One-Sided: EMTs Should Not Make Assumptions

I was riding the Brooklyn-bound 2 train during evening rush hour when suddenly a man sitting across from me collapsed onto the woman next to him. The man was white, mid-forty-ish, with oily hair and lines of black under his fingernails and in the crevices of his hands. His jeans and jacket bore caked dirt and his pants were very worn. He may well have been homeless.

Of course people often fall asleep on the subway, and their head ends up on the next person's shoulder. But they usually wake up, embarrassed and apologetic. This man didn't budge. And I remembered him appearing fairly alert; when I boarded he'd made eye contact with me.

The woman next to him tried to inch away. When his body trailed hers as she went, she tapped his shoulder. When he still didn't move, she took both hands and tried to push him upright. When she let go, he lurched slightly left, then fell forward, straight to the floor, crashing head first into the metal gear box under the seats.

Everyone in the car heard the thud and gasped. He remained motionless and I started to worry he'd had some kind of seizure or stroke. Others felt the same: a West Indian woman sitting beside me grabbed my arm, saying her husband had had a bizarre seizure two weeks ago. This reminded her of his sudden loss of consciousness.

The packed train soon filled with voices debating whether to try to help the man ourselves or get help. "Don't move him; you could damage his spinal cord," someone called out. The consensus was to alert the conductor at the next stop.

As soon as the train pulled into the station, a woman rapped on the conductor's door. After some grumbling, he emerged, took one look at the man, rolled his eyes, and, in an annoyed tone, intercommed to the rest of the train that we were stopped because of a sick person and if anyone had medical training to come to the first car.

Seconds later, two women saying they were nurses appeared. They carefully turned the man over, felt a pulse, and ensured he was breathing. Sighs of relief spread throughout the car and the West Indian woman squeezed my hand hopefully. One nurse asked for some kind of stick to hold the man's tongue down. A woman fumbled in her purse and produced a nail file, which the nurses took. They told a burly man sitting nearby to hold the collapsed man's heavy, boot-clad legs up in the air and asked a woman to search his pockets for identification to give paramedics when they arrived.

When the nurses pulled the file from the man's mouth, it was covered with blood. "Oh no, oh God!" voices echoed. "He probably just bit his tongue," someone said. Several people had now come from other cars and were looking in, concerned. "Is he drunk?" a man asked. "Don't think so. I was near him and didn't smell anything," said another.

Ten minutes later, four Emergency Medical Technicians made their raucous entrance. Ramming through the crowd with their heavy gear, they shouted, "Show's over, folks. Everyone outta the way. Get OUT of the way."

We tried to make way for them but the platform was now flooded with would-be rush-hour riders. There was nowhere to go.

"Did you hear, OUT of the way."

"Yeah, what's wrong with you people? You think this is a show?" an EMT said shaking his head at us. We all looked at each other, dumbfounded.

"Get away," the lead EMT said to the nurse and the burly man holding up the collapsed man's legs. Two other EMTs walked in carrying a folding chair.

"Clear out, clear OUT."

"Enjoying the show, folks?"

"Oh gaawd, gaawd," said an EMT standing over the man. His tone was jaded, not concerned, as if this happened all the time. Between the legs of the EMTs I glimpsed the man shifting his leg, then pawing at his mouth with his fist, but without opening his eyes.

"Wake up, WAKE UP. Y'passed out," the EMT boomed, as if the louder his voice, the faster the man would return to consciousness. The man's eyes were still closed. "You passed OUT," the EMT repeated, now in an accusatory tone.

"C'mon, into the chair." Another EMT grabbed the man's forearm and pulled. The man's eyes were still shut.

"For God's sake, be careful," said a young woman behind me, under her breath so only we could hear her. I think we were all rather afraid of the EMTs at this point.

Finally they managed to lift the man into the chair, his eyes now glazed and barely open, his head circling about like a spinning top. The EMTs carried him in the chair outside onto the platform. The conductor called out that the doors were closing. I tried to watch the man out on the platform, but it was hard given all the commotion.

As the train took off, I managed to glimpse him through the window. He was sitting on the chair but was lunging far to the side, his left side, the same side he'd fallen to on the train. His eyes were still half-open and glazed. The EMTs were paying him no mind now, laughing, talking, jokingly punching each other. I hoped they knew what they were doing, that they'd called for further help, and that the man didn't crash and hit his head again.

Later, I thought of the way he'd lunged to one side. I remembered one of my first experiences with a rare headache disorder, Trigeminal Autonomic Cephalgia. It felt like someone was stabbing me in the left temple with an ice pick. I also had heavy tearing from the left eye, and momentarily loss of hearing in the left ear. It felt like the left side of my head had just shut down.

I went to the doctor, a general practitioner. He thought it was a migraine and wrote me a Codeine prescription. I remember trying to make my way to the subway, but with those vicious stabs coming at me, combined with my lopsided sensory awareness I felt like the subway was no place for me. I could hardly walk in a straight path; I subconsciously veered to the right as if to avert the stabs coming from the left. I nearly walked into a light pole. I went back inside and asked the doctor if I could have an injection so the pain would subside quickly and I could walk normally. He said he had no injectible Codeine. Morphine then, I begged. I knew nothing about Morphine, had only seen it in the movies being given for war wounds, which is honestly how my pain felt. He burst out laughing and said if he had injectible narcotics every crackhead in the city would be banging down the doors. I grabbed my head and burst into tears. "I'm sorry," he said, softening, before helping me find a neurologist.

