Who Answers Your Call for Help?

With the flick of a switch, flashing emergency lights on our ambulance begin to reflect off vehicles and buildings. The siren’s piercing wail brings traffic and pedestrians to a halt, enabling us to weave around vehicles in response to a call for help.

FOR more than 20 years, I have been a paramedic, providing prehospital emergency medical care to the sick and injured. * Each workday is like navigating uncharted waters. I have encountered situations varying from the mundane to the extraordinary, and I have seen results ranging from happy endings to unspeakable tragedies.

Impact on the Community

Paramedics are an essential part of the health-care system in Canada. The competent medical care they administer before a person arrives at a hospital can save a life or at least limit the severity of some accidents and illnesses. *

In many areas paramedics are available 24 hours a day, 365 days a year. They may be employed by a municipal, commercial, or hospital-based emergency medical service agency. Some work with either an ambulance service or a fire department.

These specially trained men and women spring into action seconds after receiving an emergency call for help. It could come at any moment, without prior warning. Consider what a paramedic is certified to do.

Trained to Save Lives

Although paramedic training and the terms used to describe it differ among jurisdictions in Canada, it is generally classified into four levels​—emergency medical responder, primary care paramedic, advanced care provider, and critical care provider. Certification to practice as a paramedic is required by  various levels of government as well as medical authorities.

In my case here in Canada, basic training included many hours in a classroom, in a hospital, and in an ambulance. We learned how to measure vital signs, use oxygen-delivery and ventilation equipment, and perform cardiopulmonary resuscitation (CPR), as well as how to apply bandages, splints, and spinal-immobilization devices.

Then 300 hours of valuable clinical training took place in the emergency, intensive care, and labor-and-delivery units of several hospitals. The first childbirth in which I assisted was a most memorable experience​—it was like being part of a miracle! This event and other incidents helped prepare me for the next step of my training, which involved more than 300 hours of real-life experience in an ambulance with the guidance and support of two experienced paramedics. After passing written and practical examinations, I was certified as an emergency medical care assistant, now referred to as a primary care paramedic.

For several years I worked both in rural and urban areas. I quickly learned the value of my new lifesaving skills when a construction worker with chest pain walked into the hospital emergency department. Shortly after arriving, the man went into cardiac arrest. I worked with doctors and nurses who performed CPR and defibrillation and administered drugs. Within minutes, the patient’s heartbeat was restored and he began to breathe on his own. He was then transferred to the critical care unit (CCU). The next day, I was sent to the CCU, where a physician introduced me to a man sitting in bed talking with his wife. I did not recognize him until he said: “Remember me? You saved my life yesterday!” That was an incredible feeling.

The last part of my training included working with a physician who accompanied me for a 12-hour shift to monitor my patient care. Finally, I passed both the written and practical examinations and was certified as an advanced care paramedic.

Paramedics practice under the authority of a medical director, who usually works with a medical advisory committee to develop written treatment protocols, or plans. The emergency medical care that paramedics administer is based on these, or they work through direct radio or telephone communication with a select group of physicians. For this reason, paramedics have been described as the eyes, ears, and hands of a physician. Treatment given in a private home, in public buildings, or at a vehicle-accident scene could range from administering oxygen, medications, and defibrillation to intubation and surgical procedures.​—See the box  “Paramedic Treatment Skills,” on page 15.

Risks and Challenges

Risks and challenges are an inherent part of a paramedic’s daily routine. Work is done in all types of weather and, at times, in unsafe locations or circumstances. Even driving to an emergency call can be dangerous.

Exposure to blood, body fluids, and infectious diseases is a constant risk. To protect ourselves, we wear such personal protective  equipment as gloves, masks, goggles or face shields, and special suits or gowns as needed.

