community of my home city and know enough Chinese to order dinner, get my face slapped, and yell like a drill sergeant at a class full of kung-fu students. Unfortunately, it’s all in Cantonese and I just exhausted my Mandarin repertoire.

The prisoner stands up with a hopeful look on his face and fires off an excited string of Mandarin. “好. 这些人不相信我. 我有胸部疼痛.”

In unison the firefighters and officers look at me to see if I can tell them what’s going on. “Sorry man, that’s all I got, let’s go to the hospital.” I motion to the gurney as he does the shackled penguin waddle out of the holding cell. Kevin and I put on the leather hand restraints as the officer takes off the handcuffs. I’ll need access to his arms to treat him, yet he’s still in custody.

As we’re walking past the rows of holding cells I’m asking one of the officers what’s going on. “Yeah, we used the translation service on the phone, he said he has chest pain and knows that no one will believe him so we called you guys.”

“What’s he in for?” I always ask as I want to get an idea of how dangerous someone is – it doesn’t affect my treatment but it’s nice to get a heads up if I’m going to be sitting in close proximity to a violent criminal.

“We picked him up yesterday on a sting-op. Busted about a dozen brothels in a couple different counties. These guys were trafficking young girls from Asia on container ships and forcing them into prostitution. This guy was pimping out girls as young as thirteen! I tell ya’, right now, I hope he is having a heart attack – he deserves it!” Damn!



Service 4/4

As I open the back doors of the rig I see the two extra firefighters in the back of the patient compartment. CPR is in progress and having extra people to help out is always better so the medic took a few riders. We help them unload the patient while keeping an eye on IV lines and monitor cables. I hand the monitor to Brittany and tell her to keep close as we roll the gurney into the waiting team of doctors and nurses. One of the fire fighters is “riding the rails” – he’s standing on the bottom rail of the gurney, one hand holding on and one arm applying as much of a compression to the patient’s chest as is possible on a moving gurney.

As the paramedic is giving a verbal hand off to the medical team we disconnect the monitor leads and transfer the patient over to the bed. A flurry of motion ensues as the hospital staff go to work picking up the code where we left off. I take Brittany to the corner of the room where we are out of the way and I can explain what’s happening as the team administers more drugs and shocks the patient a few times.

After ten minutes it’s obvious this person isn’t going to come back to the living. They are going through the last few motions of working a code – throwing the “Hail Mary” drugs at him in the hopes that something was overlooked or an underlying unknown condition is preventing the resuscitation from working. The ED tech doing compressions is a friend of mine and he’s getting a bit fatigued from doing CPR for the last five minutes.

“Hey Nick, you want some relief? My ride-along needs the practice.” Nick gives an exhausted nod of his head as drips of perspiration land on the pale patient below him. Brittany bounds up to the step stool at the side of the bed and trades off with Nick without missing a beat. I coach her on hand placement and compression rate as she furiously puts all of her heart into keeping this man’s heart working.

While Brittany continuously pumps on the man’s chest, I’m standing next to her explaining some of the things she’s feeling and giving pointers. “Don’t worry about the broken ribs, keep pushing, he’s got bigger problems. Give the chest a full recoil, let it inflate after every compression.” I push my fingers into the man’s femoral artery. “Push a little harder, there you go, now I can feel his pulse in the femoral from every compression.”

After two rounds Brittany is completely exhausted but she’s still pushing for all she’s worth. Nick catches my eye as we stand behind Brittany. “They’re about to call it, you want me to take the last round?”

I pull Brittany from the stool as Nick jumps in for the final round of CPR. Nick’s a good man – he knows that we were all just going through the motions on this one but Brittany doesn’t need to be the last person doing CPR when they decide to stop. She did a great job and it’s best to leave on a high note rather than a depressing coast out.

This was our last call of the day and as we take the quiet roads back to the deployment center Brittany has a flurry of questions and observations from her day on the streets. Kevin and I have quiet smiles on our faces as we discuss the day and her performance. Her enthusiasm is contagious and we were just happy to provide her some experiences to help prepare her for the unknown that awaits her overseas.

