Notes from an emergency room doctor: The patient
was the victim of a motor vehicle accident, another
car gone over the cliffs on one of the many mountainous
roads that meander from 101 to the ocean. Only
minutes before, the e.r. had been a madhouse of
activity in a frantic effort to assess and stabilize
him. Now he was on his way to surgery.
I was pleased with our effort. A difficult job
had come off well. The paramedics, who had transported
the patient to us, were still about, restocking
their drug and equipment boxes, and documenting
their efforts for the official record.
I see the paramedics every day I work. They
bring in my most critical patients. But while
we each have our job to do, when it comes to critical
patient care, I think my job is the easier one.
When a patient arrives, I have everything at my
disposal - plenty of equipment, a talented nursing
crew, access to more help if I need it, and lots
of light. But when someone's trapped in a crashed
vehicle, at the bottom of some 100 foot ravine,
in the blackest of night, saving a life is not
"The most difficult situations, when it
comes to logistics and danger," one medic
told me, "are vehicles over the side. Los
Virgenes Canyon by the tunnels, Kanan-Dume, on
every one of those winding roads to the coast,
on nearly every square foot of them, we've had
a car over the side."
In a "car over the side" situation,
"we send a lot of equipment," an L.A.
County fireman-paramedic told me. What's needed
is a lot of coordination and expertise. At the
scene arrive two fire engines, a paramedic unit,
a USAR (Urban Search And Rescue) hook and ladder,
a helicopter air squad, an ambulance, sheriffs,
and perhaps another USAR from L.A. City.
"If it's dark, the air squad will hover
giving us light."
Then, the medics rappel down the cliff with
first aide boxes and extricating equipment. When
ready, the patient is pulled back up on a metal
stretcher or hoisted up to a helicopter in a litter.
Well trained on how to get the job done, another
medic rattled off the order of rescue: "Safeguard
the area, extricate the patient, stabilize the
patient, package the patient, and evacuate the
Different paramedic systems operate in L.A.
County, Ventura County, and the City of Los Angeles.
Ventura County is serviced by a private paramedic
ambulance company that follows the fire department
to a scene and transports any patient, minor or
critical, to the hospital.
In the City of Los Angeles, the paramedics are
employed by the fire department and also have
their own ambulances.
In Los Angeles County, paramedics are trained
firemen who subsequently obtain paramedic training
as well. As members of the fire department, they
too follow a fire department engine company to
the scene, but they call upon private ambulance
companies, manned by lesser trained EMT's (emergency
medical technicians) to transport the patient.
If a patient is in serious condition, the paramedics
accompany the ambulance. If a case is minor, they
become immediately available to be directed to
another scene while the private ambulance transports
the patient without them.
The systems differ because the demographics,
population, geography, and politics of each area
differ. But all paramedics, regardless of what
entity employs them, are well trained in advanced
life saving techniques. And they're the very special
people who - when you're at home, or at work,
or just out there somewhere, perhaps in the dark,
ill, injured, in pain, or trapped in a car over
a cliff - they're there first, giving you comfort