Synopsis: Paramedics and EMTs are the first responders of the health system and often find volent, confusing situations on their arrival. A former paramedic describes the “inside story” of the job, its dangers and rewards.
Host: Reed Pence. Guests: Kevin Hazzard, author, A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back
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Adventures of a Paramedic
Reed Pence: When an ambulance speeds down the street, siren blaring and cars swerving out of its way, you have to admit that your heart may beat a little faster as you watch it fly by. You ask yourself “what kind of emergency are they headed to? Can they get there in time? Will the victim live or die?” According to Kevin Hazzard, the men and women who drive those ambulances also experience racing hearts and uncertainty. He’s a former paramedic whose new book, A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back, takes readers into the world of medical emergencies to show how paramedics deal with the day-to-day chaos of their jobs.
Kevin Hazzard: You really need to enjoy the chaos, because you are always going to be short handed and a little bit outgunned. There’s no way that two people are the right tools to lift a five hundred pound man out of a third story walk-up. When you reach that moment, some of the rules and some of the practices and procedures of medicine need to go out the window, and you need to say, “What do we need to do to get this guy downstairs, because he’s in a bad way?” Whether it’s as simple as that or a car has rolled over and seven people inside and now they’re all over the place in varying states of need and it’s just you and your partner and it’s 2:30 in the morning. There are a million ways in which the job can be difficult and you can be totally outmatched. You need to enjoy those moments.
Pence: Hazzard didn’t start as a paramedic, but an EMT or “emergency medical technician.” Many people don’t realize that there’s a difference between them.
Hazzard: The easiest way to sum it up is imagine if the EMT is a nurse and the paramedic is the doctor. EMTs go through anywhere from six to eight months to school and it’s the entry level; they are the understudy on the ambulance. Paramedic does about another year and a half of schooling. They can shock people with the paddles you always see. They can give medication, intubate all sorts of procedures that they can do, so they are the more advanced person on the ambulance.
Pence: There are also different types of ambulance services. Hazzard started out on a non-emergency ambulance – but that doesn’t mean he didn’t get called to handle trauma situations.
Hazzard: There are also ambulance companies that take people to and from appointments — they bring them to dialysis and bring them back to the nursing home. That’s supposed to be what it is. There’s not a whole lot of regulation or oversight on them. But nursing homes wind up using those ambulance services to avoid the specter of a 9-1-1 call. So they call a non-emergency service to show up for a fall or a stroke. They can mask it and seem like, “oh well, it was non-emergency, we didn’t have to call 9-1-1. This is a precaution.” That’s where the trickiness came in. You have this underequipped and not necessarily highly trained company that’s responding to what ultimately are real emergencies.
Pence: The premiere ambulances are the ones that answer 9-1-1 calls, be they fire department vehicles or those attached to a hospital like the one that Hazzard eventually worked for in Atlanta when he became a paramedic. Even with the advanced training and hundreds of hours on the ambulance, Hazzard says there are certain things that paramedics can and can’t do.
Hazzard: If you are having an allergic reaction, or you are choking, if your heart is beating too fast or too slowly, if you’re having severe respiratory issues, you’re having a seizure. These are all things that an ambulance is very well equipped to handle and get you back into some form of normal. Sort of the major life threatening ones from someone choking to someone delivering a child and everything in between, a lot of those can be handled quite well on an ambulance. But of course, there are often times things that aren’t quite as dramatic. Somebody passes out, and that seems like not that big of a deal, but there are a million things that can be behind why you passed out.
Pence: Hazzard says that when victims or loved ones asked him about the extent of an injury at the scene, many times he couldn’t give them a satisfactory answer
Hazzard: Even bleeding, traumatic injuries – people would say to me all the time, “Do you think I broke it?” You just shrug. You didn’t want to be flippant about it, but you try to explain in as nice a way as you can, I can’t do x-rays. I have no idea. Even if it doesn’t seem minor sometimes the most minor falls are the ones where someone breaks a major bone and you think I have no idea how that happened. So you certainly are limited. It seems like the less dramatic the situation, the less an ambulance is able to do for you.
Pence: He says that a paramedic has to be a bit of a detective when he or she arrives at the scene, taking in the environment and searching for clues as to what happened.
Hazzard: There’s a sort of Sherlock Holmes aspect to it in that we don’t have the advantage of a blood test or urine test or a CT. It’s a very primitive form of medicine in that regard, and so you have to lean on what you’re seeing from the patient. You have to lean on what the patient says, what the bystanders are saying, what the situation says – where are they, what’s the house look like? Your experience, all the things that you’ve learned through the years and what that tells you. And you have to try to peice it altogether quickly and correctly, and then decide where you want to go. To me that was always the most fascinating part of it, was that, you show up and something has happened and maybe you have no idea. Maybe what you’ve been told is dead wrong and you have to sift through these clues and figure out where you are. In that regard, having been a reporter and being a paramedic and I found they were essentially the exact same thing. You’re called out to an unusual circumstance and you’ve got to figure out what happened and then find a way to tell that story.
Pence: One incident that he recalls from the book is an example of just how difficult it is to determine what’s wrong when nobody actually saw the victim become injured. They were called to a family meal on Thanksgiving where no one at the table saw exactly what happened.
