A Day (Or Night) In the Life of a Volunteer Paramedic (Part 1): Typical Shift At The Rescue Squad

I was recently asked by a member of the public what a typical day is like for me. That is such a hard question to answer because each shift is so different. Being a bit of a smart aleck, I asked them "what day?" I work a rotating 24hrs on/72hrs off schedule with the private ambulance transport company. My volunteer paramedic schedule of 12hr shifts is set up around my work schedule. I prefer running as the Region A medic on Sunday and Monday nights. Sometimes I run Sunday days because I can take the chase car to church and respond from there. I also volunteer with the Fire Company which is separate from the Rescue Squad. Fire duty crew is a 12hr shift every 6th night. I work holidays, am out in all sorts of weather and I don't know what a "weekend" is anymore. And I haven't even started on the regular continuing education classes I have to take to keep my certifications current.

But let's give this a try. Let's assume that I'm on duty at the volunteer rescue squad as the regional medic. The shift begins at 6pm, but since everything in fire-rescue goes off 24hr clock time, it's actually 1800. I usually leave home at least an hour before the start of my shift to allow for travel time with rush hour. If it's one of the days when my roommate is working night shift and won't be home to take care of the pets I leave earlier so I can drop my dog Fiona off for a sleepover at a friend's house.

Well, she's already asleep in the car. Apparently, Fiona was more than ready for a sleepover while I'm on duty.

Once I get to the station, I change into my uniform if I'm not already wearing it and call the county dispatch center to place my unit in service. Then I do a quick duty check to make sure I have everything on the unit and change the battery in the portable radio.

One of the ALS Chase vehicles we used to run from the rescue squad station. Oh, and a helicopter.

Then it's time for dinner. You never know when you'll get a call, so food is always a high priority. Every time you sit down to eat, go to the restroom, start your workout, etc., you feel like you're tempting fate to give you a call. Most shifts, I end up coordinating dinner with the ambulance crew on duty. After dinner, I like to do training of some sort.

Extrication Training

Training can be pretty much anything. If you don't train your skills and knowledge gets rusty. You don't want to be trying to relearn that splinting procedure on a call. Training is important! Two of my favorite evening shift training options are doing area familiarization/driver training and practicing ALS/BLS skills. If you know the shortcuts, major streets and intersections--and even better the addresses, your response times are faster because you already know where you're going. Long summer evenings are perfect for this kind of area familiarization. Practicing skills such as intubations on the dummy, doing a drug bag check (and reviewing the indications, doses and contraindications for all the drugs in the bag), and teaching basic skills to new members are other good options. The more you know, the more you practice, the better you will be under stress in a critical incident. I also try to review at least one of the local protocols per shift. Knowing the protocols is very important, and there are always protocols you don't use very often.

Bunk room at the station. The night this photo was taken, I ran a lot of calls and consequently didn't spend much time in here.

After training, sometimes there is time to use the station gym, work on projects, and watch TV before bedtime. I usually pick a bunk room as soon as I'm done with my duty check and before dinner. And at any point in time, this routine can and will be interrupted by calls. In the area I cover, the average time it takes to run a call once you allow for response time to the scene, an on scene time of about 15-20 minutes, transport time and the return trip to the station (often via the scene to retrieve the chase vehicle) is about 2-2.5 hours. Critical patients require more documentation, so the report-writing time at the ED is longer.

People often ask how busy we are. The truthful answer is that it depends upon the day. Calls seem to come in waves. At one point in time, there will be 4 calls going on at once and I'll be on one and there will be units from 3 other stations on calls in my area. Other days I'll run nothing the entire shift. Some shifts I will run 6 calls and never really see the station.

Another question or rather statement I hear a lot, is "so you're an ambulance driver?" Well, technically, yes, I am. But I'm a whole lot more than an ambulance driver. I'm actually a paramedic. I've successfully completed about 2,000 hours of classroom and practical training, followed by about 8 months of field training before I was allowed to run calls on my own. So, "Yes, Ma'am. But I'm a little more than just an ambulance driver..."

