Danger Unseen, Just Another Call?
By Nate Preissinger
I work in EMS. More than that I work for an agency that covers 400 square miles encompassing 14 cities, one of which is the seventeenth largest city in the United States. Needless to say we respond to a lot of calls. I believe the number is somewhere around 135,000 calls a year. What that means for me is 6-10 calls a day or around 1800 patient contacts a year. We get a lot of calls, and they run the gambit of medical complaints. Everything from, literally, a stubbed toe to cardiac arrest. We run medical calls, trauma calls, and medical transports that require an ambulance. On any given day you don't really know what it is you'll see. You're dealing with human beings and every call, similar complaint or not, is unique. You just really never know what you'll run into. You try and prepare yourself for what you're responding to, think about what you'll need to do, things you'll need to say, and things of that nature. Every call has the potential to change on you often in ways you'd never suspect no matter how much you think through the situation.
It was a Friday night about 4 hours into our shift. We'd just finished a call. Meaning we'd responded, picked up a patient, taken them to the hospital, then cleared available, and were now headed to a post. The radio crackles to life “Medstar 55 incoming 88 Romeo”. And so it begins a new call, no sitting at post for a bit now. Shortly afterword we begin to get call information.
We will be responding to a psychiatric/suicide. We get a lot of those, it's a common call no matter where you work in EMS. Often it's people with chronic psychiatric conditions that are just not doing well today, they may be lonely, aggressive, or just out of medication. This one comes out as the exception to normal. The call is a suicide. Through the details on the call notes we know it's a self inflicted gunshot wound and we read there is family on scene. When calls like this come out you always have more than one patient. Obviously our first goal is to attempt to treat the actual patient, to correct or stabilize the condition in which the patient had placed themselves, and get them to the hospital… when we can. Sometimes there is nothing we can do. Either way we are the first ones there to comfort and help the family even in the brief time we are there. When you get dispatched on a call like that you begin to mentally prepare both for possible interventions you we'll have to perform and on the words you we'll use to provide comfort and support for the family. I've had someone describe it to me as “You hope for the best and isolate for the worst".
We are not law enforcement, our job occurs after the scene is “safe" and so we stage on any cash that has potential danger. This means we get closer to the call, within a couple blocks, and wait for, usually, the police to clear the scene and let us know we are good to come on in. In that respect this call was no different. We began our drive toward the area of the call. I looked back from the passenger seat of the ambulance into the back where we had a paramedic student riding with us that night and informed him of what was going on. About that time the computer updated and informed us we were clear in. As we were still driving there was going to be no need to stage and so I informed Tyler who was driving that we we were clear in. Shortly afterwards dispatch cane through the radio and started Officers on scene are requesting we upgrade to priority one.
I've worked with Tyler pretty much since he started at Medstar and I couldn't ask for a better partner. We get along great we understand how each other things and often anticipate each other's thoughts and actions when dealing with critical patients. He is much more experienced than I am having been in EMS much longer. In our eyes the most important thing is our families. Honestly in a lot of ways we're brothers. We know each other's moods, we are there for each other when things are rough. We have each other's backs. I'm there when he needs me and absolutely I know he's there whenever I need him, both on and off the job. He's an awesome friend and as far as I'm concerned he's family.
When we turn into the street the first thing we see is the full moon hanging just above the trees at the end of the street. It's a peaceful and forlorn sight. Tyler comments on how cool it looks. As we pull up to the house, we see the police cars parked in the area and an officer at the front door. Tyler tells our student to help me get our equipment and he starts across the yard toward the door. I walk around the back of the truck to open the doors and pull out the cot our student has loaded with our equipment. The night is still and quiet, the sun had set behind us as we drive toward the call the last rays of light disappearing shortly after we had been cleared in. Because of the trees everything is covered in shadows with the moonlight eerily flickering through the leaves. I place my hand on the door, pull the handle, swing open the door, and then instantly, everything changed.
