Today I had some real awesome ambulance work. The difference between today and yesterday was that today I rode with paramedics. They can do much more than EMTs, they go for at least an extra year of school, and thus can do a heck of a lot of advanced life support (start IVs, administer drugs, etc.).

I woke up at noon, dressed myself and got down to the ambulance building again. Almost the same people, all the employees lounging around waiting on call for their turn to get the next dispatch. I settled in for a few minutes, and got partnered with two paramedics and ambulance #23.

About a half hour into it, the lead paramedic tells me we have to go. I hop in the back, and I ask her what the dispatch information is. Something about a pregnant 18-year old female with abdominal pain, possible diabetic or something. Dispatcher information is never clear, and she was telling me even less. We show up, the girl is 3 months pregnant, and feeling abdominal pain. We took her down the stairs on a stair-chair, and then onto a stretcher and to the hospital. I didn't do much this time, I just helped the paramedic going down the stairs backwards, and I got to take a look at the pre-hospital care forms the paramedics filled out.

Back to the ambulance bay, where nothing happened for 2 hours. I spent nearly the whole time watching tv, then on the phone, then having a snack from the vending machine. Then we got a real call, one where they dispatched the Paramedics on priority. They rushed out, not even closing the garage door like they usually do. The lead explained to me that a woman at the local ER was having a genuine heart attack, but the cardiac catheterization lab which could handle it was at the other hospital, 7 miles away. Sirens on, we blew through a few lights and wound up at the hospital. Inside the ER, the paramedics got out the portable EKG heart monitor and the portable IV pump, and moved the patient onto the ambulance. A doctor came along, so I got to sit in the front this time. She wasn't looking so healthy, 60 year old smoker I think. The paramedic warned me that this was a serious case, she could "crash" en route, so they had her on 2 IVs and they were watching her heart on the monitors. You know, that squiggle. Even I could tell it looked abnormal. We brought her to the ER, I got to carry the heart monitor and oxygen tank, then the IV pole, then her belongings, then her chart. From there, we brought her up to the cath lab, where they were readying their X-Ray fluoroscopy equipment. Cool stuff, it's like a live X-Ray on a tv screen, where they inject dye into a vein and find where the clot is, then wipe it out with drugs and tubes.

Once she's in the lab, we all relax and then start packing everything back up. The driver is showing me the heart monitor, when the dispatcher calls him on his cell phone, not even waiting for us to get back on the ambulance and using the radio. Another call! But we're not even back in service yet, still cleaning up. It doesn't matter, we nab the other paramedic who is speaking to the doctor, and head downstairs.

Now, here's where it gets interesting. The radio comes to life, and tells us that we have a "Priority One" dispatch, a cardiac arrest in progress. That's where the Paramedics, who are trained in Advanced Cardiac Life Support, come in. We run onto the ambulance, and once a short distance from the hospital, put our lights and sirens on, and floor it.

I thought I was getting used to the ambulance rides with the lights and sirens. They go through red lights, but not before slowing to a crawl first and creeping past any traffic waiting at the light (getting broadsided is a real danger, that's why). But this time was totally different. First, this was siren plus horn. The driver kept twisting the siren dial, going from a wail to a yelp to a honk. If the cars wouldn't get out of his way at the light, he drove on the opposite side of the street. We blew through intersections way over the speed limit. Brandywine Avenue, a straight road, has a speed limit of 30mph. We flew through it at over 70. Woo-hoo! And just as I'm enjoying this, as well as getting keyed up, the driver says "how about some music" and turns the radio on! So now we're making sharp turns, weaving through traffic, while listening to Queen's Bohemian Rhapsody. My God how surreal it all was. At least the paramedics were grinning. I just sat back as we got onto the highway, with the diesel ambulance truck pushing over 90mph, to the tune of "Bismillah- No! We will not let you go..." while on the way to some life or death situation.

We get to a nursing home, but they made us park in back ("You might scare visitors") I get to throw the heart monitor and Oxygen cylinder onto the stretcher, while the lead takes the medications out of the padlocked cabinet. We hurry inside, where we find another crew made it there before us, they're surrounding an old woman, trying to give her CPR and in the midst of inserting an airway tube down her throat.

I stood in the back of the room while I watched four medics working on the woman. I'd never seen real CPR done on a real person before. It somehow looked a little easier than on a dummy, she looked softer, as if they didn't have to press as hard. But then again, she was a really old woman, from the looks of it; emaciated, just skin and bones. She flatlined, so they tried injecting her with heart medication into her lungs to see if it helps. It didn't, so they continue CPR. The airway tube went in too deep, so only one lung was getting air. The lead readjusts it, while another tries to suction the airway. One that happens, her breathing sounds clearer, no more gurgling when they manually ventilate her with a bag mask. Then, they opened the medication box and squirted epinephrine and atropine (both heart medications) down her airway and into her lungs. It's not working, and by this point 20 minutes have passed. They check her heart rhythm, but there is still nothing, so they go back to CPR. Interestingly enough, I never knew that doing CPR makes the hear monitor squiggle. Instead of a nice rhythm, it looks like some squiggly uneven sine wave.

Well, after 30 minutes, they called the doctor, who ordered them to stop. The lead asked what time it was, and I told her. 6:15. She noted it, and everyone stopped working, and started cleaning up. They put the woman's wig on the table, and pulled out the tube. The other guy pulled off the heart monitor and another cleaned up the empty medication bottles.

They all seemed nonplussed. I mean, she was an old woman, and her odds were poor anyway. Her heart just stopped, it went flat. You can't shock a heart that's gone completely flat. For some reason, I don't feel anything. Sad, maybe, but not creeped out or anything. If I had to touch her, it would be a different story. Ah well, Inna lillahi wa inna ilahi raji'oon. I guess we all have an apointment with death.

It's snowing here, in April. Whooah, it's a crazy world we're living in....