there is a lot to do at the firehouse between calls

equipment checks, cleaning apparatus, housekeeping and training

we had just finished washing the ambulance when the dispatch radio erupted

“Paramedic 16, chest pains……and the address”

I climb into the driver’s seat and fire up the engine

open the bay doors

flick on the emergency lights

check my partner is belted up before we start rolling, and hit the sirens to warn passing traffic

my partner wrestles with the onboard computer

she verifies the address and confirms the fastest route

I know where to go but there is always some anxiety when responding

will we hit traffic? will we find the location rapidly? where is the best entrance to the building?

my partner reads the dispatch notes on the computer

69-Year-old female, chest pains, breathing normally, sitting in her lounge

we have to cross the city through heavy traffic

sirens blazing, my partner keeps switching the tones to alert drivers that we are behind them

some cooperate and pull over, some don’t see us and block our path, others panic and swerve erratically in front of us

it’s a fine balance driving an emergency vehicle with lights and sirens

we want to avoid delays in getting to the patient but we don’t want to be in our own accident

I stop at every red light and make sure drivers around me know I am creeping through

often drivers cross my path at intersections, oblivious to our presence

how can you not see a big red truck blazoned with flashing lights?

how can you not hear the loud sirens just a few feet away?

well you can miss them easily with modern cars being almost soundproofed

and drivers filling the interior with loud music or checking their cell phone

I weave through the scattering cars

squeezing through gaps just a tiny bit wider than my side mirrors

then we find a break in the traffic and speed on to our destination

my partner yells above the siren “next left and its the third house on the right”

I pull up, turn off the sirens

we always leave the engine running at a call

there are a lot of things to do and we must do them rapidly

fortunately, experience brings an orderly rhythm to what seems like total chaos from the outside

In neutral-check

parking brake on-check

hit “on Location” on the computer-check

zero the trip meter to measure the transport distance-cCheck

surgical gloves on -check

portable radio on -check

my partner has already climbed out and grabbed the monitor from the back

she turns round to yell “ airway bag” in my direction

I acknowledge her and grab the bag following her up the path and through the front door

I pause to scan the room for potential hazards, our personal safety is of prime importance

no sign of weapons, no sign of a struggle, we are cool

an elderly husband stands next to his wife, she is sitting on the couch looking distressed

my partner exudes calmness as she asks questions of both the husband and the wife

she quickly gathers a picture of what has been going on before we arrived

no cardiac history and she was not exerting herself, the pain in her chest is crushing

during the interrogation, I have been firing up the monitor and stuck leads on the patient

a few moments later we capture data on her oxygen levels, her blood pressure and can see her heart rhythm

my partner looks at me and says “stemi”

that is our code for a heart attack, we need to work fast

I run outside and bring the stretcher to the door while my partner helps her walk to the entrance

we quickly load her onto the stretcher, still attached to the monitor

the stretcher is fully automatic, raising and lowering with the touch of a button

I hook it to the arm extending out of the back of the ambulance and lock it in

the wheels lift up and I slide the stretcher inside

this is our office, we can work faster in this cramped space

my partner starts to get a line while I prep the saline flush

I hook up a 12 lead for a full heart monitor and my partner gives the lady aspirin and nitro

I check her blood sugar and give my partner the vials for blood sampling

while doing all this I start to visualize exactly where we are and determine the fastest route to the hospital

my partner glances over at me and her eyes flick toward the cab

this means its time for me to drive to the hospital

I step out the side door and notice the husband in his car behind me, his engine running

“sir, please don’t follow me to the hospital, I will be crossing red lights and I don’t want you to get into an accident”

I climb into the cab, updating the computer that we are en route to the hospital

light and sirens are on as I weave through traffic

I drive as smooth as possible so my partner can work safely in the back

no heavy braking, no fast turns, but a safe fast pace

I turn off the lights and sirens as we pull up at the hospital

update the computer to arrival status-check

read the trip meter to get the transport mileage for the report-check

parking brake on -check

radio on-check

in neutral-check

engine off-check

gloves on-check

portable radio on-check

I walk to the back, open the doors and pull out the stretcher

wheel the patient inside

my partner briefs the ER reception of our patient’s condition, and they assign a room for us

we wheel her down the corridor and transfer her into a bed

my partner gives a concise report to the doctor, he quickly acknowledges and takes over the treatment

we delivered a stabilized patient, our job is done, well almost

we have to sanitize everything and restock 

a report must be written documenting everything we did and the patient’s condition

I clean the rig and get all the equipment and supplies ready for the next call

we cannot be short of vital equipment 

my partner completes the report and uploads it to the hospital computer

we are ready for the next call and update our status on the computer

I start driving back to the station, no need to rush

we chat about the call, decompressing after forty-five minutes of intense action

we reflect on what went well and what we could have done better

before we reach the station, the radio crackles

we recognize our call tones, stop talking and listen hard

“Paramedic 16.. trouble breathing,… address”

we take the call and update the computer

lights and sirens on

check the location and best route

we are rolling through heavy traffic, and my partner interrogates the dispatch notes on the computer

adrenalin rushes through my veins, I breathe deep, staying calm and in control

we do all this nine times over in a 12-hour shift