Closest Most Appropriate 1/7
Close
Pronunciation: klos
Function: adjective
Inflected Form(s): clos·er; clos·est
1 : being near in time, space, effect, or degree
2 : having a strong liking each one for the other <a close friend>
3 : very precise and attentive to details <a close observer>
4 : decided by a narrow margin <a close race>
Appropriate
adj. əˈproʊpriaɪt; v. əˈproʊpriˌeɪt/ Pronunciation: uh-proh-pree-it
Function: adjective
Etymology: Middle English, from Late Latin appropriatus
1 : the determination that the service provided is suited for the condition
2 : being suitable for a particular person, group, community, condition, occasion, and/or place
3 : proper
Walking up the stairs to the front door I take in the neighborhood. Children playing next door stop to stare at the fire engine – all the lights flashing – parked just in front of our ambulance, which smells of abused brake pads. It’s a nice neighborhood, not one I’m called to very often, in a quiet suburb of the county with expensive cars parked in front of well manicured lawns. I’m heading towards the door that has been left open for us and check my pager to make sure the numerics match. It’s an acquired habit from working in the hood where walking into the wrong house wearing a uniform can be a fatal mistake.
Taking the stairs one by one I’m thinking of the patient I’ll be responsible for in a few minutes and quickly brainstorming the possible treatments as compared with the equipment I have on hand. I’m a little tired and frustrated from the delayed response time and the distance my partner and I had to cover to get to this house. Nearly 16 minutes is longer than anyone should have to wait for an ambulance and 18 miles is longer than a crew should have to drive code-3 (lights and siren) to reach a call – at least in this county. But on this day I’m in a back-roads wealthy suburb of a county that is three-quarters urban sprawl. Not surprisingly, this area of golf courses and farmland doesn’t have as much freeway access as the more populous areas.
I recall during the drive that the dispatcher said something about this area being “Level Zero” – meaning no available ambulances in this part of the county – and that we were the closest unit. I’ll take her word for it as all of the ambulances in the county are tracked by GPS and calls are automatically routed to the closest crew. While driving to the call I listened to the radio traffic talking about a collision on the freeway ten miles further away with multiple patients, one trauma activation, and another crew taking a motorcyclist to a landing zone to be air lifted to the closest trauma center.
The dispatcher was so busy with the high call volume that she didn’t send the call information to the Mobile Data Terminal which sits on the console of our unit. Usually I can get some specifics about the patient I’m responding to from there, but not on this call. So I’m going off the pager that only tells me where to go and gives a generic chief complaint of the caller. In this case it’s “Chest Pain / Shortness of Breath.” It’s a call I’ve run hundreds of times and it can manifest in any number of causes and levels of acuity. From the frequent flyer in the hood who just needs a sandwich and a place to take a nap to the identifiable coronary artery occlusion that requires a cath lab and a code-3 trip to the nearest Cardiac Receiving Center.
Walking through the doorway to the house I see a few children and family members taking quick awkward steps to get out of my way, the way people often do when they suddenly find themselves unusually “in the way” inside their own house. I’m heading towards the kitchen/great room where I hear the squawk of the fire fighters’ radios. Walking in I see the fire captain talking to a woman in her 30s while he examines prescription bottles and writes down details. His mannerisms are business-like in the way we all turn on the A game when it’s a real call. I’m starting to think this woman’s husband may have had a heart attack when I turn to see the small boy sitting on the sofa with a non-rebreather oxygen mask on and a fire medic kneeling at his side staring at a monitor. Another fire fighter is standing next to him holding an IV bag – the small boy already has an IV going.
Okay, now they have my attention. Sure it was a long response time but fire medics don’t usually start IVs before I get there unless it’s serious. And children don’t have chest pain! As I walk up the fire medic stands up with a relieved look in his face. Crap, this is a very real call!
Paramedic Pulp Fiction 