Patio Garden Therapy

Late last summer, the garden and I moved…to a bigger patio about 8 miles down the road. There’s no space for an actual garden bed here and the management is really particular about what is on your patio. So I’m making do with a few more pots. I also had to get a storage bench to hold my gardening stuff. Not that there’s anything wrong with more pots, beautiful flowers, or a nice reading spot in the middle of them…

Rocking chair and patio tomatoes...and the lovely Fiona with her frisbee.

Back in March, my “black cloud” showed up again, and I ran a series of tough calls. It didn’t seem to matter if I was riding backwards in the bucket seat on the engine, covering as the Region A medic, helping a friend with driver training in preparation for EVOC or having another insanely busy day working at the ambulance transport company. It all began with a code that went out a couple miles from the station Wednesday night.

Every new medic needs at least one confidence-building critical call, where given all the variables everything goes pretty much like clockwork. I’d come down to the station to take one of the new members out in the second out (unstaffed) ambulance for pre-EVOC driver training. Just as we were about to head out, the station tones dropped for a cardiac arrest and an EMT/driver walked in and asked if I wanted to take the call. A quick check showed that we were much closer to the scene than either of the two medics initially dispatched and the first out unit wasn’t at the station. So I grabbed my drug keys, we squirreled it and arrived on scene just after the engine and before all the other EMS units. I grabbed the drug bag, walked in and handed out work assignments to the crew to facilitate the “pit crew method” I heard about at the EMS Today Conference earlier this year. From there it went like clockwork. The patient started in asystole and when we reached the ED 10mg of Epi and 50mEQ Sodium Bicarb later the patient was still in asystole and the doc called the code. Unfortunately, asystole (aka flatline or no heart rhythm at all) is the stablest rhythm of them all.

The next day I was at work, and it was one of those really busy days. One of my patients that shift was a tiny premature baby who had developed necrotizing enterocolitis. Necrotizing enterocolitis is the death of tissue in the intestine and occurs most often in premature or sick babies with a 25% mortality rate according to the National Institute of Health.[i] I checked with the doc in the Peds ED the next week and he confirmed that thankfully this little one was treated in time and survived.

A dressed up patio storage bench turns this corner of the patio into an inviting place to relax outside.
Mama ducky is admiring that orange Gerbera daisy too. 

The next night, after a busy day acquiring the patio storage bench, I had fire duty. Riding backwards on the engine can be fun and a nice break from bossing a medic unit... until you get dispatched on that 2:50am stabbing three doors down from the firehouse, are the only medic on the engine and are first on scene after the police. We did everything we could. This patient's wounds were too severe and he practically bled out in front of us and in the end did not survive. The calls where a patient starts out talking to you and ends up dead are the worst. This one was particularly difficult due to the circumstances.

Needing some version of therapy after those calls, and now that spring had arrived, I started working on the garden again. I still have a few pots I haven’t planted yet. Between turning an old bookshelf into a potting bench and acquiring a storage bench/seat per request from the management company, the patio has become a lovely place to read and work.

New job for an old bookshelf: potting shelf.

The rest of the garden is still in the works, but I have squash, beans, cucumbers and a variety of herbs and flowers growing.

Planter of Basil varieties and the lonely Zucchini plant.

When you spend a significant portion of your time caring for ill, injured and dying people, it's nice to be able to come home and care for something healthy and alive.

Green Beans.

Cucumbers and trellis.

I like to daydream about God being the supreme gardener. He has more plant varieties than I could ever dream of...and He's got the whole universe to grow them in. But you can also think of gardening as an analogy for life. Any gardener knows that caring for a garden requires weeding, thinning, pruning and re-potting. God does the same for our lives. We may not know the master plan for the garden, but He does. And in the end, He works everything together for our good and His glory-- even though we may not see it at the time. In the end, God is the one who gives and takes life. I've gotten to see a decent share of both recently. It's a good reminder that it is a privilege to be alive. Use your time wisely and don't take it for granted. We never know when our time on earth is up. Don't waste your life.

Citronella, Violas and Oxalis (shamrocks) decorating a corner of the patio.

For me, that means doing my job at work or as a volunteer to the best of my ability and then coming home and taking care of my garden... and spending time playing with and training my dog Fiona.

Fiona at 9 months

Besides, who knew Border Collies loved to swim?

Yep...she's out there swimming after a stick.

---

[i] http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm