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Patient Care



     EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we to publish your dilemma, we'll pay you $50. E-mail ideas to

     The lady seated on the bench in front of you looks about as whipped as anybody you've ever seen. She says she's 32, but she looks old enough to be your mom. It's four in the afternoon. There's a chill in the air, and the sky above you is like a featureless layer of old lead. It's surely toxic, too, for this woman. Her many layers of clothing are worn, stained and full of holes, and they punctuate her state of suffering with that air of unwashed feet, stale perspiration, old cigarette smoke, dried urine and dead skin you find so often in people who live on the street.

     For a moment you note the sameness in the color of the clouds above you, the urban neighborhood around you, and generally, the person in front of you. It's the hue of despair, and it transcends your medicine.

     You've been called because somebody told somebody that Marilyn, here, was having trouble breathing. You certainly see no such physical signs. But she confirms it for you (ever so vaguely), and, as inevitably as the coming storm, she wants to go to the hospital. In minutes, you're on the radio shopping for an ED bed. You find one halfway across town, and soon enough, you're on your way.

     Q. There's no way this lady was ever having any trouble breathing; she just wants to get out of the weather. But our protocols say that if somebody wants to go to the hospital, we have to take them. Our system doesn't have a lot of resources. Isn't there some way we can stop wasting them like this?

     A. I hear you, but are you so sure of her intent after such a brief encounter? The problems of people like Marilyn are so much bigger than we are, and our part of their solution is so small. Why not just transport them? Besides, maybe this is not such a waste. Today's poor have been overlooked for years, and in many towns they simply have nowhere to turn but to EMS. Make no mistake, exposure to a snowstorm without the possibility of shelter is as deadly an emergency as any you can experience. It'll only take a few minutes to get Marilyn somewhere safe.

     Q. It's hard to argue with any of this, but we're here to address people's medical emergencies, and we can't do that when we're tied up on non-medical calls. That "M" in EMS stands for "Medical." Admit it, this isn't a medical call.

     A. You're probably right about the "M", especially if you ignore the "E" and the "S." (You're smarter than that!) There was a saying in the 1970s that if you aren't part of the solution, you're part of the problem. Personally, I think there's another whole dimension to our roles, and those of us who engage it find our work so much more fulfilling. It's human kindness, and it lets you reach out and touch the spirits of people like Marilyn, healing what no mere technician can ever touch.

     Q. What does that mean, exactly? It sounds like a lot of Kumbaya to me.

     A. I have seen the lowliest, poorest-paid EMTs quietly slip money into the pockets of people like Marilyn while they thought nobody was watching. I have known others who returned to the homes of the elderly on their own time to make sure they got to their doctors' offices or to a grocery store.

     Q. No matter how generous you are, how much good can you do with a few bucks now and then? It'll be spent and forgotten in no time at all. Not only that, but so many people do those kinds of things just to be recognized by others. Nobody respects them.

     A. True. There are no perfect people, only perfect intentions. But for every few phonies, there's at least one who's the real deal. Sometimes their secrecy is preserved and we never learn about them. But when it isn't, their actions can inspire those around them. We all have our ups and downs in this business, and we all get tired sometimes. But I don't think we ever have to hate our jobs. We may never be wealthy, but we do get to return to lives that are so much more blessed than the lives of people we see every day.

     You can't help everybody with money, especially on an EMT's wages. But often, you can help somebody. What if everybody did?

     Thom Dick has been involved in EMS for 38 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at

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