Monday, October 15, 2012

EMS: Those pesky little details...

I love crime dramas, mysteries, thrillers, and psychological suspense.  It's my thing.  I like crime shows and novels, and have a passion for writing in this genre... I just am fascinated by it all.

When I decided that I wanted to be a writer, the advice given to me was "go live a lot, so you have something to write about".  That made enough sense to me.  I felt like I wasn't qualified to write what I wanted... like I would make a fool of myself if I tried to write an entire book as green as I was at writing, hell, at life itself!

I thought that some knowledge would just come with age, but if I wanted to get to the heart of the human experience (where I believe most good fiction focuses), I needed to put myself in a position to live there.  Immerse myself in it. 

In public service, Police, Fire, and EMS workers routinely encounter people on what is often the worst moments of their lives.  We see their births, their pain, and sometimes their final moments in this world. 

There is a toll that this takes on even the hardest of the hard.  Emotions are bottled, and humor deflects reality.  For some the outlet is working in the garage, or helping a neighbor with siding.  For others it is watching  a sad show or movie that gives you an excuse to cry without being questioned about why.

Not everyday is a life changing event, however, and (though I do not, by any means, want to downplay the emotional toll that this job comes with) some of the most challenging and frustrating and COMMON struggles faced by these individuals often get overlooked in fiction.

The devil is in the details, my friends.  So I made a little list... sort of a writer's guide to emergency response situations.   (I also would like to point out, that no two cities/counties are the same... there will always be slight differences from one jurisdiction/coverage area to another. Heck, sometimes partners don't even do things the same... but that's another post altogether.)

The quick and dirty on 911:

  • Split level houses are EMS hell.  You would not believe the sheer number of people who put bed-ridden grandma in an upstairs back bedroom.  Really.

  • Just because you can walk to the stretcher, doesn't mean you should.  If a patient weighs over 300lbs, and the stretcher weighs 100lbs... and the EMT weighs 150lbs... well... they don't lift themselves.  In these cases, the best thing to do is a side to side transfer.  Pull the patient over from their bed to the stretcher using the fitted sheet underneath.  You will not have to lower the stretcher nearly as far, or lift it as far.  If the patient is upstairs in bed... you're gonna need back up.  Call dispatch and ask for 'lift assist'. 

  • Even in some hospitals and or doctors offices, most elevators were not made with stretchers in mind.  No joke.  EMS personnel often has to struggle with 'breaking down' the cot and juggling monitors, oxygen cylinders, and other medical gear, just to fit in an elevator to get to a patient- and if they need a back board, this is not an option. *grrr*  In hospitals, crews often have to hike across the building to get to 'special equiptment' elevators. (for this, there are not words.)

  • Sometimes there is no street sign, no numerics on the mail box, or on really bad days, that road just isn't on the map.  GPS is not accurate enough for 911's, and in most places not allowed.

  • I don't care how many times you've seen it on ER... Asystole (flatline) is not a shockable cardiac rhythm.  Asystole = Dead.

  • The stereotypes on TV about Firefighters/EMT/Paramedics are tired and untrue.  They portray the women in only one light, and the men are all sluts... sure there are some, but they are just like everyone else- individuals.  Not all gambling addict, alcoholics with commitment issues.  Not self destructive due to major life traumas... just... no.  For the most part, they are pranksters with a jovial (if not crude) sense of humor.  They are just normal people.

  •  Dead bodies do not look easily identifiable in most cases.  (unless in is very recent) Of all the shows out there, Bones is the most accurate.  In a matter of days, people 'melt' into carpet... just be careful kneeling next to the victim... I've done that... dude. :(  Water makes it worse.  I won't go into much detail here, just email me if you have questions.  Just know, its messy.  The smell singes your nose hairs and stays with you for hours.  PD/Sheriffs Dept, take care of evidence while EMS stand by, Coroner does his/her thing, then once Coroner is finished, they all help load victim, together as a team, blocking the inevitable hoards of onlookers from view. 

  • Inmates in prison (at least in my state) do not wear orange scrubs and canvas shoes until they leave the prison grounds.  They wear bland tan, or navy, or gray until the squad is called and they need transported to a hospital or are doing trustee work off prison property. Then they are "dressed out" in neon orange with bold black lettering.   Even if the patient is hemorraging, you must wait at the 'sally-port' for the guards the vest, lock&load, and the 'chase vehicle' (a prison vehicle with armed guard) to be ready to follow the ambulance to the ER. Armed to the teeth.

  • Cars do not yield most of the time.  While they are supposed to pull to the right,  some pull to the left, and more often than not, they just slam on their brakes and stay in the middle.  People who are jamming on their radios usually don't even hear us and then nearly wreck when they happen to see the lights in their rear view.

  • When you have a code (cardiac arrest) you need a jump kit (an 80lb bag containing airway kit, trauma kit, portable suction, the medic kit (IV supplies, etc.), cardiac monitor/defibrillator, Oxygen cylinder, back board and straps (solid surface for CPR), the stretcher... dude, it gets heavy.  Try huffing it back to the squad  from gen pop in the middle of a prison hall while bagging and doing chest compressions whilst carrying 160lbs of gear, as inmates call out various critics of your derriere.

  • There is a lot of paper work... for everything.  A morning truck check out, a morning drug check out, run reports in triplicate for every run (aka: trip, or call), a run report and refusal form for every trip in which the patient declined/didn't need to go to ER... just.... everything, incident reports for unusual occurrences/events.

So, this is a list of just some of the everyday crap...  details that could add a little spice to a situation in your fiction... I hope someone finds this useful!  

Happy writing!  To those of you participating in NaNoWriMo with me this year, GOOD LUCK!!!

P.S.  you know that episode of Law & Order: SVU were Stabler's pregnant wife was in a MVA, and Benson was the only one who could fit in the crumpled car so the Firefighter/medic walked her through how to start and IV... THAT WOULD NEVER HAPPEN.  Thus, the importance of research... I lost a lot of respect for the writers of L&A that day.  It would have taken them ten minutes to call and ask someone how to write that accurately.

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