Back at the deployment center I’m filling out Brittany’s evaluation form where I give her high marks in all categories. Brittany puts her form in the camouflage backpack and joins her camouflaged classmates in the lounge as they compare stories of their day in the Big City. I suspect Brittany has some of the best stories of the group today.

She’s a shining example of the young people that are making sacrifices for our country every day. These are young men and women from across the country who take an oath, put on a uniform, and deploy across the world. Many of them will find themselves in dangerous situations, and maybe some of the things they learned in our Big City will be of use in future deployments.

Service 3/4

After the call I’m driving through the hood so Brittany can see some prostitutes as our last call brought that into the conversation. With Brittany squealing with excitement after watching a young woman get into a car with a complete stranger I’m passed by the Big City PD who’s moving fast.

“Brittany, you might actually get a real call today. PD just passed us and another one is coming up behind us.” We get used to the driving patterns of PD as they have a particular mode of travel when going to a real call. Despite the cop shows that depict officers traveling Code-3 to every call our local PD tends to just light up at intersections and occasionally hit the air horn to get someone’s attention. They are the urban land-sharks of the hood that gracefully slide through traffic following the scent of blood to the crime scene.

A few seconds later the radio comes to life. “Medic-40, respond code-3 for the GSW at the corner of really bad street and even worse street, please stage out, your scene is not secure.” Brittany has her gloves on before the dispatcher finishes the sentence and wearing her camouflage battle dress uniform all I can see in the rear view mirror are her bright shiny teeth in a big smile. I light up the rig and head in the direction that PD was going.

Just as I’m thinking about shutting down to stage and wait for the officers to secure the scene the dispatcher comes back and clears us to proceed. We arrive to find police cruisers blocking the street and yellow tape being rolled out to keep the crowd back. There’s a cluster of officers standing next to a young man who’s collapsed on the sidewalk with a small pool of blood forming under him. It’s Kevin’s tech so he’s first out and walks up with the fire crew that just arrived. Brittany is staying with me as I’m getting the equipment out of the rig.

I hand her a set of trauma shears and motion towards Kevin who’s kneeling by the young man. “go on – get in there and cut some clothes off.” I don’t think I’ve ever seen anyone skip in combat boots yet that’s pretty much what it looks like as Brittany joins the others in cutting clothes and looking for bullet wounds.

It’s the perfect textbook scenario for rapid assessment and treatment of a trauma victim. Four minutes from the time the call went out to arriving on scene with fire and EMS pulling up at the same time. Seven minutes spent on scene stripping clothing off, controlling the bleeding, and putting the patient on a back board. He has two entry wounds, one in the neck and one in the upper chest. Both appear to be small caliber and bleeding from the chest wound is controlled with a chest seal to reduce the possibility of developing a collapsed lung. We decide to use a hard back board because of the close proximity of the neck wound to the spinal column.

With strobes flashing and siren wailing, I make the five minute Code-3 drive to the trauma hospital with my police escort just behind me. Kevin’s reassessing for neurological deficits and starting IVs as Brittany is doing her best to take vitals in the back of an ambulance running Code-3. She’s using all the techniques we showed her on the previous non-emergent calls: slipping the bell of the stethoscope under the cuff so you can corroborate the auscultation by feeling the palpated systolic pressure with the other hand, and supporting the arm on your leg while lifting the heel of your boot to isolate noise and vibration. She’s a quick study and is keeping her cool on a highly stressful call. Seventeen minutes after getting the call we are pushing the gurney into the trauma bay, which is already crowded with the trauma team of doctors and nurses. By the time Kevin is finished with his paperwork the young man was already headed for the operating table.

Brittany is helping me clean up the ambulance as another rig comes in to the trauma bay. I could hear the siren from a few blocks away and see their lights flashing as they entered the parking lot. Brittany and I change gloves so we can help out the crew – they are bringing in a critical patient.