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THE SHIFT | By Michael Morse, EMT-C The Shift takes readers through a typical 24-hour shift in a busy urban fire-EMS department. IT'S 2045 HRS. The radio chatter is relentless as the city begins its nightly reawakening. Sometimes things get quiet between 7 and 11, but tonight is not one of those nights. Five of our six rescues are in the rescue bay, mingled with 10 or 12 from surrounding communities. The ramp was designed for a dozen or so units; it is a marvel of personal ingenuity how we manage to squeeze so many trucks into so small a place, especially considering the urgent nature that exists when we arrive. Another ambulance joins the gang, this one from our neighboring city, Cranston, and the driver leers at me as he passes. He sees fve Providence ambulances sitting idle and wonders why he had to come to Providence on mutual aid. It is a nightly struggle trying to keep up with the calls, and at times we may stretch our time at the ER, knowing that as soon as we go in service, another call will come in. "Rescue 4 in service," I say into the mic as soon as Jared returns to the truck with fresh linens for the stretcher. "Roger, Rescue 4, respond to 243 Sassafras Street with Engine 11 for a 78-year-old male, possible CVA. "Rescue 4 responding." Jared begins to maneuver the rescue out of the bay, slowly at frst, with only inches to spare as we weave our way out, then he sees daylight and hits the lights. We wait until we are clear of the hospital grounds before turning on the siren. Rescue 3 comes in service and is immediately sent to the east side for an assault, Rescue 2 jumps in for a report of a pedestrian struck, and another mutual aid company responds to Providence, this time for a reported shooting. There was a time when the Providence crews would scramble to get in service for a shooting, or anything "good," but the troops are tired and have seen enough. Plus, it's good to let the "out of towners" in for a good one now and then, and not stick them with all the mundane ones. "Engine 11 to Fire Alarm, 78-year- old male with right-sided weakness, establishing vitals." "Rescue 4, received, on scene." Jared retrieves the stair chair from the rear compartment, I grab the blue bag, and we enter the home. Our patient is sitting in a favorite chair, eyes watery, looking dazed and breathing into the nonrebreather the frefghters from the 11s have put on his face. "Less than an hour," says Miles, the offcer in charge of Engine 11. The frefghters and Jared wrap "Jim" in a sheet and lift him onto the stair chair, while I get some important infor- mation from his wife, who is standing close, worried. I listen to her answer my questions and mechanically write notes on my pad (When did he last appear normal? What medical history? Does he take any medications?), but my subconscious takes in much more. There is a magazine on the coffee table, a book lying facedown next to it, the television is still on, their favorite show or maybe just the next one that happened to be on when things got scary. There are dinner dishes drying in the kitchen sink, a pleasant garlicky smell lingers, and pictures of people from a few generations are everywhere, behind magnets on the refrigerator, hung on walls, yellowed photographs behind framed panes of glass propped on top of the TV. I am an intruder in their home, and this might be the last moments they spend together in it. I've worked with Miles for years and know he has done a thorough evalua- tion and don't want to waste any time, so we load Jim onto the stretcher, help the missus into the back and get moving. One of the frefghters drives the rescue, and Jared joins me in back and assists while I establish an IV, recheck vitals and inform the ER that we have a 78-year-old male with a history of hypertension experi- encing sudden right-sided weakness and slurred speech with a signifcant facial droop, 180/110 with a pulse ox of 98% with O 2 , event began at 2050 hours, ETA fve minutes. Jim is in the stretcher, his wife leaning as close as she can. Jared sits next to her, and I'm in the captain's seat, keeping an eye on things, watching the drip, seeing the bag fll, then empty, then fll again. I have been invited into their life, and hopefully I've done my part well and given them the chance to continue living together. A team is waiting for us at the ER; I give my report, and they are whisked away, my memory of them already fading, their lives their own, and my small but vital part in theirs over. The ambulance bay has emptied, the radio gone silent, but it won't be long before the next wave hits. Michael Morse, EMT-C, is a rescue captain with the Providence (RI) Fire Department. A Small But Vital Part Your role in patients' lives may not be large, but it can be important "I have been invited into their life, and hopefully I've given them the chance to continue living together." 56 APRIL 2014 | EMSWORLD.com EMS_56_TheShift0414 edit.indd 56 3/14/14 8:34 AM