Rescue! EMTs on the Job

Four emergency helicopters clatter overhead as they approach a serene mountain lake. One lands on a narrow strip of gravel beach, and within minutes its crew loads a patient and the chopper lifts off again. Another circles high above fir trees, waiting for its turn to load. Campers and boaters watch from a safe distance, shielding themselves from the dust and small pebbles blown into the air as the choppers land and take off.

Two cars on a highway too narrow to have a line painted down the center have collided head-on. Nine volunteer emergency medical technicians, including me, and two ambulances have come as far as 18 miles to assist. Two patients are bleeding profusely and one is unconscious. Two others are less than fully conscious. We load each into a helicopter according to the severity of his or her injuries. The fourth helicopter is loaded 70 minutes after the initial call for help, and the ambulance leaves with the last two patients for a 95-minute drive to the hospital. Their injuries are not life-threatening.

The key to saving lives is quick response. But in some locations, getting a patient to a treatment facility within “the Golden Hour” can be quite a challenge.

I am part of a medical response team in a northern California county so sparsely populated that it doesn't have even one stoplight. Trinity County, larger than the state of Rhode Island, has only 13,000 year-round residents and features thick forests, rocky canyons, and twisting rivers. Many residents live on remote dirt roads in the mountains, where there is no phone or electric service. Our organization is officially known as Southern Trinity Area Rescue, but everyone in the area calls us STAR. We are a network of 17 emergency medical technicians (EMTs) who volunteer to be on call several days each month, staying within earshot of the phone, or carrying a two-way radio so that we're ready to respond to an emergency at a moment's notice.

But what happens once we get the call? It is our job to recognize potentially life-threatening conditions and to respond automatically. We are trained to provide basic pre-hospital life support and medical care to the sick and injured. We provide oxygen to the lungs and control bleeding when necessary. We all know how to perform cardiopulmonary resuscitation (CPR) and we use an automatic electronic defibrillator when a heart stops. We do not do any kind of surgery, and the only “drug” we can give a patient is oxygen. It is our responsibility to stabilize the patient and provide or arrange safe and efficient transportation to a hospital or trauma center.

Oxygen Comes First

In the business of saving lives, the focus is ultimately on one thing: oxygen. Brain damage from lack of oxygen can begin in just four minutes, and is almost certain to occur after 10. It only takes a 10 percent loss of blood in 10 minutes to cause hypoxia, a condition in which cells in the organs of the body begin to die from lack of oxygen. With this in mind, it is the EMT's highest priority to ensure the patient's supply of oxygen.

Oxygen is supplied to the body by two systems. The respiratory system brings oxygen into the body and the circulatory system carries it throughout the body. The cycle begins with a breath. As the lungs fill, the air enters alveoli, small air sacs lining the inside of the lung. Small capillaries filled with blood lie near the surface of the alveoli. Only two thin layers of tissue separate the blood cells from the air. In a process known as diffusion, the blood cells collect oxygen molecules from the air and release carbon dioxide molecules into it.

Meanwhile, the double pumping action of the heart keeps the blood moving. The left side draws oxygenated blood from the lungs and pushes it through the heart to all parts of the body through arteries. Every living cell of the body combines oxygen with glucose (a sugar) to create energy. This chemical reaction, called metabolism, has two byproducts, water and carbon dioxide. The carbon dioxide replaces the oxygen in the blood, and the right side of the heart pumps the blood through the veins back to the lungs, where the cycle begins again.

Damage to either the respiratory or circulatory system can threaten a life. Two STAR EMTs recently treated a healthy man in his late twenties who was experiencing chest pain and difficulty breathing. These are classic heart attack symptoms, so a helicopter was dispatched and the man was immediately put on oxygen. At the trauma center, doctors discovered spontaneous pneumothorax, a condition in which a weak spot in the wall of the lung tears unexpectedly. Air was leaking into his chest cavity as one lung gradually collapsed, decreasing his oxygen intake. He was heading toward hypoxia. Fortunately, emergency surgery repaired the tear and the man recovered.

On the Road or in the Air

A helicopter can often pick up a patient and return to the trauma center in our region within 70 minutes. An ambulance, on the other hand, would take at least that long to get to the hospital, even from the edge of our 1,300-square-kilometer (500-square-mile) territory. The helicopter has another advantage, too. It's staffed with a nurse and paramedic, who can perform more advanced techniques than we EMTs, such as administering intravenous drugs.

A few years ago at our local rodeo, a 12-year-old boy dislocated his shoulder when he was thrown from a bull. The dislocation was extremely painful and his arm was locked in position above his head as if he were reaching up. This wasn't life-threatening, but it became obvious that his arm was in danger when we tested his capillary refill. To do this, you squeeze the tip of a finger, pressing on the nail. The nail bed turns white when you squeeze, and then should return to pink within two seconds after you let go. This boy had no capillary refill. The cells in his hand were not receiving adequate oxygen and his arm was at risk. A helicopter arrived in just 15 minutes, kicking up considerably more dust than the herd of horses running in the rodeo ring. Doctors were able to move the arm to its normal position and circulation was restored.

Luck saved a life one beautiful summer day at our lakeside festival. Two teenagers began some dangerous clowning around on Jet Skis near shore. The worst happened when one teen fell into the water and was hit in the head by the other's Jet Ski. The ambulance and several EMTs just happened to be right there, distributing health information at the festival. A helicopter was dispatched immediately. The brain, like any other tissue, can swell or bleed when injured. This swelling can create dangerous pressure within the confines of the skull, which forces the entire organ toward the brain stem at the base of the skull. The brain stem is the controlling center for virtually all functions necessary for life, including respiration. The boy was given oxygen to slow the swelling and protect his brain stem. He received emergency brain surgery at the trauma center—and survived.

In all these cases, fast action was critical. Would you know what to do in a respiratory or circulatory emergency? A CPR class can teach you how to keep oxygen circulating even after the heart stops. Your local Red Cross can tell you when classes are offered in your area.

Vocabulary

circulatory system:
The organ system that carries oxygen to the body and removes carbon dioxide and other wastes.

respiratory system:
The system of air passages through which a living thing breathes.

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Activity

  1. Write a paragraph that describes how the process of respiration occurs inside the body.
  2. What do a collapsed lung and deforestation have in common? Write a couple of sentences to explain your answer.