Pajama Man: An Introduction to Professional Etiquette

"EMS Reruns" is an advice column designed to address dilemmas you may have experienced in EMS that you didn't know how to handle. If you can think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. That ain't much, but it'll cover a set of bike tires or a nice dinner with your sweetie. And it'll get your name (and your agency's) in print. E-mail ideas to emseditor@aol.com.

There's a chill in the Saturday air as you lock the door and head for your truck. Walking across the lawn, you hear a few leaves resisting the tidy breeze that sweeps them back and forth in the street. You fill your lungs with fresh air and toss your bag in the truck's bed, pausing to glance at the stars. It's Nebraska-Oklahoma day. You hope the calls cooperate so you can watch the game.

In the comm center, there's some serious French Roast action going on when you arrive. You and the offgoing crew like to show up a half-hour early to cover each other's late calls. They're in quarters, so you pause for some of that coffee and a look at the sports page. But you don't get much time for either coffee or news before the PA system barks out your unit number: "Medic 103, respond with fire, medical aid, 4319 El Cerrito, not breathing, run map 43. Time out, 0732."

It's a Martha call (as in "Martha, Martha, wake up")-probably the most common kind of EMS call you get between 0400 and 0800, other than traffic. But you don't get a lot of traffic calls on Saturday mornings. In no time at all, you're pulling up to the address. You hear the engine's siren winding down as you open the side door and reach for your stuff. The familiar roar of that diesel sounds pretty close.

The front door of the residence is open. You announce yourselves and make your way through a living room full of doilies and Hummels that smells like fresh coffee. You glance at a big old grandfather clock, ticking peacefully, as you make your way down a hallway and into a bedroom. There are two elderly women in the corner farthest from you, crying. A younger lady is performing what looks like good CPR on an elderly gentleman on the carpet, and another elderly man in his pajamas is bent over the patient. It sounds like the pajama man is praying.

The lady performing CPR tells you the group is a hodgepodge of family members who were planning to catch a flight for California and then onto a ship for an Alaskan cruise. The patient simply collapsed in front of her, and she has observed him to be apneic and pulseless. She says she is the patient's daughter and a CCU nurse at a nearby hospital. She tells you her 70-year-old father has no pertinent medical history, takes no meds and has been in great health until now.

Q. How can you tell if the lady is really a practicing CCU nurse?

A. You don't need to, as long as all she's doing is decent CPR. But you should be able to quickly assess her medical acumen by the way she relates the history to you.

Q. Should you ask her to stop CPR, even if she wants to continue?

A. Only long enough to assess the patient's rhythm. If she's really the patient's daughter and she's really a CCU nurse, her family will remember for the rest of their lives that she did everything she could-and so will she-whether her father makes it or not. Those memories will be powerful and they will be crystal-clear. The family will also remember your courtesy, or lack of it. A good strategy would be to ask her to pause long enough for you to read the ECG, then offer her the choice of continuing compressions or ventilations. In fact, if she really seems sharp, offer her the IV. CCU nurses can do just about everything; if she's for real, she could be an incredible resource.

The pajama man moves out of your way as soon as you arrive, but during your primary exam you notice he's moved right back in. He inscribes a little cross on the patient's forehead with his thumb and mumbles something in a foreign language.

Q. What's the deal with this guy?

A. If the foreign language is Latin, he may be a priest. It may be a good idea to ask him about that, and (considering his pajamas) if he's related to the patient. Priest or no priest, if he's a close family member and the patient doesn't make it, he's facing the same kind of grief as the rest of the family.

Q. Even if the pajama guy is a priest, shouldn't he wait until the patient is dead before he performs last rites?

A. Most religious figures will do whatever they can to avoid interfering with EMS crews. We should probably extend the same courtesy to them, especially since last rites in some faiths are not just for people who are already dead. Death is a private experience for most of us; in such circumstances it is actually the medical people who are the intruders, unless they are specifically invited. Face it, we don't resuscitate a lot of people. And eventually, nobody gets out of here alive. Some very experienced EMTs and paramedics consider it an honor to witness the beginning or the end of a life, when we may indeed be witnessing an act of God.

Q. In most states, isn't it against the law to interfere with EMS crews?

A. Hmm, don't know about most, but those laws are common in the United States. The fact remains that you will rarely need to invoke one, as long as you can remember the way you felt last time you were observing in a CCU or an OR and somebody pushed you around or treated you with disrespect. That didn't make you feel very good, did it?

Most of us receive a few hundred hours of technical training and are then simply expected to act like professionals. Nobody teaches us what that means, but certainly it means a lot more than you can learn from a journal article. In short, remember there are other kinds of caregivers who share our commitment to a patient's well-being. They have expertise all their own-maybe a lot more than we do. They warrant our respect. And they can make our jobs a lot easier.

If we let them.