“She says she can’t walk,” one of the firefighters told me.

“That’s because she can’t,” I replied.

I heard the wheezing from the front door. The fire company had arrived first, a call for an eighteen year old with difficulty breathing and a peanut allergy. She was in a bedroom, sitting at the edge of the bed, panicked look in her eyes and truly struggling.

“Brian, get the chair. Somebody put her on ten liters with a non-rebreather.”

Somebody had to be in charge, may as well be me.

“Do you have an epi-pen?”

She shook her head yes, then no. I figured she had one but it wasn’t with her. Her throat was closing up fast, she became even more panicked. I drew up .3 mg of 1/1000 epi from a vial and administered it into her triceps area. The first sign of relief was in her eyes. Then the wheezing subsided a little. We carried her out tho the rescue, I gave her a little more epi and her pulsox went from 83% to 95%. She started to cry. I can’t imagine anything worse than not being able to breathe.

I spent ten years fighting fires in Providence. I’ve been in charge of an ALS Rescue for almost ten. Believe it or not, there are a lot of firefighters who have been around a lot longer than me. It can be intimidating responding with these people, especially the thirty plus year fire eating ems hating firesaurases.

It doesn’t matter if you have been around as long as me, or are brand new; somebody has to be in charge of patient care, and it may as well be you. The firefighters, even the old timers respect competence. They do EMS but don’t love it. Some don’t even like it. They want you to take over, and they appreciate the people who can.

We took the girl to the ER for further observation and an evaluation. The fire guys didn’t show it, but they felt the same satisfaction I did. Not much beats a possible life saving intervention.

It must be easy sitting in the office, reading the report stating the case against sending ALS units to care for intoxicated people, and rubber stamping the same old “change of mental status requires transport to an emergency facility” response on the paperwork. Day after day, week after week and year after year we respond to the same payphones and street corners for the same intoxicated people. One dies, another joins the party. It’s the circle of life on the streets of Providence.

I’m sure tomorrow’s report will stand out, the one that reads about how a guy was struck by an auto in front of the station where twelve minutes ago the rescue was set to a pay phone a mile a way for “a regular,” who claimed he was intoxicated and wanted detox. It was his third such call in the last twenty-four hours, hist fortieth this month and well over his hundredth this year.

It’s a little different sitting in a quiet, safe, warm office reading about delayed responses, and traumatic head injury, and trauma codes than it is to leave an intoxicated patient at the ER, paperwork half done, and fly toward the radio report of a guy your age fighting for his life while the nearest ALS unit is tied up, and that ALS unit is you, then arriving on scene, 1oo yards away from the door you left twenty minutes ago to get the same old drunk and seeing a twenty foot blood trail, and at the end of that a crowd of horrified people standing safely away from a crumpled form with his head smashed, his larynx crushed, his teeth lodged down his throat and his eyeballs popped from their sockets. His respiration’s are down to six, his BP is crashing and he needs to be in the operating room, NOW.

It’s not easy wheeling that guy, now a trauma code past the same old drunk sitting comfortably on a stretcher in his nice warm bed for the night, and knowing he “doesn’t give a fuck”,” because he tells you so every night, and knowing the report you plan on sending to headquarters will look nice and pretty, and end up in the pile of all the others trying to make sense of all of this.

It just wouldn’t be right to use the report I had started in the rescue, the one covered in the victims blood and brain matter, and send that one upstairs. Or would it?

I tore it up and started a new one. It looked nice and clean when I was through.