The Ambulance You Never Think About

Things People Don’t Understand About EMS

By Scott Ash

You’re late for work.

Coffee in the cup holder. Traffic is already terrible. Somebody three cars ahead apparently believe 42 miles per hour is an acceptable speed in the left lane.

Then you hear it.

A siren.

You check the mirror.

There it is.

An ambulance.

Now everyone has to move. Somebody panics and stops directly in the middle of the intersection. Another driver seems completely unaware that the giant box covered in flashing lights behind him would like to get past.

And maybe, for just a second, you’re annoyed.

Seriously? Right now?

You pull over.

The ambulance passes.

You pull back into traffic.

And thirty seconds later, you probably never think about that ambulance again.

But have you ever wondered where it was going?

More importantly, have you ever wondered what happens when it gets there?

Because while you continued toward work, the grocery store, school, or wherever your day was taking you, two people inside that ambulance were heading toward a situation about which they knew almost nothing.

“Difficulty breathing.”

“Unknown medical.”

“Person down.”

“Possible overdose.”

“Child not breathing.”

“Chest pain.”

“Motor vehicle accident.”

Sometimes that’s nearly everything the crew knows.

And they’re going anyway.

The Ambulance Isn’t Really About Transportation

One of the biggest misconceptions about EMS is hidden right in the name ambulance.

People still tend to think of it primarily as transportation.

Something happens. An ambulance arrives. The patient gets loaded. The ambulance takes them to the hospital.

Except the transportation part is often the least interesting part of what just happened.

Paramedics bring a small emergency department to wherever you decided to have your emergency.

And people choose some spectacular locations.

Bathrooms.

Attics.

Swimming pools.

Freeways.

Construction sites.

Casinos.

Bedrooms with approximately four inches of walking space surrounding the bed.

And, mysteriously, the upstairs bathroom of every house with the narrowest staircase ever constructed.

Paramedics don’t get a clean treatment room with perfect lighting and the patient conveniently positioned in the middle of a hospital bed.

Sometimes they’re kneeling on concrete.

Sometimes they’re wedged between a toilet and a bathtub.

Sometimes they’re crawling into a wrecked vehicle.

Sometimes they’re trying to start an IV while bouncing down a highway.

And sometimes they’re doing CPR in front of someone’s family while a dog is barking, a police officer is moving furniture, somebody is crying, and another relative keeps asking:

“Is he going to be okay?”

That is where emergency medicine begins for EMS.

Not at the hospital.

Right there.

Not Everyone Who Calls 911 Is Dying

This surprises people.

Paramedics respond to heart attacks, strokes, shootings, overdoses, major crashes, respiratory failure, seizures and cardiac arrests.

They also respond to…

Constipation.

Toe pain.

Medication refills.

“I haven’t felt right since Tuesday.”

“My doctor told me to come in three weeks ago.”

“I can’t sleep.”

And the legendary:

“I’ve had this pain for six months, but tonight I decided it was an emergency.”

That’s EMS.

But here’s the part that deserves more understanding.

Sometimes the ridiculous-sounding call isn’t ridiculous at all.

The person complaining of “indigestion” may be having a myocardial infarction.

The elderly patient who “just feels weak” may be septic.

The person who simply “fell down” may have a catastrophic neurological problem.

The patient sitting calmly on the couch apologizing for bothering you may be considerably sicker than the patient screaming from across the room.

That is why paramedics ask so many questions.

They’re not interrogating you.

They’re trying to figure out which story your body is actually telling.

Paramedics Don’t Just Follow Protocols

There is a persistent idea that EMS is basically:

Take blood pressure.

Give oxygen.

Start IV.

Drive fast.

Hospital.

Modern paramedicine is far more complicated.

Paramedics assess patients, interpret ECGs, administer medications, manage airways, treat shock, recognize strokes, perform resuscitation, manage overdoses and make dozens of decisions while operating with limited information.

But one of the most important things a good paramedic develops isn’t carried in the ambulance.

Pattern recognition.

That little voice that says:

Something about this patient isn’t right.

It comes from education.

Training.

Experience.

And seeing thousands of patients.

The monitor can give you numbers.

Experience sometimes tells you what those numbers haven’t revealed yet.

The Ambulance at the Convenience Store

Here’s another one.

You see an ambulance parked at a convenience store.

Two paramedics are inside buying drinks.

Maybe you think:

Must be nice.

What you don’t know is that they may be nine hours into a twelve-hour shift.

Their “lunch” may currently consist of beef jerky, an energy drink and something rotating underneath a heat lamp whose origins cannot be scientifically determined.

They may also have finished a cardiac arrest twenty minutes ago.

