EMS Reruns: Backup Ambulance

EMS Reruns addresses dilemmas in EMS. If you think of an example, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail Nancy.Perry@cygnusb2b.com.

Well, you were in a pretty good mood. But now, with the last few stanzas of "Hotel California" fading away, you pull into your station's driveway and spot a backup unit parked in your bay. Just that fast, the day ahead of you goes dim. You're suddenly cr-r-ranky. You spent your last shift cleaning one of these things after you noticed a brake pull in your regular unit. Then, thanks to a rainstorm at the shop, you cleaned your regular ambulance as well -- busy night and all -- for the oncoming relief crew. All part of the job, eh?

But dang, this is another backup rig. The offgoing crew moved into it at 2 a.m., after they turned on the A/C for a COPD patient and the whole ambulance was suddenly permeated with the odor of diesel. They had to park it and remove the patient, who couldn't tolerate the environment, until a supervisor could arrive with this thing. Sure enough: They were busy all night, and it's filthy. Breakfast will have to wait.

Now you're being toned to a private address about six miles away, so you saddle up. You sign for the narcs, and the offgoing crew says you're topped off with fuel and O₂. The front suspension bounces, rattles and squeaks as you traverse the gutter and head south on Third. The seats in the cab are shot, and there are holes in the floor mats. The cracked windshield has a month's worth of dirt on it, there's an audible exhaust leak, and in the course of checking your mirrors you notice the interior handhold on the right A-post seems to be secured at the top end with duct tape. If that's not bad enough, one glance at the instruments reveals your electrical system is charging at a whopping eight volts. You're in trouble!

You shut down your warning equipment, call for an ambulance and a mechanic to meet you on scene and continue your response. On arrival, you leave your engine running and make entry. The patient is a 75-year-old woman in acute CHF. She's really sick, but she derives some relief from your CPAP and meds. By the time another crew arrives, you're just about out of portable oxygen. You jump in their ambulance and transport to a local facility, then make it back to the scene ahead of a tow truck. You hitch a ride to the garage, where a mechanic listens to your account. He shrugs without a word.

Q. We have two problems here. One is, nobody seems to take care of the backup rigs except us. But worse than that, the people who take care of the regular units can't seem to keep them running.

A. It sounds like you need to start working your way up the chain of command and wake some people up. Out of seven things you mentioned about this ambulance, six are safety issues, and all of them make you personally look like an amateur.

Q. Been there, done that. The fleet manager says he's had his budget cut. The supervisor says he's talked to the operations director. The operations director's a loser. We've asked him to come by our station, but he never makes it, so we've sent him memos, called him and brought him photos. He always acts surprised and sympathetic, but nothing gets done.

A. Don't give up! It's actually cheaper to maintain a fleet than just fix failures. Time for a visit with the chief, or whoever is above the ops director.

Q. Knowing our ops director, I'm sure that would prompt him to retaliate. He already considers me a troublemaker, and I think it would be enough to cost me my job.

A. There are two kinds of troublemakers in EMS. One kind are whiners, who usually complain on their own behalf (and don't clean backup rigs). The other kind are advocates, without whose courage and commitment systems don't get better. You sound like the latter kind to me. Your concerns seem legitimate, and I suspect they're not just yours. Your equipment needs to be safe, for you and for the public. If it's not and nothing else works, it's worth a scrap -- maybe even with a little help from your local TV station.

Q. Considering the state of the economy, that may be easy for you to say. But this is no time for me to be discarding a good job.

A. Sounds to me like your job is guaranteed to get somebody hurt. If that happens and you've done nothing, I can guarantee you it won't seem so good.

Thom Dick has been involved in EMS for 39 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.