A Paramedic's Life

By Neal Lindley

This story follows the life of one paramedic as he is transformed from a wet behind the ears and new EMT to a knowledgeable and experienced paramedic. This story is an entertaining and informative look at the not-too-distant past. It provides nonmedical readers with a rare look at life in the streets while also serving as an educational tool for new EMTs and paramedics. This book is not for the faint of heart. The author shoots straight from the hip as he discusses some of his most memorable calls in raw detail. Sometimes tragic, sometimes humorous, but always eye-opening.

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Mar 27, 2020
• ISBN: 9781645842279

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A Paramedic's Life

Neal Lindley

Copyright © 2019 Neal Lindley

All rights reserved

First Edition

PAGE PUBLISHING, INC.

Conneaut Lake, PA

First originally published by Page Publishing 2019

ISBN 978-1-64584-226-2 (pbk)

ISBN 978-1-64584-227-9 (digital)

Printed in the United States of America

Table of Contents

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Chapter Eight

Chapter Nine

Chapter Ten

Chapter Eleven

Chapter Twelve

Prologue

Y ou better get me there before the engine, I told my partner in a groggy voice.

We had been awakened from an early evening nap for a difficulty-breathing call. The 911 dispatcher said the patient was a twenty-four-year-old female with a history of asthma. I had been partnered with Trey for about six months, and we worked well together, finishing each other’s sentences and knowing what the other person likes to eat or hates to eat and what kind of girl the other one would find attractive—things you learn about someone when you spend seventy-two hours a week with them for months on end. On scene, I could rely on him to do the things I wanted him to do in the way I wanted him to do them.

We pulled up in front of small white house. I radioed back to the communications center that we were on scene and code 4 (not in need of any other assistance).

All right, dude, I want a nebulizer setup on a nonrebreather and get an in-line neb setup with a 6.5 tube, in case I need to get her intubated, I instructed Trey before getting out and heading to the front door. Inside, I found two young men sitting on a sofa. I thought it was odd that they were just sitting there, but they clearly had a concerned look on their faces.

Where is she? I asked the one who looked the most competent. He simply pointed to his right. You, come with me.

On the floor of the kitchen was my patient. She was on all fours with her back arched, gasping for breath. It was a position that only people in the worst respiratory distress assume. I walked over to her and put my arms around her back and grabbed her wrist.

You’re not going to like this, but I gotta turn you over to get you to my ambulance, I warned her. I pulled her up to my chest and instructed my conscripted assistant to grab her legs and head out to my ambulance. He did an amazing job for a layperson. He hooked one arm under her knees, so he would have use of the other for the door. At the ambulance, I stepped onto the bumper and handed her upper body to Trey. By the time he had her sitting on the pram, I had made it inside and up to the head of the patient where I slapped the mask on her face. It was already filled with the fog from the Albuterol nebulizer Trey had started. I grabbed my stethoscope to listen for her lung sounds. I couldn’t hear any in the bases or middle lobes. When I listened at the top of her lungs, I heard restricted wheezes. It was clear to me that she was dangerously close to respiratory arrest (completely stopped breathing) when we arrived on scene. It was also clear to me that I should start thinking pretty seriously about intubating her (placing a latex tube in through her nose, since she was conscious, and into her trachea, so I could manually force the medicine into her lungs). She responded to the treatment rather quickly, however, and I started hearing breath sounds from the rest of her lung fields. It was at that moment that I heard engine 72 radioed that they had arrived on scene. Of all the incompetent engine medics in the district, the one on engine 72 stood out as the worst. I had once watched him struggle to figure out how to use a blanket to immobilize the neck of an eleven-year-old boy who fell off a roof. I stopped him when he thought he should wrap it around the boy’s neck like a noose. What struck me now was the time I heard the dispatcher give the engine after (whenever a call is made to dispatch, they repeat what is said and give a time), Engine 72 on scene, 1822. That’s 6:22 p.m., which was three minutes from the time we arrived on the scene. That was what knowing what to do and having a good partner was like. Although I didn’t always have a good partner, it made things that much easier.

You need anything? the fire medic asked, standing at the back of the ambulance. You good?

Yeah, man, we got it. You can go available, I replied.

