A twist of events

As I mentioned in a previous posting, we have ran so many critical calls that our minds had adapted to our environments. We could do our jobs flawlessly like robots, but at what cost? What about our empathy and caring.... Had we lost some of it or all of it along the way? What about  our personal lives? Help others and then help yourself...  Sometimes the hardest life to save is your own. As a medic how does one save themselves?


I stepped outside my dark hotel room into the bright hallway when I caught the attention of 2 of the other U.S. medics eyes. "jesus, you look like S**t Mike" they exclaimed. I just mumbled agreeably as I made my way outside to hail a taxi and get to work.  Dark bags under my blood shot eyes squinted in pain. Off to work... I have now been in country longer than most of other western medics. I am salty and short timing.


  Upon arrival to the station I dropped my gear inside and went for a walk to the local store. As I walked down the busy dirt road covered in old plastic bags, rusty cans, paper, wrappers, needles,  and other random debris I enjoyed the amaturer  graffiti that covered every business and every wall around me. Many of the businesses window's where broken and all of them where covered with bars. As I continued my journey for a redbull I observed all the children living in poverty in our neighbored.


 They all had there soccer jerseys on and loved playing soccer, unfortunitly they only had a dirt field and used garbage with stones to mark the field goals. By the looks of there raggedy soccer ball it was unbelievable it still held air. I was based in a very poor neighborhood that taxi drivers refused to go to at night. I serviced the poorest, and busiest area in the city. In addition to that my coverage area expanded for miles outside of my response area due to the shortage of Paramedics and doctors. I never got a break and with back to back day/night shifts I did not sleep. The other american medics could not believe how I did it. Some of them had came for ride a longs with me, one day was enough for them... but no one could believe I had been working this station for 8 months everyday. 


I have been working as a rapid response paramedic at the busiest station  in Riyadh Saudi Arabia (a city the size of Los Angels) for about 8 months as of writing this. The incredible shortage of Advanced Life Support staff has resulted in severe sleep deprivation, overtime every week, exposure to an incredibly high volume of critical cases, and places my safety in jeopardy on a daily basis in multiple ways, including 2 ambulance accidents I was involved in and a combative patient that I received a dirty needle stick from, a man with a knife that tried to stab me, an explosion that knocked my colleague to the ground, and the list go's on and on. I was not just a medic working a regular job I was fighting a freaking war with the streets of Riyadh.


 The critical cases I see have began to blurr together for me, from explosions, to gun shots, to stabbings, to huge car accidents, people being struck by cars and assaulted, abused, heart attacks, strokes, baby's being born,  and many many other things, thats just in the past 2 weeks. Even the medics in Iraq and New York City I have spoke to do not see the kind of volume. I am proud to serve the community I do, and to also have the busiest station, but a break would be nice.


I could deal with our heavy call volume, bad niegorhood, and frequent safety hazards... Sure they run a toll on me, but there where other factors in place. The ambulance crews I use to enjoy working with where switched around and theres been a lot of conflict with the new crews and I. Work has been very stressful lately.


I have been a real train wreck.... BUT today things started looking up.


As I write this today is my last day at the busiest ALS station in Riyadh. The manager from a brand new station called me today.  The station is in a very secure nice area where many high profile patients live. The call volume is much slower and the crews  seem great.  I was transfered there effective today and I feel great. I will be the first medic at this station and can not wait to start. In addition to this I moved out of the hotel today that I have been living in for the past 8 months and finally got my own apartment on a western compound!
It appears I am on easy street now, fate had saved me from burnout. Don't worry Ill still see crazy exciting things to share with you all. Ill make sure of it!

My Road safety and Seat belt presentation

It gets frustrating over here everyday with all these car accidents and unsafe driving practices. I felt compelled to do some community outreach and gave the below presentation to kids at the american international school last week. I also brought an ambulance down to the school and let the kids check it out. It was my first time doing this so forgive the excess "um's" for the first few minutes of the video. I was a bit nervous.

1 survivor

The Blades from the helicopter had just stopped spinning. A small amount of dust could still be seen in the air as the moon light shined down upon us. It was a beautiful and otherwise quite night on this old rural highway. I did not have much time to take in scenery on the way due to the fact that we had reached speeds of over 210kmh(130mph)
 Dispatch suggested we where to far away to take the call, but boy did we prove them wrong.
The sounds of panic around me would occasionally be replaced by shouting in multiple directions. It was dark but my eyes attempted to take in all the pandemonium surrounding me. I started constructing a plan. The helicopter crew and 1 ambulance where already on scene and  2 other ambulances could be herd in the distance responding.
The first thing that caught my eye was the mangled wreckage of what I think use to be a large white van or possibly a small bus. It was impossible to tell any longer through all the twisted wreckage and broken glass.

