3 Things that Make a Paramedic Pucker

Oh, $#@%!

paramedics taking patient to helicopter
There are plenty of things that make a paramedic pucker up. Anthony Boccaccio/Getty Images

You might think paramedics and EMTs are pretty cool customers. They sure seem to have it all together when chaos swirls around them. It's their job. I've now been a paramedic longer than I haven't, and I can tell you that despite our rock steady exteriors there are quite a few things that make us cringe. Sometimes it's because we are in danger. Sometimes it's because we know what's coming. Sometimes, well, we cringe because our patient just decided to move to the next level of sick and we know it's not going well.

Paramedics and EMTs are just like ducks on a pond. On the surface we're calm and serene, just floating by with everything under control. Underneath, however, we are paddling like mad.

When Stupid Rubber Meets the Road

cars crashed
How does that even happen?. Automatt/Getty Images

Cruising around in an ambulance for 12 or more hours per day gives one an opportunity to navigate through a gauntlet of poor driving and clueless pedestrians. There is a reason they call us ambulance drivers after all. Like anyone, when a kid darts out between parked cars and makes you test your antilock brakes, paramedics tense up a bit. It might be even more of an issue for us, since we will have to take care of the kid we squish.

But typical stupidity on the roadway is magnified by a factor of thousands when we turn on the red lights and siren. In every state's driver's handbook is a chapter on what to do when the ambulance (or police car, or fire engine) is approaching with the lights flashing and the siren wailing. And in every state, the drivers must skip that chapter, because nothing -- and I mean absolutely nothing -- makes a paramedic pucker more than rolling up behind a car with the lights and siren going full steam and having that car stop dead in the middle of the road. That's right, no pulling over to get out of the way. They just simply stop.

I wish I could say it's an uncommon occurrence, but stopping in the lane without pulling over is nearly guaranteed to happen every time we run hot (or, as we say in California, run code 3).

When the Arm Bends in the Wrong Places

Broken wrist
Broken wrist from a skiing accident. (c) Tara Fontana

Just because we are a little bit odd and seem to like gross things doesn't mean we're not human. Paramedics still say things like "Oh!" and "Jeez!" when we see an arm that is turned in the wrong direction. Palpating an injury and discovering crepitus is likely to give any medic the creep factor.

The worst is when there is supposed to be a bony structure and that structure isn't there. Want to see a paramedic go weak in the knees? Watch what happens when he (I say he in this case because female paramedics are much tougher than male paramedics) picks up a leg whose shattered bones make it more like lifting a garden hose than a garden rake.

When Their Patient Dies but Only They Know It

cardiac arrest in the rain
Sometimes the paramedic knows the patient's dead before the patient does. Bruce Ayres/Getty Images

The brain is downstream from the heart, so when the heart decides to stop suddenly (cardiac arrest) the brain doesn't get the message right away.

Twice I've been in the back of the ambulance when my patients' hearts stopped without them knowing it. Since they were hooked up to the EKG I was able to see as soon as the heart started quivering instead of pumping blood. In one case, the patient was telling me a story about her recent vacation and she didn't stop talking until I asked how she was doing. Then, her eyes rolled back and she died properly.

Six months later it occurred again. The other guy was traveling with his grandson, who happened to be too little to sit in the front seat of the ambulance with the airbag. When grandpa's heart stopped, his little buddy was there to watch it. Again, it wasn't until I asked grandpa how he was feeling -- since I could see his heart had stopped working -- that he had a mild seizure and stopped breathing.

I was sitting in the emergency department one day years after I had both of those patients. I was writing a chart when an ER nurse, visibly shaken, walked up and told me a story about a patient that had just gone into cardiac arrest. She was walking by his bed and saw on his EKG monitor that his heart had stopped. The patient was watching her walk up and nodded at her. Perplexed by the juxtaposition of his obvious consciousness and the fact that his heart done gave out, she asked him how he felt.

"No!" I exclaimed as she's telling me the story. "Never ask them how they're doing. That's when they figure out they're dead!"

Sure enough, her patient frowned at the question and promptly died. There is a pucker factor all EMS folks -- paramedics, EMTs, docs and nurses -- share at the idea that we know when our patients are dead even before they do.

The good news is that all three of these patients did not go toward the light and we were able to get them back from the dead. In the case of grandpa, I even got to meet him and his grandson at a football game a few months after his heart stopped in my ambulance.