Three minutes on scene was critical in this case. Once she went into respiratory arrest, it would have been exponentially more likely that she would have died. Even though asthma was a relatively simple problem to fix, it was life-threatening. This patient actually refused transportation to the hospital. What would they do there anyway? She had contact with an asthma trigger, and now she was better. I pulled my cell phone out of my pocket and called the physician back at the hospital and explained the situation. He agreed that she could stay at home. So I filled out the report, and we left.

We were heading back to our station within twenty minutes of our arrival. The next problem to solve was where we were going to get dinner. After eleven years in EMS (emergency medical services), I was used to calls of every kind—medical problems or traumatic injuries involving everyone from infants to the elderly. Sometimes many of them all at once (mass-casualty incidents). I had become a bit jaded, to be sure. I stopped having sympathy for people who crashed their cars on clear days with great road conditions. But I wasn’t always a knowledgeable, capable paramedic. There was a time…well, let’s go back to the first day.

Chapter One

Ijoined the Jump Club while stationed in Korea because I always wanted to parachute. The club was primarily run by the local detachment of the Pararescue Squadron at Kirkland Air Force Base in New Mexico. It was also a chance for me to learn a little about the life of a PJ, as their members are affectionately called. I had been working in intelligence for three years, but at the end of my enlistment, I’d be able to cross-train into something else if I so desired. Naturally, I was looking into all the possibilities. I talked with OSI agents, linguists, and even air traffic controllers, but when the PJ staff sergeant gave me the tour of their shop on the first day of Jump Club, I knew that I wanted to be in pararescue. The talk of skiing in the Alps and diving in Hawaii was appealing, but when he opened up one of their backpacks full of IV bags and little vials, it just spoke to me. I completely forgot the fact that I wasn’t even able to sit through our annual first-aid training without feeling nauseated. It wasn’t that I couldn’t handle seeing carnage. I had seen plenty of that in my time by then; it was something about the cartoonlike presentation that just made me feel funny. I knew I’d have to get over that somehow.

I rotated out of Korea and ended up at Colorado Springs, Colorado, working in Cheyenne Mountain. It was funny that I had always wanted to work there before, but after working at a fighter squadron, the thought of a desk job bored the hell out of me. I wasn’t even doing my job; I was in charge of supplies! But then Desert Storm / Desert Shield saved me from making sure there were enough pencils and paper clips for everyone, and I finished out my time there in the Indications and Warning Center—a much more fitting position of someone with my background. With my enlistment coming to an end, it was time to start working on making the transition to pararescue. I was worried that my bad knee might keep me out, but I just figured that Motrin would be my best friend. It turned out that I wouldn’t even get far enough to need a plan to manage my pain. Pararescue was a field with less personnel shortage than intelligence operations, and that ended my plans right there! I didn’t want to do any other job in the Air Force, and I didn’t want to keep doing my current job either, so I started to look into emergency medical services. The problem was, I knew next to nothing about the field. Luckily, I was working with Gary, who had been an emergency medical technician (EMT) before joining the Air Force. He was able to tell me quite a bit about it. Just the terminology was a big help. I learned that there were different levels of EMT. They started out as EMT-basics, then progressed to EMT-paramedic after getting enough experience and education. There was an EMT-intermediate level, too, but most people didn’t get that certification, and some states didn’t even recognize them. Now it was time to get the education.

I learned that there was a school right there in Peterson Air Force Base. That would be perfect since I lived a mile from the front gate. I made a few calls to the sergeant who ran the school and learned that I would not be able to attend. Apparently, there were only fifteen seats available, and they already had fifteen students. I offered to stand in the corner or bring my own chair, whatever might get him to change his mind! He was unwavering. While complaining about it to Gary at work, the civilian security guard overheard me and said he could help. He was a retired Army sergeant major with a lot of connections at nearby Fort Carson. He said he knew the guy who runs the medic training program there. I figured it was a long shot, but there’d be no harm in asking.

Without another word, he picked up the phone and dialed the number. He didn’t look up the number; he just knew it apparently. In his gravelly voice, he explained my situation to the man on the other end and simply asked, You think you can get him in? Then he grunted a couple of times and said, His name’s Sergeant Lindley. Yeah, staff sergeant. Okay, thanks, Tony. Then he returned the phone to its cradle and handed me a note he’d been writing while on the phone. The note had the building number where the class would be held and a crude map on how to get there from inside the base’s main gate. I couldn’t believe it. I was going to EMT school!

