Sometimes it is about the money...

I love my job. Despite long 24-hour shifts with snippets of sleep and being woken up for what may not be an actual emergency but is an emergency to the patient. And sometimes we are being woken up to a true emergency. The kind of emergency where you walk bleary eyed and still half asleep through the patient’s door to find their grown son crying and begging you to help his dad. Dad is on the bedroom floor, unresponsive, his eyes open, he is not breathing. And now you’re awake. You jump into action. You instruct your partner to start CPR while you make sure the patient receives oxygen and you ask his still crying and panicked son when his father was last seen awake (alive) and if he had been complaining of not feeling well? Has he been sick lately? Does he have any medical conditions? To this question the son shows you a plastic bag with a dozen or more medication bottles with labels you currently don’t have the time to read because you’re performing lifesaving procedures.

Because this call came out as a sick person due to the caller having been too excited to give the 911 dispatcher the needed information to dispatch the call accordingly and send the necessary units (the fire department for much needed assistance, another ambulance for extra medically trained staff to help with those life-saving procedures, the supervisor so someone can oversee everything and keep the family informed and at bay and possibly law enforcement for irate bystanders) you and your partner are the only ones at this location at the moment. The caller figured if he hung up, help would get there faster. But we are not the ones on the phone. 911 is on the phone, relaying everything to us so we can be prepared and won’t be surprised when we arrive on the scene of the emergency.

After calling over the radio for extra units, advising that we are working a cardiac arrest my partner and I do what we can while the lifeless man’s son keeps asking what is wrong with his father and he continues to beg us, almost screaming, to help him. I attach the monitor to see what rhythm the patient’s heart is beating in. Is it a rhythm that could benefit from electrical shock and medications or is it a rhythm that only needs CPR for now until we have enough people there to pump the man’s heart and make sure oxygen gets pushed into his lungs while I can get intravenous access to give lifesaving medications. While I do this, I am trying to explain what is going on, what we are doing, and I tell the patient’s son that more personnel will be arriving soon, so that we will have extra help. I refrain from adding that whoever called 911, and I know it was the son, should have given all the necessary information so more help would have been sent and things would be going more smoothly, and his father would have received all the needed help from the get-go.

His son is confused. Why don’t we snatch dad up, put him onto the stretcher and race him to the emergency room?? Because if we did that, his dad would have no chance of survival. We need to keep that blood pumping through his body, keep his organs and brain oxygenated because without the brain, resuscitation of the heart would not achieve the desired results: for the patient to wake up and continue life and for his son to spend more time with him. Even though it is understandable that family is upset, it can put emergency personnel in a difficult and sometimes dangerous situation if the mentally anguished family member becomes angry and might even start making threats. In that case our first priority is no longer the patient but, you guessed it, we are. Luckily those situations rarely occur, but as a first responder you never know, and you have to be aware and ready to leave the scene.

At this point more help has arrived. First responders take over CPR and my partner is tired at this point. It is recommended that personnel switch out after 2 minutes of doing CPR. Tired compressions are not adequate compressions, and the heart does not benefit from them.

Now we have established intravenous access and given medications. The patient has been intubated and therefore has a patent and secure airway for adequate oxygen delivery to his lungs. After every round of CPR, we check for a pulse and evaluate the heart rhythm on the monitor. The supervisor has spoken to the son and calmly explained the situation, procedures, and game plan. It was easier for the supervisor to communicate with him since he did not have several other things going on at the same time. Even though we are capable of doing that a family member benefits from speaking to someone who is giving them their whole attention and can calmly answer any questions they may have.

After close to 20 minutes the heart rhythm on the monitor indicates electrical activity. We check for a pulse, and we find one! Since blood is now circulating through the patient’s body without our assistance a blood pressure can be obtained, and it happens to be stable! CPR will be continued for 2 more minutes to help the heart keep going. It’s like an extra push. We continue breathing for the patient and monitor his condition before moving him prematurely. We want his heart to continue beating on its own for a bit before we move the patient and cause disturbance to his fragile physical state. After all, this man was technically dead for at least 20 minutes.

We arrange for transport, make sure the patient is moved safely and securely, we make sure, that the breathing tube does not become dislodged during movement, and we also want to keep that intravenous access in place, in case we have to give more medications. As we roll the stretcher toward our ambulance, the patient’s son is now overcome with relief. He is crying, thanking us all profusely, he is patting us on our shoulders, almost trying to hug each of us. There is a chance he may talk to his dad again! To him the nightmare is over. We on the other hand know that there is no guarantee that his father will survive. But for now, things are looking good.

On the way to the hospital, I sit in the back of the ambulance with my supervisor, making sure the patient remains stable and alive. He is there to assist should the man’s condition change. For now, he is sitting in the seat behind the stretcher, breathing for the patient, while talking about everything that was done on this call so far. We obtain vital signs every few minutes but at one point I can no longer feel a pulse. The patient’s blood pressure has dropped to a dangerously low level. I get out a bag of medication that will help get the patient’s blood pressure go back up and keep his heart pumping adequately. His pulse is now dropping as well. I quickly put the IV tubing in the bag, look at how much of the medication I have on hand, estimate the patient’s weight, convert it from pounds to kilograms and calculate the proper medication dosage for this dying man in my head using the formula I make myself practice every week so I can use it when I need it. And tonight, I need it.