Hazzard: A woman collapsed on the floor and the family was in a panic. We got there and at that point she was in cardiac arrest. We started doing everything we could. It wasn’t until we got into the situation that my partner discovered that she had choked on a piece of broccoli and that was what started the situation. It was emblematic of what that job is. It is an imperfect situation every time. Medicine ideally is not practiced on someone’s on the living room floor, but that’s the reality of life — that emergencies happen in all kinds of places. The people sent out to try and clean it up are going to be coming from behind the eight ball and short handed, but they are going to do the best they can as quickly as they can.
Pence: Paramedics and EMTs are called to some pretty horrific scenes where people are stuck in crashed cars and there are legs and arms nearly cut off in the wreckage. Did he ever get used to the gore that he would have to deal with on a weekly basis? Does anyone?
Hazzard: If I was called out to you and you had been hit by a car and your legs were horribly mangled, I can’t help you if I think about how much pain you’re going to be in already – how much more pain you’ll be in when I start to straighten your leg. I have to simply say, it is not an extension of you, it is simply what my job requires right now. This leg is just something I need to fix, you know? Which is the same approach you take with a child. You pick up that child, you’re not holding somebody’s child, it’s purely a heart and set of lungs and a core body temperature. That’s how you have to look at it. There needs to be that level of detachment. Otherwise, you just simply couldn’t do the job, for the same reason no one would help to run a call on a family member. You would simply think too much about that family member and not enough about the job.
Pence: That detachment, though, has to be tempered with empathy for the victim. He talks in the book about one of his partners, Josh, who always took time to comfort elderly people he was called on to help.
Hazzard: One of the things that I truly loved most about that job was the quiet calls where there’s an old woman who felt a little bit dizzy who called and we got there. And really, she just wanted someone to talk to, or she needed someone to talk to. Maybe she really was sick and she just needed a little bit of compassion. Those were really wonderful moments. There’s a great human connection that happens when the curtains of our exterior are dropped and we allow people in. That’s what happens on a 9-1-1 call. People trust you an awful lot, and that’s a great responsibility, but also a great reward in and of itself. He was one of the first people that taught me that. Take a minute, sit down, hold someone’s hand and look them in the eye and just be human for a little while. That sustained me through long periods of that job, for sure.
Pence: When we see or hear an ambulance roaring down the street, we think of those in trouble, the ones who called 9-1-1. Hazzard says that oftentimes, the people in the most trouble at a scene are the paramedics themselves.
Hazzard: You’re almost always it seems, called out to a compromising situation. Whether that’s an accident and now you’re standing in the highway, or even at night we’re the ones that stand out the most being in the bend in the road, it’s the middle of the night on a small road. We saw these headlights come around the corner and heard the screech and before any of us had any time to react there was a car forty yards away coming at us at 65 miles an hour. To me that was a horrifying thing because we had no time to move. Luckily he skidded out of our way. So you have those. You have bystanders who are violent or angry. You have patients who are violent and angry, whether it’s because they are drunk or on drugs or they have psychiatric issues, or some people are just angry people.
Pence: If you’ve never been involved in an accident or a medical emergency your ideas about paramedics are probably informed mainly from TV dramas. Hazzard says that the totally committed men and women you see on the tube with cutting edge equipment arriving at the scene aren’t always what you get in real life.
Hazzard: It’s a tax-fed industry. So, there aren’t many police departments, fire departments or EMS services in the country that have everything they need. You always hear teachers saying that they have to spend out of their own pocket every year to buy supplies for the students. It’s no different in public safety. We always were short handed on both staff and equipment. You were told, “Hey, look, you’ve got to make do.” So that was always a factor. And then, there’s a human factor involved. Not every person doing any job is always 100% committed to it. All the great paramedics that I worked with, and I worked with many, had a ton of empathy for their patients, and they care and they’re going to do everything they can. They take great pride in being very good. But there certainly were people that weren’t and it was startling to see and again it seems to happen over and over in life no matter where you go. It’s just I think a little bit more stark when the stakes are as high as they are in the back of an ambulance.
Pence: Hazzard left the job after he realized that the hours and days he worked left little time for his wife and family. He loved his years on the ambulance working the streets and byways of Atlanta, and enjoyed helping those in need. He says that he hopes his book will give readers some insight into that world, and make them look at the people who work in it in a new light.
Hazzard: The thing that surprised me most about working this job was how misunderstood and overlooked the field was. I don’t think anyone has ever gotten in it for the hope of accolades or a slap on the back. This is an incredibly difficult job and these are ordinary people, often times not incredibly well paid, working in difficult situations that are saving American lives right here. They are saving your neighbors and your family and your friends, and they are doing it on your own street. I would like to see the people who have dedicated themselves to someone thing so worthwhile get a little bit more, if not necessarily recognition, just the respect that they deserve for this incredibly difficult job that they do with a smile on their face everyday.
Pence: You can read up on just what it’s like to train and work as a paramedic in Kevin Hazzard’s book, A Thousand Naked Strangers, available now in stores and online. He also invites guests to visit his website at Kevin Hazzard – with two “z”s — .com. For more information about all of our guests, visit our site at radio health journal.net. You can also find archives of past programs there and on I-tunes and Stitcher.
Our writer-producer this week is Pat Reuter.
I’m Reed Pence.