* * *

I had a few preconceptions of how the classroom would look and feel and how the instructors would conduct the class. I had been in Army briefings before and assumed the class would have a similar tone—fairly rigid and well-structured. I remembered how different we Air Force briefers were from the Army and Marine briefers I had seen in the past. I would get up to give a briefing to a hundred officers—some of whom were generals as a lowly E-3 senior airman while the others would send up a major to present the briefing with an E-5 or E-6, pointing to maps and charts for him. I was mentally preparing myself for the different environment as I drove to Fort Carson that first day of class. I prepared well in advance the way I usually did for college courses and other trainings that I’d received. I bought the latest edition of the textbook. I read two lessons ahead of what the syllabus said I needed to, and I fully expected to be one of the top students in the class, as usual. I arrived early, also as usual, but I thought I had made a mistake finding the right building. The numbers matched, and as far as I could tell, I was where my crude map told me I needed to be, but the building in front of me looked condemned. It was a faded-yellow two-story wooden structure that still retained most of its siding, but it was missing some windows and a bunch of shingles. I was sure I was in the wrong place until I saw other cars pulling up.

At least no one is going to care much if we scratch the paint while we’re holding classes, I thought.

I sheepishly asked the first soldier, who seemed approachable, if I was in the right place. He assured me I was. Being the only Air Force guy there made me stand out much more than I was comfortable with. If it had been any other service branch, it would have still been awkward. But with the Army, it was akin to being the kid from a divorced family who took the opposite parent’s side. I was not exactly sure since my parents weren’t divorced, but it was the feeling I had. Since the Air Force split off from the Army’s Air Corps after WWII, there had always been a little rivalry between the branches. We were so much alike, yet completely different in many ways too. Physically, the only thing different about me was that I wore my rank on the sleeves, while soldiers wear theirs on their collars. Apparently, it was enough of a difference for everyone to see instantly. I felt like an alien who just landed on earth. To their credit, no one suggested dissecting me to see what was inside, but at least a few of them actually poked my rank insignia to see, I assume, if it was real. Once inside, I chose a seat on the end of a row, more toward the middle, as opposed to the front row that I usually preferred. As I tried to conceal my discomfort, I looked around the room to see the tiny classroom becoming crowded, actually overcrowded, with students. There was none of the rigidity and control that I had experienced during other encounters with the Army. The room was noisy. There were side conversations throughout the room. Everyone there already knew several of the others. It made sense; they were all already Army medics taking the class simply to have a civilian certification, if and when they separated from the Army. About ten minutes after the class was scheduled to start, a sergeant walked to the front of the room and began yelling. What he was yelling, I couldn’t quite hear. He said who he was and where the latrines were; that much I could figure out. But I didn’t actually hear what his name was or where the latrines were. I figured I’d find out his name soon enough, and I saw the latrines on my way in. It was not like it was difficult; there was one hallway down the center of the entire building. All someone would need to do was walk the hall and look for the sign. They were the only doors that were labeled in the entire building.

Once everyone had taken a seat and the room had quieted down, the instructor asked if there was anyone who wasn’t already a medic. I shot my hand up without a second thought. I looked around the room; I was the only one with my hand in the air.

Air Force? the instructor began. You aren’t a medic? What’s your MOS, then? MOS is an abbreviation for military operational specialty. In the Air Force, we have AFSC (air force specialty code). But I knew what he meant and answered promptly.

Intelligence operations, I replied, realizing that I was going to be ridiculed for that.

Intelligence operations. Okay, he said, surprised but not sarcastic. The rest of the room couldn’t hold back. The place erupted with laughter.

