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The Paramedics-They're There First

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 so easy.

"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 patient."

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 and hope.