Paramedic: On the Front Lines of Medicine - Softcover

Peter Canning is a full-time paramedic in Hartford, Connecticut. In addition to his government jobs, he has worked as a cabdriver, cook, meatpacker, telephone solicitor, book reviewer, and laborer. A graduate of the Iowa Writers Workshop, Canning is currently at work on a novel about EMS.

The City
 
I head south on Interstate 91 (I-91) on this January morning. It is a drive I have made many times over the years, first as a child coming to the city from the suburbs to visit my father at his office in Constitution Plaza. He’d take me shopping at G. Fox, Korvette’s, and Herb’s Sports Shop, and then to dinner at Honess’s, where we would eat bluefish and steamed clams, or to Valle’s for steaks. Later I drove to work myself, parking on the capitol grounds and entering that grand building on the hill with the gold dome where I worked for the governor. From the distance, above the countryside, Hartford’s skyline rises as impressive as the Land of Oz or the metropolis protected by Superman. I used to think of the city as a symbol of all that was good with America—progress, jobs. Yet I knew for all the light, there were also shadows. In 1968 when I was ten, the north end of the city was racked with riots in the wake of the assassination of Martin Luther King, Jr. One morning our biweekly cleaning woman who came from Hartford got out of her car, drunk and shouting that she wouldn’t get on her knees “to clean no floors for no white woman.” One year a coworker of my father’s had a bullet pierce a window of his station wagon on his commute to work, forcing my father and others to start using an alternate route. In later years working for Senator, then Governor Weicker, I accompanied him into the city’s poorer areas and saw the poverty through the windshield of our escorted car. And I researched and wrote the speeches, the ones that cited the fact that Hartford, despite being the capital of one of the wealthiest states in the union, was one of the country’s ten poorest cities, that its infant mortality rate rivaled that of third-world nations, that its schools were segregated and failed miserably to provide their students with equal educational opportunity.
 
In recent years, in Shakespeare’s words, “sorrows” have come to Hartford, not as “single spies, but in battalions.” The city’s manufacturing base, which fueled its growth for nearly a century, is gone. The insurance companies and financial institutions that are at the city’s heart have undergone mergers, major downsizing, and layoffs. Long-standing stores and restaurants, like some of the ones my father took me to, have closed their doors forever. As the city’s tax base has eroded, the number of those needing assistance has risen dramatically. Crime, poverty, unemployment, homelessness, AIDS, and other diseases are at epidemic levels. Today Hartford’s population—its lowest since World War I—is predominantly black and Hispanic. The blacks live largely in the north end along North Main Street and Albany Avenue in crumbling private homes and apartment buildings and in notorious public housing projects like Bellevue Square and Stowe Village, centers of a thriving illegal drug trade. The south end, which still houses old Italian families, is increasingly Hispanic. And while there are still mansions in the west end, most of the city’s well-to-do residents have fled over the years to the affluent suburbs like West Hartford, Newington, and Simsbury, the town I grew up in. While Hartford was once a bastion of Protestant Yankees, today only 5 percent of its schoolchildren are Caucasian.
 
Interstate 91 intersects with I-84 on the raised highway east of the city. I follow I-84 west, going through a short aboveground tunnel with its “Welcome to Hartford” message embedded in concrete. The road twists, turns, and rises above the streets. Below are empty factories with broken windows and deserted parking lots with grass sprouting through the cracks in the asphalt. I take the Flatbush Avenue exit and then turn on Newfield just before the railroad tracks. On the left is the Charter Oak public housing project, a collection of small two-story units with rusted bars on the outside windows, a scene of gang warfare, drug trafficking, and several of the city’s record fifty-eight homicides in 1994. As in other areas of the city, here a car can be forgiven for not stopping at a red light.
 
I turn onto New Britain Avenue, passing check-cashing stores, garages, gas stations, doughnut shops. A few blocks away, just across the city line into West Hartford, are the offices and cavernous garage of the Professional Group, the home of Professional, L&M, Maple Hill, and Trinity ambulances. At this hour, young EMTs and paramedics go about checking their ambulances. They stock them with spare oxygen tanks, bandages, IV solutions, and long backboards. Others undo their bullet-proof vests and punch out after a long night of battling disease and violence on the city’s streets.
 
I wish it were not my first morning. I wish that I had been working here for years, and that on walking into the garage and into the supervisor’s office, people will hail me by name and think, “It’s Peter Canning. He is a grizzled veteran, a great, proven paramedic. I would trust him with my life.” Few of them know me. I am a rookie with much to prove.
 