He made me explain that I was there on my own to get my EMT certification, and I wasn’t there for any official Air Force capacity. I didn’t want everyone to know for one good reason: fraud, waste, and abuse (FWA). That was the program that both the Air Force and Army had that was set up so that anyone could report what they saw as fraudulent, wasteful, or abusive use of government resources. I knew that it wouldn’t be too difficult for someone to make the case that allowing a perfectly serviceable Air Force staff sergeant in a specialty that was critically short-staffed attend an EMT course that had nothing whatsoever to do with his job constituted fraud, waste, and/or abuse of government resources. I tried to keep my answer brief but enough not to give anyone reason to start prodding for more. After all, my supervisor saw fit to let me attend classes rather than spend $10,000 on renewing my security clearance. That was the argument I was sure my boss would make if she were questioned. The instructor seemed satisfied with my answer and moved on with the course outline. Since everyone attending was already a medic, except for Air Force, we would not spend any time discussing the first-five chapters that had to do with basic human anatomy and how to assess vital signs. For me, that meant we were now going to start two chapters beyond the point I prestudied. I quickly realized that I should simply plan to pass the course rather than get the highest grade. We hadn’t even had our first break, and I was already two chapters behind.

We dove right into patient assessment: the head-to-toe exam. The class was moving so quickly, and I was seriously in way over my head. Still, I didn’t ask a single question for fear of slowing down the entire class and bring their wrath down on myself. I took careful notes while watching my classmates practice the process of visualizing and palpating their way down a victim’s body while announcing to the instructor what they were looking and feeling for each step of the way.

Okay, the preceptor would say, you’ve got a female in her twenties who was walking down the street. According to witnesses, she just fell over, and they called you. Okay?

Okay, is the scene safe? the student would ask.

The scene is safe, the preceptor would reply.

I’m checking for responsiveness. Checking to see if she’s breathing. Looking at her skin and noting color, if she’s cool, pale, diaphoretic. Checking pupils. Listening to lung sounds. Looking for JVD. Looking for equal rise and fall of her chest during respiration. Vitals. Palpating her scalp. Checking for deformity, contusions, abrasions, punctures, burns, tenderness, lacerations, severe bleeding. As the student called out each assessment point, the instructor would call back what the student is seeing wrong with the victim.

She’s not responding. She is breathing. Skin’s warm and dry. Pupils are equal and reactive. Lung sounds are present. No jugular-vein distention. Chest rises and falls equally. Good blood pressure. Pulse is thready.

During the first day, no one ever had a pretend injury. The point of the exercise was simply to practice the steps of the assessment.

I waited to be the absolute last one to practice. I didn’t understand any of the terms. If the preceptor had told me an actual blood pressure or a pulse rate, I wouldn’t have known what it meant. I didn’t even know how to take a blood pressure! So I fumbled my way through my head-to-toe assessment, saying the same things that my classmates said as they went along. I just wanted the day to end. The longer it went on, the further behind I became.

When I walked into my apartment, I was greeted by my sheltie, Corky. She was always happy to see me, and I know she needed some of my time too. I started a routine that would continue for the rest of the course: I’d come home, feed Corky, throw the ball in the yard for her to catch for thirty minutes, go over the material until I thoroughly understood it, then bed. For the entire first week, bedtime didn’t occur until well after 3:00 a.m. There were more than a few nights of falling asleep on the living room floor with Corky. I found it best to spread out all the materials on the floor and study there since I didn’t have another surface that could hold all my notes and the additional reference books I bought. I looked up the things in my notes that I didn’t understand. That was to say, I looked up everything in my notes, initially—distal, proximal, medial, lateral, superior, inferior. They made no sense to me. I knew that all this was basic knowledge to everyone else in my class. They used each flawlessly. In the meantime, I was saying superior when I meant proximal and distal when I meant inferior. There was something positive that I noticed early on in my study sessions: I was too damned afraid of failing that I had no time to feel nauseated. After two weeks though, I still had not been taught how to take a blood pressure. I knew I had to confess to someone and get myself trained.

By the third week, things were coming more easily to me. I began speaking this new medical language so well that I sometimes surprised myself. Though my coffee maker was still my new best friend, I no longer stayed awake until the early morning, trying to keep up. The new information was building off the old information. I had done myself a huge favor by studying the fundamentals so thoroughly in the beginning. Then the victims at school were beginning to present with actual problems too. Now when I’d announce to a preceptor that I was looking for equal rise and fall of a chest, I’d get an answer that suggested flailed chest, which presented with paroxysmal chest movement upon respiration. A flailed chest or flailed segment is basically a section of ribs that are floating in place and move in the opposite direction of the rest of the chest. I was led to believe that I would see this often in the field. We also started practicing extracting victims of a car accident using our lead instructor’s old Chevy