It must be easy sitting in an office somewhere, reading a run report for a repeat 9-1-1 caller, with another report stapled to it making the case against sending ALS units to care for intoxicated people. Simply rubber-stamping the same old “change of mental status requires transport to an emergency facility” response on the paperwork that some disgruntled EMS worker submitted after another shift full of the same faces with the same demands is better than depositing it into the circular file, I suppose. Day after day, week after week and year after year, we respond to the same pay phones and street corners for the same intoxicated people. One dies, another joins the party. It’s the circle of life on the streets of Providence.
I’m hoping tomorrow’s report will stand out. It’s about how a guy was struck by an auto in front of the fire station where, 12 minutes prior, the rescue was sent to a pay phone a mile away for a regular who claimed he was intoxicated and wanted detox. It was his third such call in the last 24 hours, his 40th this month and well over his 100th this year. That report might get some attention. Somebody might actually read it and feel the desperation and frustration in the words, the anger barely disguised by formality, and sense the growing disintegration of morale among the people providing emergency medical services at the street level.
But probably not.
It’s a little different sitting in a quiet, safe, warm office, reading about delayed responses and traumatic head injuries and trauma codes, than it is to leave an intoxicated patient at the ER, paperwork half done, and fly toward the radio report of a guy your age fighting for his life while the nearest ALS unit is tied up, and that ALS unit is you, then arriving on scene, 100 yards from the door you left 20 minutes ago to get the same old intoxicated male, and seeing a 20-foot blood trail, and at the end a crowd of horrified people standing safely away from a crumpled form with his head smashed in, his larynx crushed, his teeth lodged down his throat, his eyeballs popped from their sockets, his respirations at 6, his BP crashing and a desperate need to be in the operating room 10 minutes ago. But 10 minutes ago you had “Michael” in the back of the truck—“Michael,” who is pleasant enough and simply doing what we allow him to do. He uses the system to his benefit, as any self-respecting homeless man with nothing else to do would do. The choice of a cold night in the bushes or a warm bed in the ER is an easy one, and salvation a simple phone call away.
It’s not easy to wheel the guy who was struck by an auto at 40 mph and is now a trauma code past the homeless guy who uses the system as a means of survival, even though his survival system has in all likelihood cost a different man his life. It’s not easy to watch him sit comfortably on a stretcher in his nice, warm bed for the night and know he doesn’t give a shit because he tells you so every night, and know the report you plan on typing up and sending to headquarters will look nice and pretty, and end up in the pile with all the others trying to make sense of all this.
Perhaps I should send the report I had started in the rescue, the one covered in the victim’s blood and brain matter, and send that one upstairs. Maybe a little reality would sink in. But by then the blood will have dried, the brain matter will mean nothing when the person it once belonged to is far away, and these thoughts will never enter the mind of the person who eventually looks at the report and barely skims it and puts it on the pile with all the rest. Like I said, it’s a little different upstairs.
I tear up the bloody report and start a new one. It looks nice and clean when I’m through, but it says all the same things, and the urgency is gone from my words, the rage that fueled the original tamped down to a mere flicker of what it should be.
Before I put it in the outbox, the tones go off, and I respond to a pay phone for an intoxicated male seeking detox.
Michael Morse, EMT-C, is captain of Rescue 5 in Providence, RI, and has served on the city’s busiest engine, ladder and rescue squads as a firefighter, rescue technician and lieutenant during his 21-year career. He is the author of the books Rescuing Providence and Responding.