I don't know whether the man on the subway was drunk, on drugs, or had a serious medical problem. But he needed help. If I didn't look so middle-class and white-collar - and white, I wonder how I might have appeared to medical personnel during my TAC attack, jittery, stumbling, emotional, unable to walk a straight line, begging anxiously for an injection. As a longtime criminal defense attorney serving the indigent, I know the kind of assumptions often made by police but I didn't know they were made by City EMTs as well. After recently reading Shannon Burke's engrossing, enlightening novel, BLACK FLIES, based on his experiences as a Harlem EMT, I realize I probably wasn't imagining these EMTs were acting on assumptions based on the man's appearance, assumptions that can be deadly.

Comments

[Patrick Creeden]

Speaking of making assumptions, the author and shotgunmary are making a lot of assumptions about a job they know nothing about.

The so-called nurses could potentially have made the situation worse by putting something in this mans mouth. If in fact he was having a siezure, he could have bitten through the nail file, and the fragments could have obstructed his airway and thus caused him to choke. We are trained not to put anything into patients mouths.

Perhaps the crews have picked this man up before. Perhaps the man was not truly unconscious and wanted to go to the ER for a cot and hot meal ( Yes, it does happen) I don't know, I wasn't there.

As far as raising our voices to get people to move remember a few things
1) Subway platforms are loud, and sometimes voices need to be raised in order to be heard.
2) Sometimes people don't move ( fore whatever reason) until voices are raised.

Regardless, one sided attacks against EMS providers ( yes I am an EMT) are not the solution to the problem either. Neither is neo-socialist class warfare like shotgun mary seems to be engaged in.

[macmedic]

The fact that the conductor didn't clear the car tracks nicely with his bizzare "is there a doctor in the house?" type announcement--both odd and neither good. That FOUR EMTs showed up, and not just two EMTs or two Paramedics or two of EACH, is also unusual.

He "then fell forward, straight to the floor, crashing head first into the metal gear box under the seats. "? How? A half-gainer dive under his OWN seat? Or did his fall all the way across the car striking his head on the opposite seats? The 2 train, unlike most of the lettered trains, does not feature perpendicular seats; they are all parallel to the train's sides. I'm not doubting Ms. Planks' veracity, but if this were testimony against one of her clients she'd have a FIELD DAY on the cross. Well, if she did trials and not appellate work.

Odd, also, that not one of them asked ANYONE what they saw--what had happened. Even if they ACTUALLY recognized the man from one or many previous encounters this would be a standard question. As for loud, we NEED the room to WORK. And, sadly, I've seen many people gawk at complete strangers, as though staring is somehow palliative. Well, it IS cheaper than HBO. "Show's over" doesn't shame many into moving on, but every little bit helps.

[bxmedic]

They were not wrong that a bunch of gawkers were impeding their access. While there may have been no room to move by the time the EMT's arrived why was that crowd there in the first place? Only two people stepped up to help, so it should have been no more than a crowd of 4. The conductor, 2 nurses, and the woman who he was leaning on. Why were you still there? Humans are a curious animal and have used that curious nature to evolve and grow into what we are today. We are however intelligent enough to know that if you're not helping you're probably in the way and should do something to remedy that rather than wait until it is too late. You witnessed two "nurses" do more harm than good. It is likely the blood was a result of the file being shoved into his mouth. As for the quick exit from the train, thats standard procedure. Between the crowd and limited space the first move is get the patient out of the train. If the patient is not in obvious distress we'll move to the ambulance where we perform a detailed assessment and start any necessary treatment. This gives us a controlled and environment and more importantly preserves some dignity for the patient.

[bxmedic]

You're making some assumptions that generally do not apply to EMS. The vast majority of our patients are the city's disenfranchised poor. Those without primary healthcare or any healthcare, victims of violent crime, substance abusers, etc are the backbone of our patient population. These are also problems that disproportionately affect the not so middle class, white collar and white. Take a look at where we work. Here is a link that lists every 911 ambulance in NYC and the intersection from where they serve their neighborhood. These are distributed based upon call volume and need. Look at the neighborhoods with the greatest unit densities. We are packed into areas like the South Bronx, Harlem, East New York, Jamaica, etc and far more scattered through Williamsburgh, Midtown, Throggs Neck, Inwood, Astoria, and on and on.

[JadedParamedic]

I question the quality of a person who identifies themselves as a nurse then jams ANYTHING into an unresponsive persons mouth. This has not been a standard of practice for almost 25 years. As far as the EMT's how else would you suggest they remove the patient? That "folding chair" is a chair designed to transport pt's, also known as a stair chair,. And are you saying that nobody onboard that train was standing there just to gawk?

[Shotgun Mary]

This is just yet another symptom of how our society discriminates against those who seem less fortunate than the masses. All over this country those who appear anything less than middle class receive worse healthcare and less respect than their counterparts. It can be seen in everything from the police officer who shoots an unarmed black man to the outrage expressed by the masses against a non-white, working class single mother who has more children than her neighbor thinks she should have. I have no idea how to fix it, but each day I encounter a story like this that makes me sick and causes me to think less of those who are supposed to be the pillars of society.