Inside an ambulance

Tracey Detillieux inspects the stretcher in the back of an ambulance prior to her shift. (Peter Lozinski/Daily Herald)

Ambulances are worth thousands of dollars fully equipped, and maintaining an emergency room on wheels is not an easy task

When most people think about the tools used by a paramedic, they might think about a first aid kit, gloves and a stretcher.

But it takes a lot more to keep the ambulances running. It takes a checklist, a hose and a squeegee – and those tools can be as important as any of the expensive equipment inside.

It certainly isn’t the side of being a paramedic that you would see on television, but it’s vital, and it was on full display on a Tuesday at the East Flat base of Parkland Ambulance.

Team leaders Ramsey Bellisle and Tracey Detilliuex start their shift with a full inspection. Bellisle takes a look under the hood, while Detillieux grabs a clipboard and heads inside.

The paramedics are responsible for hundreds of thousands of dollars worth of equipment, and the slightest malfunction could be costly. Nothing can be overlooked. In an emergency, you don’t want that necessary piece of equipment malfunctioning.

Detillieux starts near the front of the cabin, where they store the breathing apparatus, conveniently located near the head of any potential victim.

Moving down from the head area is the defibrillator, which also doubles as a heart rate monitor and blood pressure reader. Detilliex checks all of its functions. She immediately notices something wrong. The blood pressure cuff is leaking.

“There’s a rip in it, I can feel the air coming out,” she says.

“That’s one blood pressure cuff down.”

The part is replaced and logged.

She moves down to where the patient’s feet would be. She counts and folds linen and blankets, then moves to bandages and other single-used medical supplies.

She takes care to pay attention to the smallest detail – making sure the edge of the tape is folded so it can easily be grabbed without struggling in an emergency. She meticulously accounts for each of the supplies, and carefully places them exactly back where she found them, before moving on to the oxygen supply and the narcotics cupboard.

She knows exactly where to go. The inside of each ambulance is identical, meaning every supply is easy to find no matter which paramedic is inside which vehicle.

“There’s nothing more frustrating than going out on a call, reaching for something and it’s not there,” she says.

She finishes her checks, and wipes down the interior before busting out a mop. The inside is designed so it’s easy to clean. This prevents cross contamination between victims.

By now, Bellisle has moved on from what’s under the hood. He’s checked tire pressure, and is vigorously washing the front windshield, removing the caked-on remnants of bugs plastered across the windshield. It’s that time of year.

He checks the emergency lights. This vehicle is good to go. It’ll be checked again 12 hours from now.

All is quiet. The radio crackles as dispatchers communicate to paramedics transferring patients from one hospital to another. One crew is heading all the way out to Flin Flon for that very task. Another is more local.

A third paramedic is off to Spiritwood to teach first aid.

It’s now 10 a.m. There have been no calls today.

This time yesterday, there was already five or six. They left shortly after 7 a.m., and didn’t return to depot until after lunch. Today, they’re itching for a call. It’s a good sign that no one has been hurt, but it leaves everyone a little on edge, waiting for the rush to begin.

“That’s just the way it goes,” Detillieux sighs. It’s one of those days.

The life of a paramedic can be hectic and unpredictable, but to be ready for those busy times, there is a lot of work that goes on behind the scenes. An ambulance is an emergency room on wheels, and it has to be ready for anything.

Despite the slow morning, spirits are high at the West Hill base. Management and staff are laughing, talking and teasing, about hockey, baseball and the sasquatch.

There’s a start as a tone goes out, three loud, even beeps. The East flat crew is being called into action.

If it were the hill on call, it would be a warble. If all crews are out, a flat tone. In that case, someone else would jump into a fully-equipped SUV. That paramedic, called a rover, can’t transport anyone. But they can provide the full suite of care until an ambulance arrives on scene.

A voice crackles over the radio – an elderly man has a case of general weakness. He will be treated by paramedics and taken to the hospital for further assessment.

Depending on his vital signs, and other presenting symptoms, he’ll either go to the front of the line, or else he’ll be placed in cue and forced to wait, just like everybody else.

“People think that if you call an ambulance you go to the front of the line,” Detillieux says. “That’s not the case.”

Instead, it works a lot like any other emergency room visit. The paramedics assess the patient. They check vitals, and communicate all their findings to the ER triage nurse. The patient is placed in order of medical importance, with emergent and serious cases jumping higher up the cue, the same way as if they walk through the doors.

The paramedics call ahead as quickly as they can to report their findings to the hospital. If a bed is needed in an emergency, the hospital can make room. If a wheelchair is needed, it can be made available. But if it’s just a broken arm or a cut finger, the patients will find themselves sitting in the waiting room with everyone else.

“People get upset they’re not being rushed in,” Detillieux says, “but really, it’s a good thing.” Indeed, patients left to wait should probably be grateful their life is not in immediate danger. But with a lack of a 24-hour clinic or minor trauma centre, everyone goes to the same place, the Victoria Hospital.

That’s where the other role of the paramedic comes in, the job of counsellor.

Whether it’s calming a hysterical patient, making a scared kid with a broken leg laugh and feel better, or helping connect a patient looking for detox with community services, it’s a lot more than simple first aid.

It’s dealing with trauma, physical and emotional, in the back of a moving vehicle, in a confined space, under a ton of pressure.

Even when the phones aren’t ringing, there’s work to do, so when the tones go off, work can be done.