Checklist
 
The fundamental idea behind EMS is to commence medical treatment for injured and sick patients as early as possible—to bring the hospital to the patient at the same time the patient is being brought to the hospital. In the old days, the person who responded with the ambulance put the patient in back, got in front, and drove like hell to the hospital. (He often was the same person who drove the hearse the next day.) Today there are two main levels of prehospital care: basic and paramedic. The paramedic, the most highly trained, provides advanced life support—complex assessment and treatment including invasive procedures and the administration of drugs under the direction of an emergency medical physician both through standing orders and direct communication. The worst insult that can be hurled at an EMT or paramedic is to call him an ambulance driver. They are medical professionals, subject to continual education, testing, and medical oversight.
 
Meg Domina will be my partner on Wednesdays. A nice freckled twenty-five-year-old paramedic, she has been working in the city for five years. With Meg I will function as a basic-level partner to her paramedic, though I will be able to use my paramedic skills if needed. On Thursdays and Fridays, Tom Harper will be my partner and preceptor. After thirty paramedic calls Tom will either recommend me for medical control to work as a paramedic with a basic partner or say I don’t make the grade, in which case I will be able to work only as a basic EMT. I do have a little bit of an inside advantage. When I volunteered as a paramedic in Bloomfield I worked with Michelle Gordon, who precepted Meg years ago, and had worked with Tom in the city back when he was just a basic EMT assigned to the city. I go out with her now, so she has put in a good word for me with them. While I do not like using a crutch such as this, I will take every advantage I can get. I am rusty, haven’t worked for the company before, and have a lot to learn from how to work the radios to how to be a good paramedic.
 
Meg gives me a warm good morning, then tells me to check out the rig, while she gets us radios. The ambulance is a van type, smaller than the large box ambulances favored by most volunteer corps, who carry crews of up to four people. The van ambulance is built for twenty-four-hour, seven-day-a-week abuse. In the back there is room for a stretcher tight against one wall, and a bench seat against the other with about a foot of room in between. At the head of the stretcher is another seat where a rider can sit, facing the patient’s head. It is the preferred seat to manage a patient’s breathing. Under the bench seat are two longboards for spinal immobilization, a metal scoop stretcher that comes apart in the middle and is used to fit under somebody who needs to be lifted up but doesn’t need spinal immobilization, a traction splint for isolated femur fractures, a Kendrick Extrication Device (KED) to help stabilize the spine of someone trapped in a car, a urinal, and a bedpan. By the back door on the stretcher side is the collapsible stair chair for carrying patients down from the second, third, and hopefully not much above the fourth floor, and a wooden short board. The cabinets on the stretcher wall are filled with linen, cervical collars, IV supplies, trauma dressings, bandages, oxygen masks, and cannulas (a plastic tube with two prongs that fit under the patient’s nose to give them a richer oxygen to breathe than what exists in room air). At the head is the oxygen outlet and in-house suction unit. By the side door is a rack that holds the cardiac monitor, the pediatric box, and three spare portable oxygen cylinders. The portable suction is on the inside of the door. It is used to clear mucus, blood, or vomit from a patient’s mouth and throat. The cabinet between the back and the driver’s compartment holds the military antishock trouser (MAST) pants, a spare advanced life support (ALS) supply box, and run forms, on which we document our treatment of each patient. The main gear we take into the house in addition to the monitor includes the blue in-house bag, the airway kit, and the biotech.
 
The in-house bag has a portable oxygen cylinder, airway supplies, blood pressure (BP) cuff, obstetrics (OB) kit, burn sheets, trauma dressings, ammonia inhalants, and spare run forms. The airway kit holds the laryngoscope, and the various sized and shaped metal blades that attach to the handle. The blades have tiny lightbulbs on the end that illuminate the patient’s throat as you search for the vocal cords through which you will pass a clear plastic endotracheal tube that again comes in various sizes—from a tube for the tiniest baby to the Andre-the-Giant-sized ten tube. The biotech is a hard black suitcase that holds the emergency drugs and IV supplies, except for morphine and Valium, which are kept above the monitor shelf in a lockbox. The heart monitor displays the patient’s electrocardiogram (EKG) on a small two-inch screen when attached to the patient through three wire leads—the white lead on the upper right chest, the black lead on the upper left, and the red on the lower left side. “White is right, smoke over fire,” I say to myself to keep the order straight. The monitor also has detachable paddles, which when applied to the patient’s chest and activated can deliver an electric shock of up to 360 joules (Js) to a patient’s fibrillating heart in hopes of stopping it cold, so it can hopefully restart by itself with its normal rhythm. The newer models have hands-off pads that can be applied to the chest, one on the right sternum, the other on the left apex, so the shock can be delivered without having to be in such close contact with the person.