It's often said that in intense situations time slows down. You go through trains of thought that seem to take minutes, you perform actions that seem to take forever, but when all is said and done second have passed. It's a strange feeling your brain behind working so fast everything else slows down. What seems to take minutes is seconds. Things you have had ingrained into you through experienced and/or training are instantly accessible. These are situations that people train four years to react properly in, and even then you don't really know how you will react until you are knee deep in it. We were about to be trialled by fire. We found ourselves smack dab in the middle of a situation we are trained to avoid, in the middle of a situation no one expected… and we had to react.
The door clanged, the exterior lights bathed the ground behind the ambulance in bright white light… boom, boom, rat-a-tat.. explosions rocked the air. It took what felt like a second but was actually fraction of that to register gunfire. I ducked down as I thought “this light had me lit up like a Christmas tree”, I slashed the door shut the noise of the door closing was faint against the sound of gunshot retort and the sound of bullets ricocheting through the air. As I crouched down I texted for the weapon I didn't have. I remembered seeing Tyler walking across the lawn as I got out of the front of the ambulance… Tyler… where was Tyler… is he ok.. Just as I get ready to run around the truck to check on him I hear a yell “get back in the truck!!!” I feel instant relief it's Tyler he was yelling at the student. In what felt like a single movement I'm back at the front of the truck as I swing open my door the driver's door does the same. Tyler's arm reaches through the cab, grabs the radio and in the same motion he radios dispatch “shots fired, we're retreating" as we both enter the cab and start to drive off. As I look at the computer I see something that is honestly one of the worst things you can see in our field.
Part of our training, in fact a big part of our training, is how to avoid dangerous situations. “Scene safety” is the mantra of EMS, it's drilled into your head from the first day you sit behind that desk in school. Every scenario you run through in your training requires you verbalize the scene is safe. Looking out for danger is the first thing you do as you arrive on scene. Scene safety starts with the ringing of the 911 call. We have protocols and algorithms that start as the call taker gathers information. If the call information matches up to certain algorithms, we stage and wait for the scene to be cleared. If the call taker feels that there is sufficient reason based on what they hear on the phone to warrant caution we stage. Both of which had been in play on this call. As we approach scene, or really at anytime during our call of the need arises we can move away and stage until scene is one again considered safe. As the shots rang out and we clambered back into our ambulance we were on our way to a safer location.
As we drive off, the radio crackles and we hear dispatch acknowledging our traffic. We know they are at least partially aware of the situation and what is going on. At this point things are moving fast, information is flying through radio channels. The police radios are going crazy (we can't hear them but they are). Our dispatch is in contact with police as well. Our computer, updates with topped in information about the call information shared between the police department, the fire department, and us. As it updates the most recent information shows up on the top line. And that's where I see it it updates with words you never want see. “Officer down”
Public service really is a family, mainly consisting of Police and Law Enforcement Departments, Fire departments, and Emergency Medical Services. One of the running jokes in EMS is that we are the red headed stepchild of public service. Meaning an afterthought. Read almost any story about a tragic event and if you see EMS listed at all it's usually one or two sentences about how someone was transported by ambulance to such and such hospital. Most of that has to do with the nature of emergency and the nature of our job. Law enforcement and Fire secure the scene the nature of their jobs means they are usually on scene long after the emergency is over. EMS is different we come in grab the most critical patients, stabilize them and head off to the most appropriate facility for further treatment. EMS is usually long gone before the public at large is even aware anything has happened. Despite that joke, which is honestly more about how we feel about public perception then how we feel about how we are actually perceived by our fellow first responders, we know Law Enforcement and Fire are there for us when needed, and vice versa. Like any family we have our ups and downs and squabbles but when push comes to shove we care about each other and we look out for each other. So emotions run high when you hear any or respond to an injured first responder. And when you are on scene when it happens, when it's a scene that no one should be getting hurt on, when it basically falls in your lap, there really aren't words that can describe the intensity of emotion and adrenaline that comes into play. We had found ourselves smack dab in the middle of such a situation. Family was in trouble and we were the closest help available.