Or a suicide.

Or a dead child.

Or an elderly patient whose spouse of 60 years stood in the doorway and asked them not to let her die.

And now they’re standing at a convenience-store counter deciding between peanut M&M’s and a protein bar.

Because another call is coming.

It always does.

Why Are There So Many Emergency Vehicles?

People occasionally see three fire trucks, an ambulance and several police cars outside one house and wonder whether someone called the entire government.

Sometimes emergencies require people.

A cardiac arrest isn’t a two-person operation.

Neither is a difficult extrication.

Neither is carrying a 300-pound patient down a staircase.

There may be someone managing the airway, someone performing CPR, someone establishing vascular access, someone administering medications, someone documenting, someone talking with the family and someone coordinating the scene.

What looks like chaos from the sidewalk often has considerable structure inside it.

Going by Ambulance Doesn’t Mean You Skip the Line

This one should probably be printed on the side of every ambulance in America.

Arriving by ambulance does not automatically mean you receive an immediate hospital bed.

Emergency departments prioritize patients based on medical urgency and available resources.

The paramedics can’t manufacture an empty room.

They can’t order the hospital to accept their patient immediately.

And they don’t control how many patients arrived before them.

Sometimes an ambulance reaches the emergency department and the crew remains there waiting to transfer care.

Which creates another problem most people never see.

That ambulance isn’t available for another call.

There May Not Be Another Ambulance Around the Corner

This may be the least understood part of EMS.

People dial 911 and expect an ambulance to appear.

And most of the time, one does.

What the public rarely sees is the system behind that response.

Units are already transporting patients.

Crews are tied up at hospitals.

Another ambulance is handling a cardiac arrest.

Another is across town.

Another crew may be finishing a 12-hour shift that became 14.

From the public’s perspective, the system works because an ambulance arrived.

From inside EMS, the question is sometimes:

How many are left?

That matters.

Because the next emergency doesn’t wait for an ambulance to become available.

EMS Sees the Things Society Doesn’t

Paramedics have an unusual privilege—and sometimes burden.

They enter people’s lives without an appointment.

There is no waiting room.

No cleaned-up version of reality.

They see the house.

The family.

The refrigerator with no food in it.

The medications someone cannot afford.

The elderly person living alone.

The veteran drinking himself to sleep.

The frightened teenager.

The exhausted caregiver.

The person experiencing homelessness who called 911 because he had nowhere else to go.

The woman who says she fell down the stairs while carefully avoiding eye contact with the man standing behind her.

Sometimes the medical emergency is only the most visible symptom of a much larger problem.

And paramedics see it.

Sometimes the Job Is Medicine. Sometimes It’s Something Else.

Some calls require medications, electricity, needles and advanced procedures.

Others require sitting down.

Listening.

Convincing someone to go to the hospital.

Explaining something to a frightened family.

Helping an elderly person off the floor.

Finding a medication list.

Calling a daughter.

Holding someone’s hand.

Or simply saying:

“We’re here. Tell me what’s going on.”

You won’t find that intervention inside a drug box.

But experienced paramedics understand how powerful it can be.

And Then There’s the Next Call

Eventually the patient reaches the hospital.

The ambulance doors close.

You might assume the crew’s job is finished.

Not quite.

Equipment must be cleaned.

Supplies replaced.

Medications accounted for.

The stretcher disinfected.

Reports completed.

The ambulance made ready again.

Maybe there’s finally time for food.

Maybe someone gets to use the bathroom.

Maybe the crew talks about what just happened.

Or maybe:

BEEP.

The radio comes alive.

“Medic 6, respond priority one…”

And off they go again.

So the Next Time You See an Ambulance…

Maybe you’re sitting at a red light.

Maybe you’re heading home after work.

Maybe you’re already late.

Then you see flashing lights approaching in your mirror.

Pull to the right.

Give them some room.

And after they pass, take a second before disappearing back into your day.

Because somewhere ahead of you is another person whose ordinary day just ended.

A father is clutching his chest.

A mother can’t wake her child.

Someone wrecked their car.

Someone can’t breathe.

Someone’s grandmother fell.

Someone is performing CPR on the person they love while desperately waiting to hear sirens getting closer.

And inside that ambulance are a couple of people heading directly toward whatever everyone else is running away from.

You probably won’t know their names.

You won’t know what they find when they arrive.

You probably won’t ever know how the story ends.

That’s okay.

Most people aren’t supposed to think about EMS very often.

In fact, that’s probably a sign that life is going pretty well.

But someday, when the sirens are coming to your house, you won’t be wondering why that ambulance is interrupting traffic.

You’ll be listening for it.

And hoping it gets there soon.