Caring for patients includes dealing with their family members, their friends, or even strangers, whose emotional reactions can be extreme or unpredictable. It is tragic when a husband and wife who have spent decades of life together are separated by death. It is not easy to inform the surviving mate. On one occasion I had to inform a woman that her husband had died. She reacted by punching me and running out of her house and into the street screaming and crying. I was able to catch up with her, and she turned around, grabbed me, hugged me, and then began to cry inconsolably on my shoulder.

Interacting with individuals who are emotionally disturbed or under the influence of alcohol or drugs requires empathy, tact, and compassion. People in such a state can be unpredictable. During my career, I have been bitten, spat on, and assaulted in other ways by patients who were unable to control themselves.

The job is also physically strenuous, routinely requiring heavy lifting, sometimes in a very awkward position. Much time is spent kneeling and bending to care for patients. Work-related injuries are a reality for us. Injuries to our back, shoulders, and knees are most common. Some injuries are serious enough to end a career. Shift work is also expected and can be physically exhausting.

Caring for people who suffer a life-threatening illness or injury is mentally and emotionally stressful. A paramedic must stay calm, use sound judgment, and make rational decisions in times of crises. Paramedics are eyewitnesses of human suffering and tragedy. They see and care for people who suffer horrific physical injuries. I vividly remember one young man who was crushed in an industrial accident. Virtually unrecognizable below his lower chest, he begged my partner and me not to let him die. Sadly, despite our best efforts and those of a team of physicians and nurses, he died less than an hour later.

Some scenes are truly heartbreaking. We received a call to an early-morning house fire. A husband had just arrived home from work as his wife and three-year-old daughter escaped from their burning home. Three more children, aged four months to five years, and their grandfather were trapped inside until firefighters were able to take them out of the house. I was on one of several teams of paramedics that worked in vain to save their lives.

Perhaps at this point you are wondering why anyone would want to be a paramedic. At times, I have asked myself that same question. I am reminded of Jesus’ parable about the neighborly Samaritan who willingly gave of himself to help an injured man. (Luke 10:30-37) Being a paramedic involves giving of oneself physically and emotionally to answer someone’s call for help. For me personally, being a paramedic has been a rewarding profession, but I look forward to the time when I will be unemployed. Why unemployed? Because, as God promises, in the near future no one will say: “I am sick.” Furthermore, ‘death and pain will be no more.’ (Isaiah 33:24; Revelation 21:4)​—As told by a paramedic in Canada.

[Footnotes]

[Blurb on page 13]

I did not recognize him until he said: “Remember me? You saved my life yesterday!” That was an incredible feeling

[Blurb on page 14]

During my career, I have been bitten, spat on, and assaulted in other ways by patients who were unable to control themselves

 [Box/​Pictures on page 15]

 PARAMEDIC TREATMENT SKILLS

A paramedic is trained to ensure that a patient has an open airway, or passage, so that air can enter the lungs. This may require intubation, which involves the insertion of a flexible plastic endotracheal tube through the mouth and vocal cords into the trachea, using a laryngoscope. Or it may call for a cricothyrotomy, using a needle, a small catheter, a guide wire, and a scalpel to insert a larger catheter through a patient’s neck directly into the trachea. The insertion of a needle and catheter through the chest wall is used to treat the life-threatening complication of a collapsed lung.

Another skill is intravenous therapy. A needle is used to insert a catheter into a vein. Thus, solutions such as normal saline can be infused. Alternatively, an intraosseous device can be used to infuse fluid directly into bone marrow.

A paramedic may use a cardiac monitor/​defibrillator to monitor a patient’s electrocardiogram. Additionally, the unit may be used for defibrillation (delivering an electric shock to restore normal heart rhythm and function in cardiac arrest) or for cardioversion (delivering a synchronized electric shock to slow a dangerously fast heartbeat). The monitor/​defibrillator can also be used as a temporary external pacemaker to speed up a heart that is beating too slowly.

[Credit Line]

All photos: Taken by courtesy of City of Toronto EMS

[Picture Credit Line on page 12]

Taken by courtesy of City of Toronto EMS