EMS Revisited: Paradise City EMS--Looking for Life Among the Ruins

In the September 1989 issue of EMS Magazine, Carl J. Post, editorial advisory board member and associate director of the graduate EMS program at New York Medical College in Valhalla, NY, wrote an essay about EMS life in New York.

A few miles north of Kennedy Airport, New York--the shift is about to change. Outgoing crews chide their fresher replacements about what to expect out there. Incoming medics carefully check out each rig. Someone's been stiffed! The 4x4s are short. The D5Ws weren't replaced. A KED was never returned from the public hospital two nights before. A missing long board is out on a call.

A female cop drives by and eyes the butts of the medic crews. Some of the medics posture in the direction of ED nurses who are scurrying to or from their shifts. Fourteen-year-old kids are being stabbed a block away. Hypes are blowing each other away a half block the other way.

The ED is full of patients lying on stretchers, awaiting beds. M or G cylinders are positioned by them to maintain O2. On the ramp, adrenaline highs are developing. Rock-and-roll time is about to start! Green-clad medics are set to charge forth and rove, looking for God only knows what. But, green is good; it's better to look like a garbage man than a cop. People don't usually shoot the sanitation workers; they don't usually off the medics. Some wear Teflon body armor, but the bosses aren't into it. The older folks figure that wearing protection leads to the need to have it.

It's show time! The moving vehicle makes the high all the greater! It rolls by crack deals and passes hookers in front of the welfare hotels. Dispatch heats up. Pedestrians get struck. School's out, and knifings over soured crack deals occur. The sun shines, and leaves glisten in the warm breeze.

Medics trade war stories. They chill out and boost each other up in the process. Two KEDs, two long boards and a few bags of Ringer's are gone after an hour. The radios blare. Number and letter codes blend with golden oldies from the '70s. EMS is out on the street--just cruisin'. Medics are looking for work--and it isn't hard to find.

There are few rules in the world that surrounds them. They blaze through that world. The rig is locked on scene. Drugs and alcohol are all over the place. Gunshots and stabbings prove it. Hookers sport tattoos that would do a sailor proud.

The music blares on. The calls blend to make a twilight symphony of discord, agony and green-clad EMS people rockin' and rollin' to the scene. Homeless folks, with an aroma all their own, stumble, get hit or stroke out. EMS digs through creepy crawlers to expose deformities and the rare open wound. Young girls split tibias by leaping out second-story windows to avoid abuse, rape or both.

The uninsured go to the public hospital so they'll get meds without a 16-hour wait. Narcan, Ringer's D50, thiamine and O2 fly in the face of torments real and imagined. Medics help out with minor trauma in the ED, as nurses help surgeons remove bullet fragments from the shoulder of an 11-month-old baby. Tears, groans, fear and profanity fill the air. Paramedic students start lines. MVA patients wave at me and smile; their collars are gone, and our extrication has left them pink, instead of bluish-white.

We grab deli food on the run, augmented by Gaviscon or Maalox. Knife-and-gun-club members are everywhere.

The domestic interactions continue to elicit calls for the green-clad angels of mercy. Grandma has an arterial bleed from a laceration. A 4-year-old has Grandma's blood on bright-yellow pajamas. Nintendo lies on the floor. The Cosby Show quietly screams out a much different "reality" from the television screen. Folks beg the undercover cops not to arrest the "perp." The crew cheers Grandma as they take her on an all-too-familiar trek to the ED.

Green-clad EMS folks dress, bandage, console and care. Green-clad EMS folks collar, board, provide traction and perform blood work on people. Green-clad EMS folks lovingly minister to lost souls--but they don't even stop to notice. Hey, there isn't time! Assess, package, comfort--rock and roll!

Sure, you wear gloves. Sure, you're knee-deep in patients. But they're people. It's life against death, just like in the suburbs, and the medics in green are playin' for life. The job's well done. The job's done right. The paperwork is thorough. Nobody's ashamed of what he's doing.

The medics are on constant roll; they're on fire. They can't get enough of it (or so they'll say). And, it's a good thing too, because a "kinder and gentler" America offers more than enough to satisfy the green-clad feeding frenzy of eight to 13 calls per shift. (About two-thirds of them are worthy of situation-review scenarios.)

The roving rig moves on into the night. The radios punctuate the darkness. The music continues. Assessing, packaging, tubing, drawing blood, starting lines. Talking some. Treating people like people. Cutting into the fear of the young and old. Reaching out for a world that used to be--or never was--for some patients. Transfusing hope and mercy into a void of unspeakable emptiness.

"Who stocked the bag?"

"Where's the Ringer's supposed to be?"

"Wish we had a 12-lead!"

"Did you hear about the kid with 25 stab wounds? He was stable and they lost him on the table in OR."

"Are you all set?"

"Let's rock and roll!"

"89 Ginny, we're 28."

James Brown's "Living in America" plays softly.

"89 Ginny, unconscious at Maritime High School."

Sirens, lights. Sterile gloves being downed.

"S.O.P. for S.O.B., GSW and errant P waves."

"Get me some D50!"

"What's your name?"

"Blood sugar's 220; BP is getting better."

"Did you have anything to drink?"

"What happened to your leg?"

"You want to go to County General?"

Carl J. Post, PhD, is currently an EMS consultant in Lawrenceville, NJ.