Memo to the poly-substance overdose patient:

No matter how cute you think you are, calling the female charge nurse “Sir” will not improve the quality or length of your hospital stay.

It’s also my cue to leave. Have a nice day, sir.

It’s easy in our business to see only the trees and miss the bigger forest. We see diabetics who can’t/won’t take care of themselves, alcoholics, unrepentant drunks, welfare abusers, common colds, nervous parents, and malingerers of all stripes. We even have one man who routinely calls because he gets lonely.

We see nursing homes that neglect patients, doctors who leave patients with evolving MIs in the hallway for us, and visiting nurses who think 150/96 is a hypertensive emergency. It’s easy to feel that everyone is wasting our time.

I’m here to tell you to take a step back. Our cities are full of decent, hard working people striving to make ends meet. The vast majority of them will never call 911, and thus we don’t get to meet them.

Let’s look at a bit of the math. I work 48 hours a week spread across two small cities. If I project a call every hour (which we don’t do) that’s 2496 calls per year without including vacations and overtime. Wikipedia shows a total population for my two cities of 133,664. If each of my calls was for a unique patient (which they aren’t) I would see slightly less than 1.9% of the population in a given year. Many of the patients I do see actually need an ambulance, too.

Less than 2% as a worst case scenario.

When you start to feel that the whole world is full of people who don’t really need an ambulance, you are right. They are the 98%.

Jefferson lies curled on the cold concrete. He looks more comfortable there than I do in my bunk. A semi-circle of firefighters, cops, and medics stand over him.

“Jefferson, how much have you had to drink today?”

Mumble-mumble-mumble.

“Come on, Jeff, let’s get up on the stretcher.” We assist him up and into the ambulance.

“Jeff, how much have you had to drink today?”

Mumble-mumble!

“Ok Jefferson, how old are you?”

Ain’t talking to you. I drink the fifth.

“Uh, what?”

Nuthin’ to say. I. drink. the. fifth. Mumble-mumble-mumble.

Nothing profound today. I just want to send a shout out to my BLS backup.

I know there are plenty of places in this country where they send just two EMTs to every call. In most cases it works out OK, but sometimes you just need that extra set of skilled hands. I’m fortunate to work in a well staffed, tiered response system. We send BLS to the BLS calls, ALS to the ALS calls, and both to the really serious stuff.

Guys, you know who you are, and I thank you all for watching our collective backs.

“Medic 9 is clear and in quarters.”

It’s the first cold night of the year, so I’m dressed for winter. In a few weeks I will adjust and be working in shirtsleeves again, but right now I’m layered and freezing. Long-sleeved Under Armour mock turtleneck, uniform shirt, Blauer EMS parka with removable fleece liner, and a black lined watch cap defend against the chill night air. And wool socks. If you’ve never discovered Smart Wool socks, you need to check them out. Warm in winter, cool in summer, non-itchy and moisture wicking; they are a wardrobe requirement inside my boots year round.

But I digress.

We keep the back of the rig warm. Trauma patients and little old ladies alike are in danger of hypothermia otherwise. We go from freezing to sweating and back again all night. The intense activity that goes with a critical patient just makes it worse for us.

This particular critical patient is bleeding all over the place. It doesn’t take long to contaminate the sleeves of my parka, so it comes off and lands in the footwell for future cleaning. I was sweating anyway by now.

We call ahead to Big City Trauma Center. I know my patch will be broadcast over the loudspeakers in the trauma bays for all to hear, so I try my best to sound like a veteran airline pilot. “Ladies and gentlemen, if you look to your right you can see the southern tip of Lake Michigan visible in the distance.”

I fear I sound more like a frightened child. “Daddy, make it better! Please?”

I know the reality is somewhere in between, and I hope it’s closer to the former than the latter.

We arrive at BCTC in good order. Our patient has strong vital signs and is still talking to us. He has a chance. It’s a scene normally only seen in movies; we roll authoritatively into the trauma bays to find a full team of doctors, nurses, and technicians waiting. All eyes are on us, and it’s time for the Captain Cool voice again. We tell our story and step back so the team can work.

Then I realize it. Here I stand at midnight in a major urban Level 1 trauma center. I’ve just brought in a critical patient who has the attention of some serious trauma experts. I’m wearing a long sleeved t-shirt which sticks out below my short uniform sleeves. My ‘scope is around my neck, my boots have come untied, and I’m still wearing my black knit hat.

I look like a Badass Urban Paramedic.

It’s good for a smile now and a chuckle with my partner later. The effect won’t last, though. We have a truck to decontaminate and paperwork to write. Then it’s back to being shiny suburban medics again.

In my shirtsleeves of course.