An ambulance races to the scene of yet another human tragedy. It could be a road accident, a heart attack, shooting, drowning, suicide, or perhaps a very sick child. Whilst we might experience or witness such events in our lifetime, for paramedics these are routine events. But continual exposure to the work often comes at a significant, sometimes tragic cost to the paramedic and his or her family and friends.
In Signal 8, author Erik Schanssema, a retired front-line Australian paramedic, relates some of his experiences and his reactions to them. He provides graphic descriptions of a small sample of the many cases he and his colleagues attended with the intention of providing information rather than shock. Erik opens his heart and soul and tells us frankly and often with humour, albeit sometimes dark, what it was like for him to be a paramedic on the road and how it has affected him-as it still does today. The cases he describes are indelibly imprinted on his psyche. He shares his story in an effort to help former, current, and future paramedics and emergency workers who may feel alone or isolated by their experiences and to leave them with a sense of pride in their chosen work and, ultimately, hope.
This personal narrative offers a true account of a front-line paramedic's experiences with human trauma and his struggle with and survival of grief and posttraumatic stress disorder.
My partner, Arthur, an ex carpenter was powerfully built but possessing a very gentle manner. The patient, about 35 years of age, also powerfully built was lying conscious on the stretcher with his head bandaged and an intravenous (IV) drip in place in his arm. The bullet that had struck his head had fragmented on impact, the multiple pieces lodging in his scalp, but had apparently not pierced his skull. All was quiet for the initial part of the journey as we made our way without lights and sirens to the Alfred Hospital, about 45 minutes away. The situation changed suddenly and unexpectedly as the patient, unprovoked, sat up and tore the bandages from his head and ripped out his IV line, spraying blood and IV fluid around the ambulance interior. In the rear view mirror, I could see Arthur trying to calm the patient but this was clearly not working as the he then launched into a physical attack. Arthur was able to fend off his blows and somehow managed to restrain him. To my surprise, our escorting police officer remained completely oblivious to the noise and shouting behind him. I nudged his leg, urging him to assist Arthur, but he remained unnmoved. As in adult cardio-respiratory arrest cases, we treated paediatric cases similarly through critical interventions such as intubation and Adrenaline administration. In adults, Adrenaline was usually given intravenously into adult sized veins. Locating a viable vein in a collapsed paediatric patient was usually impossible. This left us with our only option at the time of administering Adrenaline via repeated injections directly into the patient's heart muscle. To do this required ceasing CPR every few minutes to allow for each required incremental Adrenaline dose. Adrenaline was drawn up from a glass ampoule and calculated against the patient's age and weight. The correct anatomical injection site, i.e. adjacent to and just to the left of the patient's sternum was located and marked with a pen. The chest wall was then pierced with a fine gauge needle and the attached syringe drawn back until blood was visualised, indicating that the needle had entered a heart chamber. Little imagination is needed to understand how disturbing this action was for the MICA Officer, bearing in mind that the needle had to be withdrawn to allow CPR to continue, between each intracardiac injection. The emotions accompanying this action were blackened by the knowledge that our efforts were in all likelihood futile.
Erik Schanssema is an Australian paramedic with a thirty-six-year ambulance career. As an ambulance officer and later as a mobile intensive care ambulance (MICA) paramedic, he is among the best-trained and most highly skilled emergency first responders. Now retired, he actively writes, travels, and paints. He currently lives in Wheelers Hill, Victoria, Australia.