You always remember your first...

I took EMT-B class in NorthEastern PA (yes, it deserves being capitalized) during my sophomore year of college, between 1997 and '98.. I had wanted to ride an ambulance since I first started seeing them on the sidelines of the high school football games, while I was playing drums in the band. How cool, to be in those orange jumpsuits, driving around town lights and sirens to save people's lives!

I already had plans to go to medical school after college and then working in an ER or as a trauma surgeon (hey...I had dreams...), so when the opportunity came to take an EMT class, I figured, why not? By becoming an EMT and working car wreck scenes and heart attacks, I learn if I can hack the pressure and stress that comes with working in emergency situations, right?

So I took EMT class, and excelled, I'd like to think. My instructors made sure we could think our way out of a problem, because honestly, the way EMS was in PA at that time, you may very well find yourself on a trip to the trauma center an hour away with one medic in the back with you and the driver in the front. There was no helo on every corner, and the local Level II trauma center only took people with their particular insurance. And if you wanted to go to a specific hospital, you better either call when you're on the doorstep, or call before leaving scene, because the doc taking your call could very well refuse your patient, sending you to another hospital. We didn't do a lot of rendevous with the medics, because they were hospital based in a delta truck (van) and we had to respond to the station and then get to the scene, because the ambulances were housed in the city council building, along with the fire dept and the police, and the local jail. There was a room upstairs with the computers to do your reports and a couple of couches, but you weren't allowed to sleep there. Therefore, there was a lot of being woken up in the middle of hte night and calling in to dispatch and driving to the station to get the ambulance out. Dispatch, who was contacted by the county (who received the 911 calls) would tone out whatever was needed. You got 3 tone outs, 2 minutes apart, before mutual aid was activated. If you called in as the aide, or EMT, you would head to the station, but if they didn't raise a driver, it would go to mutual aid and you just drove across town at 3am for nothing. I can't say that I got a lot of experience there, but I learned a lot from the medics who beat us to the scene and treated the patients while they waited for transport. Our dept didn't have a lot of money, so I learned to improvise a lot of things, and I learned that if shit goes downhill, you can't freak out. You have to suck it up and deal and learn from what is going on so you don't let it happen again. A partner of mine had to once ride with a 300lb pt in the back of the secondary ambo, with a stretcher that wouldn't go down all the way and therefore wouldn't fit in the brackets. The patient was critical, and for once they had beaten the medics to the scene and set up a rendevous. I remember him relaying the story to me, him a new EMT on his second call, terrified that the medic would open the back and see him holding the broken stretcher against the brackets with his feet and have kittens. You can say that I learned early in my career the importance of 'Improvise, Adapt and Overcome.'

I got my certification in January of 1998. In NEPA, winters tend to be a bit rough, and one night, about 2 weeks after getting my card in the mail, our tones dropped for an injured child after sledding. It had been snowing and sleeting all day, and we hadn't had classes. So my partner and I piled into his truck and headed over to the station. We made it just as the ambo was pulling out and jumped on. We got on scene, and the medics, rescue chief, assistant rescue chief, and half the dept had already gotten there (lots of people responded in the POV's from home if they heard the ambo had a crew). We got there just in time to help put the backboard on the Reeves and slip and slide down the icey road to the ambo.

Everyone piled on. The rescue chief, the paramedic, myself, and my partner. A firefighter drove, and the patient's little brother sat in the front seat. The patient was a tall kid, somewhere in his early teens (I can't remember his exact age), who had been sledding down the street at night with his brother. The parents were out, maybe shopping, maybe working, I don't remember. The patient hit a tree after jumping the curb, and had been found by the first people on scene under a car.

I don't remember much about the trip to the hospital, or the patient's treatment. I remember that he didn't have a mark on him, save for a stripe of grease on his forehead, obviously from sliding under the car. I remember being given trauma shears by the medic and being told to cut his pants. I remember that it was a long-assed ride, with the on-spot chains down, slowly driving up the highway in the snow, the emergency lights reflecting off the flakes. I remember that we couldn't call for a helo because of the weather.

The most memorable thing though, was this. The rescue chief, also a medic, called the closest hospital, General Hospital, to give report. The doctor on the other end of the radio, after learning that the patient was a minor and the parents had not been contacted yet, refused the patient, instructing us to take him to We'll Take Anyone Hospital. Neither one was a trauma center, but the local level II trauma center didn't like to be bothered at night with patients who didn't have the right insurance. WTAH was 20 minutes up a major interstate on a good day. Tonight was not a good day.

Cursing a blue streak, the rescue chief told the driver to head for the highway. 45 minutes later, we were at the hospital. I don't remember much more than what I've written, perhaps because while cleaning up the ambo I slipped while going out the side door and fell, hitting my head on the floor. Don't know if I had a concussion, but I certainly had a headache for the ride back. And I do remember that 2 days later the news reported that the patient had died of a closed head injury.

Being in Maryland now, I tell that story, and people are incredulous. Perhaps I got some details wrong, being a newly minted EMT with ZERO experience with the hospitals and doctors and things of that nature. But I do remember having a box on the back of our run forms where the patient had to put their insurance info, or sign if they didn't have any. And I do remember the hospital, specifically General Hospital, being VERY interested in which box was signed. And I distinctly remember the rescue chief cursing the doctor at GH as we drove slowly to WTAH, impuning his degree and the questionable tactics of allowing a hospital to turf what could be a critical patient to a hospital father away on a horrid night to be out driving because insurance coverage couldn't be confirmed.

Whether the law in PA had changed by then to allow uninsured people payment options or not, I don't know. I didn't know much about the law in PA at that time. But when I tell that story to my EMT students, they don't believe it. Not the part about the hospital turfing the patient, or the part where the next closest hospital was more than 10 minutes away.