I did the math correctly. The patient’s heart rate comes back up and so does his pressure. My partner, who is driving us to the hospital, called the charge nurse in the emergency room about our patient so they can have their staff ready for him when we get there. As we roll the patient into the room, I give report to the doctor and the rest of the medical staff as the patient is moved from our stretcher to their bed. They unhook our monitor cables and connect theirs. It looks like a busy beehive, but for someone familiar with the process it is very organized, everyone knows their role and does their job well. I get a signature from the nurse stating that I gave her report and I walk outside to the ambulance.

It is cold but it feels good to me since I worked up a sweat. We now have to replace everything we used, clean the ambulance and the stretcher, and get back in service for the next 911 call. I have to write a long report on everything that was done, the patient’s condition, his medical history, how he appeared when we got to him, how long we worked on him, what the outcome was, what medications I gave, how often, and how much, and a lot more. As we get back to the station and I sit down I realize how tired I am, how tired I was before this call. My partner is snoring in the recliner. I sit down on the couch, and I feel myself doze off. Suddenly the station alarm starts blaring again. We are being dispatched to a 23-year-old with elbow pain, onset of pain was a week and a half ago. It is now 330 in the morning. We drive to the residence and there are four vehicles in the driveway. The patient is alert and oriented and there are three adults in the residence. All are awake and clear headed, and they are all very likely capable of driving this 23-year-old to the ER. But no, they want us to take the patient so he “will get seen faster”. I hate to tell you this but your mode of transportation to the hospital does not determine your destination and since this is clearly not a life-threatening situation this patient is being taken to the waiting room where they will likely spend the next few hours. After all, the ER staff is still busy taking care of a patient who had been in cardiac arrest less than an hour ago.

When I finally get to go home in the morning, I am exhausted, but I feel good about the care I provided. Not just to a man who almost died, but also to the young patient with the elbow pain, and an 85-year-old female the previous afternoon, who thought her heart was beating too fast but who was actually fine and just wanted some company. I do enjoy taking a short break out of my day to talk to someone who just needs to see another human besides their doctor every now and then. And between those patients there were several others with all different complaints. A child with an asthma attack who needed to have an IV placed for medications and I used the way I have with kids so they trust me and actually let me stick them while at the same time I am trying to calm down his hysterical mother, explaining that we can get this situation under control. After all, the kid won’t calm down unless his mother will. Because if mom is not in control things are bad. But we handled it and the little boy got to keep a stuffed animal that was given to him by my partner.

A few weeks later I am grocery shopping and I see the man whose life we saved, in the store along with his wife and his son. They are picking out a birthday cake. The son looks up and nods at me in greeting. He does not recognize me out of uniform. And I don’t expect him to. I am just happy to see our former patient alive and well, spending time with his family. I keep walking with a smile on my face. I am happy for them.

The next day we have a meeting at work. It is about our pay. The person in charge of approving the budget for the county my agency works for does not think we need a raise. He won’t even hear our admin staff out when they try to propose what they have come up with. It is one thing when there is no money to give, but it is another to dismiss the request outright and to refuse to hear out someone who is trying to do what they can for their employees.

Most of us have two, some have three jobs just to be able to pay the bills. But we are also able to pick up a lot of overtime since we are short staffed. The pay situation had been an issue for so long that a lot of paramedics left to work elsewhere. And now our agency struggles to keep all the ambulances staffed. People still need emergency responders after all, be it for being close to death, or having had pain in the elbow for over a week. We have to be there; we have to respond. And we are tired, but we have to do what we have to do. I decide to pick up an extra night shift. And it is a long one because we are busy and there is no heat in the ambulance. A back up ambulance is not available. It was not approved in the budget. The 72-year-old patient with stage four COPD isn’t very happy about having to ride in that cold ambulance either but it’s all we’ve got. 

In the meantime, the person making the decisions concerning our pay is probably asleep in his king size bed with Egyptian cotton 1200 threat count sheets because he has a plane to catch early in the morning. He is going to spend his next 2 weeks in a warm climate somewhere. It’s a yearly thing. He can afford it.

I knew what I signed up for when I got this job but there are counties where the people in charge did raise the pay for their EMS agencies after they were educated about what EMS personnel are actually capable of doing.

I am not looking for pity or accolades but for fairness. After all, we deserve it. We are not trying to get rich, but after months of those 24-hour shifts (and they are not all crazy busy, but we are still expected to perform accordingly at any point during that time), we deserve to take an actual vacation during which we can relax without having to worry about our financial situations. We also deserve to be able to hold on to a nice vehicle that doesn’t have close to 200,000 miles on it. I want to take my children on a nice vacation but in order to do that I have to work a lot. And I know my kids would rather have me home at night as opposed to me being gone for the majority of them.

So yes, sometimes it is about the money. I do not have over 8 years of education under my belt or the letters MD behind my name. I am not a nurse either, but my training took about the same amount of time and in the back of that ambulance I am permitted to do more than an RN is. RNs are very capable, and they deserve their pay, I am not saying they don’t. I am saying that we deserve better pay, too.

I do not wish anything bad on anybody and I would never withhold care from a patient but should that person, who has the power to approve that deserved and much needed pay raise but refuses to do it, ever have to call 911 it would be really tempting to teach them the meaning of “You get what you pay for”.