Now I am no weatherman, but in my 28 years of watching the news I don't ever recall the meteorologist calling for "a clear day with a chance of falling vehicles". So as we know a mutilated white bus does not just drop from the sky, some one had to be driving it and being as it was some type of large passenger vehicle the chances of there being multiple occupants are high.

I was about to find out just how high.... As I walked over for a closer look and started scanning the ground I could see the body's everywhere. Several had been covered by blankets, body bags and sheets by the helicopter crew and police that arrived before me. Others remained on display in the position they had died in.

The police soon ushered me to some of the victims that might have been missed during the initial triage. Somehow some of the victims made it to the other side of a 4 lane highway. Where they ejected, did they crawl there, did someone drag them there? Ill never know. I looked down at the first person I was brought to finding his mouth and eyes wide open as if he was frozen in time screaming. Further assessment revealed he had no pulse, no respirations, and his pupils where fixed and dilated. I assigned one of the police to cover the body with a sheet as I moved on searching for others in the dark. Soon my partner could be herd yelling for me. I came to his side to find another victim, this womans brain had managed to partially come out of her skull, she had no pulse and no respiration so we moved on. The more victims we found the more we had to cover with sheets and blankets until we ran out of things to cover the bodies with.

I stood there in the dark silently with bodies scattered all around me, crying and screaming surrounded me in the distance. I now noticed the smoking remains of another vehicle that had completely burned up. I did not even realize its presence during my initial scene sizeup. What a mess! I had confirmed everyone was deceased outside I needed to check inside all the ambulances and helicopter to see what was inside. I peered inside the first ambulance to find the helicopter medic preparing to place a breathing tube in a 2 year old child that had been ejected, then I went to the helicopter to find a confused man complaining of backpain being assessed by the flight doctor in training. I was soon summened back to the ambulance to find the helicopter medic doing CPR. The child had gone into cardiac arrest. There was probably no brining him back from a traumatic arrests but since he had a pulse on arrival, he was only 2, and this was a wittnessed arrest we gave him a full workup. 20 minutes of drugs, cardiac monitoring, ventilations, and CPR did nothing

The helicopter medic had to go back to the chopper and transport the only survivor of the accident. He could not take the child because the helcopter does not take patients that require CPR prior to take off.  I sat there in the ambulance with my partner and gazed into the lifeless boy's eyes.  I decided to call the code. I told everyone we did a good job and there was nothing more we could. I called online medical control to confirm that we where going to discontinue efforts. To my surprise the doctor on the telephone said no and to continue CPR to the hospital.... He knew there was no bringing the child back but did not want us to just throw the body out of the ambulance back onto the street in front of the bystanders. We where 45 minutes away but I had to follow orders and continue efforts.

I sat there for 45 minutes taking turns with the EMT's doing chest compressions, monitoring the ecg and ventilating the patient as I pushed drugs every 5 minutes a long the way. We talked about other things on the long trip to the hospital in a a calm casual conversation. We arrived to the hospital and they had a team expecting us. They took over care and also prepared to terminate efforts. The nurse in charge of the team asked me how many more patients they should expect as the hospital staff began prepping things. She said there hospital had been placed on stand by because of the large accident involving so many people. I just told her "there all dead." "there was only one survivor and he was taken to another hospital by helicopter." They just stood around me in silence as one of the other nurses started to cry. It occurred to me later that we had become so accustom to death and ran so many critical calls that our minds had adapted to our environments. We could do our jobs flawlessly like robots, but at what cost? What about our empathy and caring.... Had we lost some of it or all of it along the way?


There is a dark side to EMS and I do enjoy talking about it sometimes. Doing cpr on a 2 year old child while casually having a conversation with your partner about something unrelated. Stepping out of the car and looking at the dead and injured laying all around you but your heart does not skip a beat, calculating drug dosages as someone lay there dieing while everyone around you is screaming and crying, responding over 130mph(210kmh) while sipping on your lattee as you prepare to enter hell on earth.... We will talk more about the dark side next entry.