In the instant I read those words aloud, words that as I spoke felt like they were going through a loudspeaker Tyler and I locked eyes and began looking for a place to turn around. It was unspoken communication we knew we needed to be instantly available. We were already in the hot zone and with that message we knew we couldn't go to a proper staging distance. About two houses down from the scene we turned around. About that time two things happened the fire department showed up and as we were informing them that there were shots fired we saw strobing lights coming from one of the officers on scene. Those lights screamed out “we need your help.” “Please come help save our fallen brother". And we took off and went in.
At this point the time that had passed was probably less than 3 or 4 minutes if that. It's probably taken longer to read this far than the actual amount of time that had passed from when we arrived on scene until this point. In a scene like this thinks unfold and evolve faster than you can think. You have to rely on training and instinct and you have to do it in that order or you'll most likely make a mistake. In a hot zone mistakes can be fatal.
As we pulled up Tyler and I were out the door I was halfway around the truck, Tyler was halfway to the fence being escorted by an officer. The best way I can describe it was controlled chaos. I grabbed our red bag, which has most of the supplies we have in the ambulance in it, out of the back of the truck and threw it at our student, looking back I'm surprised I didn't knock him over with it, and yelled “take that to Tyler.” I pulled the cot out in what felt like an excruciatingly long time and followed after. In the twenty feet it took me to get over to the officer I heard two or three shots echo through the night air. In the shadow of muted light from the various flashlights hovering around I could see Tyler and another officer pulling off the injured officer’s vest and duty belt. As I dropped the cot Tyler and the officer moved the injured officer onto the cot and we secured him and we were back at the ambulance in an instant.
“Move", “vitals", “check for injuries" thoughts running through my head. As we get the injured officer's vital signs it's obvious his injuries are more grievous than we can see. It's time to go. “We're ready" Tyler says, without looking up from the IV he's starting. I go to jump out the side and encounter two officers providing the ambulance cover outside the door. The scene lights have just lit them up as the door opens I slam the door shut covering them in darkness again. I'm not going out that way. I crawl around squeezing past Tyler and his intense focus. I'm out the call door and into the driver's seat. I've got nowhere to go the road is completely blocked with other police units arriving on scene. I'm clear behind though so I start to back up. As I do the way in front opens up, through my open window I can hear yells “Move those out of the way" I stop the back door opens, it's Fire, I hear them ask if we're ok and do we need a rider. “No I'm good" I hear Tyler say, and we're off.
I call on the radio that we're transporting to John Peter Smith hospital as I pull out of the neighborhood. “I've got a police escort" I think as I see it form. Cruisers race around me to provide blocking for the upcoming intersections. One officer in front clearing vehicles out off my way. We reach the interstate we have to weave around traffic to get on. I'm able to get to the outside lane. The first onramp we come to cars are flowing into the interstate. I weave around them and that's it every access to the interstate after that is shut down. The radio had gone in front of us. Officers from all over the city have blocked the ramps to let us pass with ease. On the other side off the interstate I see the floodgates open. I see officer's pouring south toward the scene I just left. Officers rushing to assist in a situation where all they know is one of there own is hurt. To me it speaks volumes about the bonds they have with each other. And then we're there I back in you the ambulance bay. We're inside in seconds and he's transferred to hospital staff. As things come to a crashing halt I feel like it's been hours. From the time we got on scene to the time we arrived at hospital was about 15 minutes.
A lot happened afterwards, a lot of talking, we had to clean up the ambulance, we had to go downtown and give statements at the police station. Those things seem to be more of a blur. Throughout the night we got trickles of information. Another officer had been shot as well he had been hit in the vest though and was released from the hospital a few hours later with some cracked ribs. Thank God he had on a vest. Our patient wss in surgery one of the bullets had entered his chest through his arm. Our patient was out of surgery and expected to make a full recovery. Good news. After giving out statements we were informed that our patient had asked if he could see us. We went back to the hospital. Even now I have trouble describing the emotion as I walked in that room. Seeing his family around his bed the looks of concern and relief on their faces. Seeing the officer awake and talking. “Thank you” he said his wife by his side with deep concern and greatness in her eyes. Not many words spoken, but every one had meaning. I could feel eyes welling up, couldn't say much because I wasn't going to cry. But I knew we had brought him from an injury, that had we staged could very well have been lethal, and now I knew he would go home to his family.
